Survival analysis of patients with operable skeletal metastases in apendicular skeleton

Abstract

Skeletal metastases are the most common skeletal cancers that occur 25 times more than primary bone tumours. Breast and lung cancers are the primary sites that cause 80% of total skeletal metastases at female patients, while prostate and lung cancers are the primary sites that cause 80% of total skeletal metastases at male patients. 32.000 new patients with malignant tumours are registered in Serbia every year. The estimation is that in 50% of these patients skeletal metastases will occur during their life span. In this paper, the results of surgical treatment performed at 32 patients with limb metastases were evaluated. Scope: This study evaluates the primary tumours as prognostic factor of survival in 32 patents with skeletal metastases located at limbs that had been surgically treated in IOH BANJICA Belgrade and General Hospital Sremska Mitrovica. Materials and techniques: 32 surgically treated patients for skeletal metastases were involved in this study. The data set were analysed by having descriptive statistics and analytical statistics applied (T-test, λ2 test, Kaplan- Meier survival curves and Cox Proportional-Hazards Regression). The group was divided into two subsets of participants: primary tumours with slow progression of tumour growth (kidney, breast, prostate and thyroid cancer) and primary tumours with rapid progression of tumour growth (lungs and womb cancer, melanoma and cancer of unknown primary origin). T test was used to show if there was statistical significance in the survival between the two subgroups. Results: Analytical and statistical methods confirmed that primary site and type of primary tumour had strong influence on the survival of these patients. This prognostic factor is one of the most important factors for the estimation of life expectancy that may help in decision-making on subsequent surgical treatment and the type of surgical therapy; it is also a part of all scoring systems for envisaging life expectancy in patients with skeletal metastasis. Conclusion: The type of primary tumour as prognostic factor is a very important independent factor which can help estimate the probability of survival in surgically treated patients with skeletal metastasis. Solitary skeletal metastasis from renal carcinoma is singled out in this study as it is a specific orthopaedic entity because of a long-term survival probability. In primary tumours of moderate growth long and aggressive surgical procedures for reconstruction of post-excision bone defect should be chosen due to prolonged survival.