The rise of metastatic bone disease in Ireland

McCabe, Fergus J.; Jadaan, Dima; Jadaan, Mutaz; McCabe, John P.

doi:10.1007/s10585-020-10059-7

Cited by 9 publications

(7 citation statements)

References 32 publications

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“…Imaging diagnostics and -follow-up, of both patients with previously known cancer and patients living with a known cancer, is recommendable. This is specially the case in types of cancer known to metastasize to bone, such as breast, prostate and lung cancer [ 2 , 32 , 33 ], which are also the most common types in our cohort and in the population of Denmark in general [ 34 ]. One could advocate for more awareness of skeletal-related events and imaging follow-up.…”

Section: Discussionmentioning

confidence: 97%

“…Cancer is the second leading cause of death worldwide [ 24 ] and we know from several studies that cancer incidence is rising due to increasing age, population growth, and improved diagnostics and screening methods [ 2 , 25 , 26 ]. With an increasing cancer incidence, the frequency of bone metastases has followed accordingly [ 2 ] and we therefore expected a rise in the incidence of surgical treatment of bone metastases in the extremities. Alternatively with the increasing incidence of surgical treatment, one could assume that patients live longer with known aBM before they need surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Persons with bone metastases in the appendicular skeleton (aBM) can experience impending or pathological fractures requiring surgery. It is known that bone is the most prevalent site of metastases after the liver and lung [ 1 ], however, it is unknown whether surgical intervention for aBM is increasing because of a rise in cancer incidence combined with more patients living longer after a cancer [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…4 Along with increasing the prevalence of these cancers, the total numbers of patients with bone metastasis are increasing annually. [5][6][7] Bone metastasis causes specific symptoms such as intractable bone pain, pathological fracture, hypercalcemia, anemia, and paralysis due to spinal cord compression. 8,9 These symptoms significantly worsen the quality of life of cancer patients.…”

Section: Introductionmentioning

confidence: 99%

“…These cancers are also the most common malignancies in female and male patients or the most frequent site for primary disease in cancer deaths 4 . Along with increasing the prevalence of these cancers, the total numbers of patients with bone metastasis are increasing annually 5–7 . Bone metastasis causes specific symptoms such as intractable bone pain, pathological fracture, hypercalcemia, anemia, and paralysis due to spinal cord compression 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Bone marrow adipocytes induce cancer‐associated fibroblasts and immune evasion, enhancing invasion and drug resistance

et al. 2023

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Bone metastasis occurs frequently in cancer patients. Conventional therapies have limited therapeutic outcomes, and thus, exploring the mechanisms of cancer progression in bone metastasis is important to develop new effective therapies. In the bone microenvironment, adipocytes are the major stromal cells that interact with cancer cells during bone metastasis. However, the comprehensive functions of bone marrow adipocytes in cancer progression are not yet fully understood. To address this, we investigated the role of bone marrow adipocytes on cancer cells, by focusing on an invasive front that reflects the direct effects of stromal cells on cancer. In comprehensive histopathological and genetic analysis using bone metastasis specimens, we examined invasive fronts in bone metastasis and compared invasive fronts with adipocyte-rich bone marrow (adipo-BM) to those with hematopoietic cell-rich bone marrow (hemato-BM) as a normal counterpart of adipocytes. We found morphological complexity of the invasive front with adipo-BM was significantly higher than that with hemato-BM. Based on immunohistochemistry, the invasive front with adipo-BM comparatively had a significantly increased cancer-associated fibroblast (CAF) markerpositive area and lower density of CD8 + lymphocytes compared to that with hemato-BM. RNA sequencing analysis of primary and bone metastasis cancer revealed that bone metastasized cancer cells acquired drug resistance-related gene expression phenotypes. Clearly, these findings indicate that bone marrow adipocytes provide a favorable tumor microenvironment for cancer invasion and therapeutic resistance of bone metastasized cancers through CAF induction and immune evasion, providing a potential target for the treatment of bone metastasis.

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A comparison of available guidelines for the detection of cauda equina syndrome and assessing the need for further clinical guidance in Ireland

Gavin,

Curran,

McCabe

2024

Ir J Med Sci

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The cauda equina syndrome (CES) is a rare but critical disorder, which can result in devastating motor weakness and sensory deficit, alongside often irreversible bladder, bowel and sexual dysfunction. In addition to the clinical burden of disease, this syndrome results in a disproportionately high medicolegal strain due to missed or delayed diagnoses. Despite being an emergency diagnosis, often necessitating urgent surgical decompression to treat, we believe there is a lack of clarity for clinicians in the current literature, with no published Irish guideline concerning screening or detection. The current study aims to identify and analyse appropriate guidelines in relation to CES screening which are available to clinicians in Ireland. The study design included a comprehensive literature review and comparison of existing guidelines. The review identified 13 sources of appropriate guidance for clinicians working in Ireland. These resources included textbooks, websites and guidelines developed in the UK. No Irish guidelines or advice were available on CES screening/treatment at the time of review. This review demonstrated the lack of consensus and guidance for clinicians in Ireland on how to effectively screen for CES, judge who requires further imaging and investigations and how to rule out the condition. A national consensus on thorough screening and prompt investigation for CES is necessary, and the formulation of new CES guidelines would be a welcome addition to what is available to clinicians currently.

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The rise of metastatic bone disease in Ireland

Cited by 9 publications

References 32 publications

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

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

Bone marrow adipocytes induce cancer‐associated fibroblasts and immune evasion, enhancing invasion and drug resistance

A comparison of available guidelines for the detection of cauda equina syndrome and assessing the need for further clinical guidance in Ireland

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