Evaluation of prognostic factors and survival of patients with metastatic bone disease
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Date
2016-05
Authors
Abumarzouq, Mahmoud F. R
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
Abstract
INTRODUCTION
Management of metastatic bone disease is still challenging, along with the
improvement in managing primary solid tumors, patients survive longer and they
become potential to have metastatic lesions of bone more than they had before. A
variety of treatment options could possibly be given to those patients includes
medical treatment, radiation, chemotherapy and surgical intervention. The surgical
intervention for metastatic bone lesions gives satisfactory outcome. However, there
are few factors affecting the survival of patients with metastatic bone disease such as
performance status, type of primary tumor, neurology deficit, pathologic fracture,
visceral organ metastasis and chemotherapy administration. This study was
conducted to evaluate the prognostic factors affecting the median survival and
patient’s quality of life.
METHODS
A total of 40 patients with metastatic bone disease treated surgically between
2008 to 2015 at orthopedics oncology unit, Hospital Universiti Sains Malaysia were
evaluated retrospectively, for survival prognostic factors, while the performance
status questionnaire of ECOG (Eastern Cooperative Oncology Group) was used to
assess the patient’s quality of life at three, six and twelve month after the surgery.
Subsequently, survival rate was analyzed by the Kaplan-Meier method.
RESULTS
There were 29 female and 11 male, the most common primary tumor was
breast cancer with 42.5%, followed by thyroid cancer 17.5%. Over all 14 (37.8%)
patients survived, while 23(62.16%) patients died, and the median survival was 36
months. Mean age at presentation was 54.43 years, and there were 30% (12/40)
above 60 years and 70% (28/40) below 60 years. Based on the age groups, the
survival rate was statistically significant p value (0.028). Other prognostic factors
include chemotherapy administration and site of bone metastasis (appendicular, axial
bone or both together) were also significantly correlated with the survival p value of
(0.003, 0.021), respectively. Types of the surgery was a significant factor associated
with the survival (p-value 0.038), resection and endoprosthesis surgery was the most
procedure performed in our center for (hip, proximal femur, shoulder and around
knee joint lesions) 58.97% (n=24), followed by Harrington procedure for pelvic
involvement which was 17.95% . Performance status ECG (0-2) and ECOG (3-5) of
patients was evaluated and found to be statistically significant as a prognostic factor
for survival.
CONCLUSION
In conclusion, the prognostic factors that significantly affect the survival of
patient with bone metastasis were age which was less than 60, location of bone
lesions, previous chemotherapy, and the type of performed surgical procedure.
Additionally, the study revealed that the quality of life significantly correlated with
the types of surgery and overall survival. Furthermore, the performance status
(ECOG) significantly correlated with the types of surgery and age.
Description
Keywords
Neoplasms metastasis