Chen Chih-Wei, Su Chih-Chi, Chen Jyun-Hao, Wang Jaw-Lin, Tseng Tzu-Hao, Groot Olivier Q
Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan.
J Orthop Surg Res. 2025 Jul 26;20(1):706. doi: 10.1186/s13018-025-06079-2.
The rising prevalence of metastatic bone disease (MBDex) of the extremities substantially affects patient quality of life due to skeletal-related events. Determining whether surgical intervention benefits patient survival is crucial in the management of MBDex. However, there is currently limited evidence regarding the survival impact of upper versus lower extremity involvement. This study aims to evaluate differences in survival outcomes regarding metastatic site, and the impact of operative versus nonoperative management.
This retrospective cohort study evaluated 1,719 patients with a two-year follow-up period after treatment for MBDex at a major tertiary medical center in Taiwan from 2010 to 2018. Inclusion criteria included patients aged over 20 who underwent operative or nonoperative management. Exclusion criteria involved patients with concurrent upper and lower extremity metastases. Kaplan-Meier curves and multivariate Cox regression models were used to analyze survival and prognostic factors.
Compared to upper MBDex, lower MBDex patients have poorer pretreatment Eastern Cooperative Oncology Group (ECOG) performance status. Lower MBDex was associated with worse two-year survival, particularly among those receiving nonoperative management. Common prognostic factors included ECOG performance status, Charlson's comorbidities, primary tumor type, and albumin levels, while previous systemic treatment and the presence of visceral and brain metastases were specifically detrimental in lower MBDex.
Lower MBDex is associated with poorer survival outcomes. Operative management is associated with survival benefit in lower MBDex, a benefit not as pronounced in upper MBDex. These findings highlight the importance of differentiating between upper and lower extremity metastases in survival analyses and prediction.
由于骨相关事件，四肢转移性骨病（MBDex）的患病率不断上升，这对患者的生活质量产生了重大影响。在MBDex的管理中，确定手术干预是否有益于患者生存至关重要。然而，目前关于上肢与下肢受累对生存影响的证据有限。本研究旨在评估转移性部位在生存结果方面的差异，以及手术与非手术治疗的影响。
这项回顾性队列研究评估了2010年至2018年在台湾一家大型三级医疗中心接受MBDex治疗后进行了两年随访的1719例患者。纳入标准包括年龄超过20岁且接受手术或非手术治疗的患者。排除标准包括同时存在上肢和下肢转移的患者。采用Kaplan-Meier曲线和多变量Cox回归模型分析生存情况和预后因素。
与上肢MBDex相比，下肢MBDex患者在治疗前的东部肿瘤协作组（ECOG）体能状态较差。下肢MBDex与较差的两年生存率相关，尤其是在接受非手术治疗的患者中。常见的预后因素包括ECOG体能状态、Charlson合并症、原发肿瘤类型和白蛋白水平，而既往的全身治疗以及内脏和脑转移的存在对下肢MBDex的危害尤为明显。
下肢MBDex与较差的生存结果相关。手术治疗对下肢MBDex患者的生存有益，而上肢MBDex患者的这种益处并不明显。这些发现凸显了在生存分析和预测中区分上肢和下肢转移的重要性。
