Effects of Surgical Intervention for Bone Metastases on Survival in Patients with Advanced Cancer: A Nationwide Population-Based Cohort Study

Abstract

Purpose With recent advances in surgical techniques and instruments, orthopedic surgeons are better equipped to treat metastatic bone disease. There has also been considerable progress in the non-surgical treatment of cancers, specifically in improving the survival rate of patients with advanced cancer. However, it remains unclear whether surgical resection of a metastatic bone lesion poses additional risk to the survival of patients with advanced cancer. Patients and Methods This study utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2015. Patients aged ≥18 years, who had been recently diagnosed with bone metastases (BM), were enrolled and assigned to either the surgery or non-surgery groups. The demographic characteristics were analyzed, and the adjusted hazard ratios (aHR) of mortality were calculated using Cox regression analysis. Results Of the 4,549,226 individuals in the inpatient database of the NHIRD, 83,536 patients with BM were enrolled in this study. Among them, 8802 underwent surgical resection for skeletal metastatic lesion and 66,098 did not. Altogether, 28,691 patients died, including 2798 (31.8%) in the surgery group and 25,893 (39.2%) in the non-surgery group. The aHR for mortality was 0.7-fold lower in the surgery group (p < 0.001). Conclusion This study demonstrates that surgical resection of metastatic bone lesions did not pose any additional risk to survival outcomes. Thus, we believe that surgery, if indicated, could have a competitive role in the management of metastatic bone disease.

Life Expectancy After Treatment of Metastatic Bone Disease: An International Trend Analysis

“…Encouragingly, the increase in median survival time found in this study is consistent with previous single-institution studies indicating that surgical treatment of MBD can improve functional outcomes and/or survival. [13][14][15][16][17]19,21 At the time of writing, we are unaware of any other international analysis to demonstrate improved survival over time after treatment of MBD. When applying this information in a clinical setting, providers should consider concomitant medical intervention and/or radiation therapy.…”

“…17 Isolated studies investigating survival rates are limited to short-term studies from individual or regional centers that lack diversity in patient populations, as well as treatment philosophies; furthermore, large population-based studies lack the granularity of evaluating MBD exclusively. [18][19][20][21][22][23] We are unaware of an international analysis of long-term changes in life expectancy in patients with MBD.…”