New scoring system as predictor of 90-day mortality in appendicular skeletal metastases

Abstract

Introduction. Cancer is one of the most common causes of death worldwide and occurs through the ability of malignant neoplasm cells to leave the primary tumor site and spread to other parts of the body through a complex process known as metastases. However, the decision to do surgery is dilemmatic due to the surgical risk, mortality rate, and cost control, especially in a developing country. Material and methods. A case control was investigated in our tertiary referral hospital from patients in 2013–2021. Of the 113 eligible patients, 24% (27) patients died within 3 months of their fracture. Medical records were reviewed in detail specifically for patient’s age, Karnofsky score, Lactate Dehydrogenase (LDH), C-Reactive Protein (CRP), types of the primary tumor, and metastases to another organ. Chi-square followed by multivariate analysis using backward elimination method were performed. Further ROC analysis was done to assess the sensitivity and specificity of the novel scoring system. Results. High CRP, LDH, and additional metastases to another organ besides the bone are the significant predictors of 90-day mortality after a pathological fracture due to bony metastases. A total score of 5 or lower has 78% specificity to predict a 90-day mortality after a pathological fracture due to bony metastases. Conclusions. Focus to palliative should not be commenced when a total score of 5 or lower is found. Future prospective multicenter studies would help establish the validity of this novel scoring system.