Survival in Patients Operated on for Pathologic Fracture: Implications for End-of-Life Orthopedic Care

Nathan, Saminathan S.; Healey, John H.; Mellano, D; Hoang, Bang H.; Lewis, Isobel; Morris, Carol D.; Athanasian, Edward A.; Boland, Patrick J.

doi:10.1200/jco.2005.08.104

Cited by 182 publications

(203 citation statements)

References 35 publications

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“…Results from previous studies support the association of tumor type and visceral metastases with survival [2,13,18]. Bauer and Wedin [2] reported a survival rate of 0.30 at 1 year in a retrospective cohort of 241 patients who had surgery for bone metastatic disease; they found decreased survival among patients with a pathological fracture, visceral metastases, multiple bone metastases, and lung cancer.…”

Section: Discussionsupporting

confidence: 58%

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Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

Janssen

Braun

Ready

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Previous studies have shown that perioperative blood transfusion increases cancer recurrence and decreases patient survival after resection of primary malignancies. The question arises whether this association also exists in patients with already disseminated disease undergoing surgery for metastatic long-bone fractures. Purposes We sought to determine whether perioperative allogeneic blood transfusion is associated with decreased survival after operative treatment of long-bone metastatic fractures after accounting for clinical, laboratory, and treatment factors. Secondarily, we aimed to identify potential factors that are associated with decreased survival. Methods We included 789 patients in our retrospective study who underwent surgery at two institutions for a pathologic or impending metastatic long-bone fracture. We used multivariable Cox proportional hazards regression model analysis to assess the relationship of perioperative allogeneic blood transfusion with survival, and accounted for patient age, sex, comorbidities, BMI, tumor type, fracture type and location, presence of other bone and visceral metastases, previous radiotherapy and systemic therapy, preoperative embolization, preoperative hemoglobin level, treatment type, anesthesia time, blood loss, duration of hospital admission, year of surgery, and hospital. Results Considering transfusion as an ''exposure,'' and comparing patients who received transfusions with those who did not, we found that blood transfusion was not associated with decreased survival after accounting for all explanatory variables (hazard ratio [HR] 1.06; 95% CI, 0.87-1.30; p = 0.57). Evaluating transfusion in terms of dose-response, we found that patients who received more transfusions had lower survival compared with those who had fewer transfusions after accounting for all explanatory variables (HR per unit of blood transfused, 1.07; 95% CI, 1.02-1.12; p = 0.005). We found that age (HR, 1.02; 95%

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Section: Discussionsupporting

confidence: 58%

“…Based on the existing literature, we categorized primary tumor type into relatively good prognosis (breast, kidney, prostate, thyroid, myeloma, and lymphoma) and poor prognosis (all other tumor types) [2,13,18].…”

Section: Methodsmentioning

confidence: 99%

Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

Janssen

Braun

Ready

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Finally, we did not attempt to identify factors that might be associated with prolonged prognosis. Although factors associated with shorter overall survival have been identified (eg, visceral metastases [16]), there are difficulties and inaccuracies associated with attempts to predict survival in this patient population [17]. Advanced mathematical modeling techniques are being developed to help predict the survival of patients with metastatic bone disease [7].…”

Section: Discussionmentioning

confidence: 99%

“…As the mechanical integrity of the bone weakens, patients frequently experience increasing pain, protrusio deformities, and disability. Present and/or impending pathologic fractures influence patients' function and ability to receive chemotherapy [17,21]. In the absence of frank or imminent fracture, the initial treatment for these patients usually includes analgesics and protected weightbearing combined with systemic therapy, radiotherapy, and/or percutaneous cementoplasty [9,10,21].…”

Section: Introductionmentioning

confidence: 99%

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

Khan

Rose

Yanagisawa

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Large bone loss and frequently irradiated existing bone make reconstructing metastatic and other nonprimary periacetabular tumors challenging. Although existing methods are initially successful, they may fail with time. Given the low failure rates of porous tantalum acetabular implants in other conditions with large bone loss or irradiated bone, we developed a technique to use these implants in these neoplastic cases where others might fail. Description of Technique After local tumor curettage, a large uncemented tantalum shell (sometimes with tantalum augments) was fixed to remaining bone using numerous screws. When substantial medial bone loss was present, an antiprotrusio cage was placed over the top of the cup and secured to remaining ilium and ischium. Patients and Methods We retrospectively reviewed 20 patients who underwent THAs for neoplastic bone destruction with the described technique. Their mean age was 60 years (range, 22-80 years). We recorded pain and ambulatory status, pain medication use, and Harris hip scores. We assessed for progressive radiolucent lines and component migration on followup radiographs. Eleven of the 20 patients died at a mean of 17 months after surgery. The minimum followup for surviving patients was 26 months (mean, 56 months; range, 26-85 months).

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“…Of all the new cases of invasive carcinoma diagnosed annually in the United States, approximately 50% eventually metastasize to bones [7]. Current advances in treatment options have improved the mean survival for patients with disseminated disease [13]. These metastatic lesions and other destructive processes affecting bones such as myeloma and lymphoma, predispose the bone to an impending fracture [16].…”

Section: Purposementioning

confidence: 99%

In Brief: Classifications in Brief

Jawad

Scully

2010

Clinical Orthopaedics &Amp; Related Research

117

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Survival in Patients Operated on for Pathologic Fracture: Implications for End-of-Life Orthopedic Care

Abstract: A better means of prognostication is needed. In this article, we present a sliding scale for this purpose.

Cited by 182 publications

References 35 publications

Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

Are Allogeneic Blood Transfusions Associated With Decreased Survival After Surgery for Long-bone Metastatic Fractures?

Surgical Technique: Porous Tantalum Reconstruction for Destructive Nonprimary Periacetabular Tumors

In Brief: Classifications in Brief

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