Longitudinal survival trends of patients with cancer with surgically managed appendicular metastatic bone disease: systematic review

Abbott, Annalise; Kendal, Joseph K.; Hewison, Christopher; Puloski, Shannon; Monument, Michael J.

doi:10.1503/cjs.015520

Cited by 6 publications

(4 citation statements)

References 105 publications

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“…In a large systematic review of survival in patients undergoing surgery for appendicular MBD, 1-year combined survival across 67 studies was 41%; 1-year survival for breast cancer cases was 53% versus 66% for renal cancer and 41% for lung cancer. 12 Median patient survival in our study was 19.4 months, and implant durability was much greater than patient survival.…”

Section: Discussionmentioning

confidence: 55%

“…Advances in cancer therapies such as targeted treatments and immunotherapies have resulted in improved patient survival for certain cancer types such as advanced renal cell carcinoma and non‐small cell lung cancer 10,11 . While survival in patients with MBD requiring orthopedic surgery has shown unclear temporal trends, 12 a recent study of femoral metastasis secondary to renal and lung carcinoma demonstrated measurable impact of biologic anti‐neoplastic agents on patient survival 13 . In general, the orthopedic oncology community has placed greater consideration on the benefits of en bloc resection and EPR for appendicular MBD in the appropriate clinical scenario 13–16 …”

Section: Introductionmentioning

confidence: 99%

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What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

Kendal

Hamad

Abbott

et al. 2023

Journal of Surgical Oncology

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Background and Objectives: Given advances in therapies, endoprosthetic reconstruction (EPR) in metastatic bone disease (MBD) may be increasingly indicated. The objectives were to review the indications, and implant and patient survivorship in patients undergoing EPR for MBD.Methods: A review of patients undergoing EPR for extremity MBD between 1992 and 2022 at two centers was performed. Surgical data, implant survival, patient survival, and implant failure modes were examined.Results: One hundred fifteen patients were included with a median follow-up of 14.9 months (95% confidence interval [CI]: 9.2-19.3) and survival of 19.4 months (95% CI: 13.6-26.1). The most common diagnosis was renal cell carcinoma (34/115, 29.6%) and the most common location was proximal femur (43/115, 37.4%). Indications included: actualized fracture (58/115, 50.4%), impending fracture (30/115, 26.1%), and failed fixation (27/115, 23.5%). Implant failure was uncommon (10/115, 8.7%). Patients undergoing EPR for failed fixation were more likely to have renal or lung cancer (p = 0.006).Conclusions: EPRs were performed most frequently for renal cell carcinoma and in patients with a relatively favorable survival. EPR was indicated for failed previous fixation in 23.5% of cases, emphasizing the importance of predictive survival modeling. EPR can be a reliable and durable surgical option for patients with MBD.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

Kendal

Hamad

Abbott

et al. 2023

Journal of Surgical Oncology

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“…Improvements in diagnostics and increased use of modern targeted bone stabilizing therapy [ 27 ] prolong time from diagnosis to skeletal-related events [ 28 , 29 ]. Even though adjuvant therapy has advanced, several studies did not find improvement in overall survival [ 30 ], indicating that patients needing surgical treatment of aBM are often at an advanced disease level and end of life-stage with a very poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Metastatic Bone Disease in the Appendicular Skeleton: A Population-Based Study

Hovgaard

Sørensen

Nielsen

et al. 2022

Cancers

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Background: Population-based studies of patients with bone metastases in the appendicular skeleton (aBM) requiring surgery for complete or impending fracture are rare. In this epidemiologically-based observational study we created a large population-based cohort of patients treated for aBM, aiming to: (1) monitor possible time-related changes of the incidence of surgical treatment of aBM-lesions, (2) examine differences in the population and care of patients treated at different treatment centers and (3) examine if findings from a previous pilot study regarding absence of a suitable biopsy of the lesions representing debut of cancer or a relapse has improved the awareness of aBM and hereby increased the focus on regular tumor biopsies and follow-up imaging of cancer patients. Methods: We examined a population-based cohort consisting of all patients treated for aBM 2014–2019. Procedures were performed at five secondary surgical centers (SSC) or one tertiary referral Musculoskeletal Tumor Center (MTC). Patients were followed until end of study (30 September 2021) or death. No patients were lost to follow-up. Results: Four-hundred-fifty-seven patients (493 primary aBM-lesions, 482 procedures) were included. Annual incidence of aBM-surgery was 46 aBM-lesions/million. MTC-patients had a significant better preoperative status than SSC-patients considering factors known for survival. Patients with complete fracture experienced longer surgical delay when treated at MTC compared to SSC: 4 (1–9) and 1 (1–3) days (p < 0.001), respectively. Overall survival for the entire cohort was 37% and 11% at 1 and 5 years (MTC and SSC 1 and 5 year respectively: 44% and 15% vs. 29% and 5%, p < 0.001). In patients with debut or relapse of cancer, 8% and 9% had insufficient biopsies, and 21% and 12% had no biopsy, respectively. Comparison showed no change over time. Conclusions: The current study highlights the low awareness on treating aBM at SSC and emphasizes the importance of caution in interpretation of studies not representing an entire population, thus introducing selection bias.

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“…Accurately predicting the life expectancy of patients with metastatic bone disease of the extremity is essential as therapeutic strategies largely depend on it [ 1 ]. In this setting, a multidisciplinary team treats the patient with the intention of improving function, reducing pain, minimizing the number of procedures and rehabilitation time, hence allowing the maximum quality of life for the remaining period of survival [ 1 , 2 ]. Generally, patients with short term life expectancy will most likely be treated with supportive care, short-term radiotherapy and either no surgery or internal fixation surgery as its related complications typically occur more than a year after treatment.…”

Section: Introductionmentioning

confidence: 99%

The Prediction of Survival after Surgical Management of Bone Metastases of the Extremities—A Comparison of Prognostic Models

et al. 2022

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Individualized survival prognostic models for symptomatic patients with appendicular metastatic bone disease are key to guiding clinical decision-making for the orthopedic surgeon. Several prognostic models have been developed in recent years; however, most orthopedic surgeons have not incorporated these models into routine practice. This is possibly due to uncertainty concerning their accuracy and the lack of comparison publications and recommendations. Our aim was to conduct a review and quality assessment of these models. A computerized literature search in MEDLINE, EMBASE and PubMed up to February 2022 was done, using keywords: “Bone metastasis”, “survival”, “extremity” and “prognosis”. We evaluated each model’s performance, assessing the estimated discriminative power and calibration accuracy for the analyzed patients. We included 11 studies out of the 1779 citations initially retrieved. The 11 studies included seven different models for estimating survival. Among externally validated survival prediction scores, PATHFx 3.0, 2013-SPRING and potentially Optimodel were found to be the best models in terms of performance. Currently, it is still a challenge to recommend any of the models as the standard for predicting survival for these patients. However, some models show better performance status and other quality characteristics. We recommend future, large, multicenter, prospective studies to compare between PATHfx 3.0, SPRING 2013 and OptiModel using the same external validation dataset.

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Longitudinal survival trends of patients with cancer with surgically managed appendicular metastatic bone disease: systematic review

Cited by 6 publications

References 105 publications

What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

What are the indications and survivorship of tumor endoprosthetic reconstructions for patients with extremity metastatic bone disease?

Surgical Treatment of Metastatic Bone Disease in the Appendicular Skeleton: A Population-Based Study

The Prediction of Survival after Surgical Management of Bone Metastases of the Extremities—A Comparison of Prognostic Models

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