股骨转移性病理性骨折，即将发生的和实际发生的骨折——一项患者生存研究。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford Pub Date : 2023-11-03 DOI:10.1016/j.suronc.2023.102014

Oded Hershkovich , Mojahed Sakhnini , Gal Barkay , Boaz Liberman , Alon Friedlander , Raphael Lotan

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引用次数: 0

摘要

简介：骨骼是转移瘤的常见部位。前列腺癌、乳腺癌、肺癌、肾癌和甲状腺癌占原始癌症的80%，股骨是受影响最严重的长骨。随着肿瘤学治疗的改进，患者生存期的延长导致骨转移的发生率增加。本研究考察了即将发生的股骨病理性骨折（IFF）的预防性手术与病理性股骨骨折（PFF）的治疗对患者死亡率和发病率的影响。方法：对174例因股骨转移而接受手术的患者（2004-2015年）进行回顾性队列研究。根据Mirels评分，82名患者患有PFF，92名患者患有IFF。随访期至2016年。对人口统计学数据、肿瘤学、病理学、放射、手术报告、门诊临床记录和影像学研究进行了检查。排除标准包括原发性肿瘤和多发性骨髓瘤。结果：PFF和IFF队列的平均年龄分别为64.8±13.3和60.2±11.9岁（p=0.02），其中女性62.1%，男性57%。乳房是股骨转移瘤最常见的来源。Mirels的平均得分为10±1.2。肿瘤起源与生存率之间存在关联。肺癌的生存率最差，而前列腺癌的生存期最长。IFF和PFF的生存率不同（p=0.03）。26%的患者发生了术后并发症，IFF和PF之间没有差异。结论：乳腺和肺是股骨转移最常见的肿瘤。我们的研究再次证实，与即将发生的骨折相比，病理性股骨骨折阻碍了患者的生存，应该进行预防性手术。IFF和PFF的术后并发症没有差异，但仍然相对较高。总的来说，股骨近端转移性疾病的患者比之前发表的存活时间更长，这可能是由于治疗方式的改进。

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Femoral metastatic pathological fractures, impending and actual fractures – A patient survival study

Introduction

The skeleton is a common site for metastases. Prostate, breast, lung, renal and thyroid carcinomas account for 80 % of the original cancers, with the femur being the most affected long bone. With improved oncological treatments, prolonged patient survival leads to an increased prevalence of osseous metastases. This study examines the impact of preventive surgery for impending femoral pathological fracture (IFF), versus treatment of pathological femur fracture (PFF) on patient mortality and morbidity.

Methods

Retrospective cohort of 174 patients undergoing surgery due to femoral metastases (2004–2015). Eighty-two patients were with PFF, and 92 were with IFF based on the Mirels' score. The followed-up period was until 2016. Demographic data, oncological, pathological, radiation, surgical reports, outpatient clinical records, and imaging studies were examined. Exclusion criteria included primary tumours and Multiple Myeloma.

Results

The mean age was 64.8 ± 13.3 and 60.2 ± 11.9 years (p = 0.02) in the PFF and the IFF cohorts, with 62.1 % women and 57 % men. The breast was the most common source of femoral metastases. The average Mirels' score was 10 ± 1.2. There was an association between tumour origin and survival. Carcinoma of the lung had the worst survival, while the prostate had the most prolonged survival. Survival rates differed between IFF and PFF (p = 0.03). Postoperative complications occurred in 26 % of the patient, with no difference between IFF & PFF.

Conclusion

Breast and lung are the most common tumours to metastasize the femur. Our study revalidates that pathological femoral fractures impede patient survival compared to impending fractures and should undergo preventive surgery. Postoperative complications do not differ between IFF and PFF but remain relatively high. Overall, patients with proximal femoral metastatic disease survive longer than previously published, probably due to improved treatment modalities.

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.