Surgical Treatment and Prognostic Factor for Metastatic Bone Tumor

Jeung-Il Kim; Chong-Il Yoo; Jeung-Tak Suh; Kuen-Tak Suh; Hui-Taek Kim; Nam-Hoon Moon

doi:10.4055/jkoa.2008.43.4.438

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Kim, Yoo, Suh, Suh, Kim, and Moon: Surgical Treatment and Prognostic Factor for Metastatic Bone Tumor

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(4): 438-444.

Published online: 31 August 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.4.438

Surgical Treatment and Prognostic Factor for Metastatic Bone Tumor

Jeung-Il Kim, M.D., Chong-Il Yoo, M.D., Jeung-Tak Suh, M.D., Kuen-Tak Suh, M.D., Hui-Taek Kim, M.D., Nam-Hoon Moon, M.D.

Department of Orthopaedic Surgery, College of Medicine, Pusan National University, Pusan, Korea.

Address reprint requests to Jeung Il Kim, M.D. Department of Orthopaedic Surgery, Pusan National University Hospital, 1-10, Ami-Dong, Seo-Gu, Pusan 602-739, Korea. Tel: +82.51-240-7248, Fax: +82.51-247-8395, osteokim@yahoo.co.kr

Abstract

Purpose

In this retrospective study, we tried to find out potential prognostic factors that can be used to determine the optimal treatment for some conditions that are indicated for surgery like pathological fractures or epidural compression.

Materials and Methods

Between 1985 and 2003 we treated 78 patients with skeletal metastases. A multivariable analysis was conducted using the Cox proportional hazard model. The rates of survival were calculated by the Kaplan-Meier method.

Results

We identified four significant prognostic factors for survival: the site of the primary lesion, the presence of visceral or cerebral metastases, any previous chemotherapy and multiple skeletal metastases. With these factors, we could divide the patients into two prognostic groups: the good prognostic group satisfies more than two of the four significant factors and the poor prognostic group doesn't. For the good prognostic group, the average rates of survival at 6 months and a year were 95% and 28%, respectively, and those for the poor prognostic group were 28% (6 mo) and 13% (1 yr), respectively.

Conclusion

Each patient's life expectancy should be considered when we decide the surgical method for treating metastatic bone tumor. Patients with a very short life expectancy should probably be treated with a less invasive method but patients with a long life expectancy require aggressive surgery. If the life expectancy is estimated to be at least more than 2 month and 3-6 months for bony metastases to the extremity and spine respectively, then an aggressive surgical method should be chosen. With these practical prognostic factors, the life expectancy may be predicted more accurately and so the optimal surgical treatment can be selected more appropriately.

Keywords: Metastatic bone tumor, Surgical treatment, Prognostic factor

Figures and Tables

Fig. 1

This graph shows the Kaplan-Meier cumulative survival rates for the 78 patients. The overall survival rates were 68% for 6 months, 47% for 1 year, 35% for 2 years and 22% for 3 years.

Fig. 2

This graph shows the Kaplan-Meier survival curves for the patients fo the good (A) and poor (B) prognostic group. The good prognostic group satisfies more than two of the four significant factors and the poor prognostic group doesn't. The rates of survival for these two groups are significantly different (log-rank test, p<0.0001).

Table 1

The Primary Tumors in the All Patients and the Site of Metastasis

Table 2

Distribution of the Potentially Prognostic Factors in the 78 Patient

^*Slowly progressive tumor group, Carcinoma of the breast, prostate and thyroid, multiple myeloma and malignant lymphoma; ^†Rapidly progressive tumor group, HCC, carcinoma of the stomach or lung; ^‡Moderate progressive tumor group, Other carcinoma and sarcoma.

Table 3

Multivariate Analysis for the Prognostic Factors

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