International Journal of General Medicine (May 2021)

Effects of Surgical Intervention for Bone Metastases on Survival in Patients with Advanced Cancer: A Nationwide Population-Based Cohort Study

  • Shih JT,
  • Yeh TT,
  • Shen PH,
  • Wang CC,
  • Wang SH,
  • Chien WC,
  • Chung CH,
  • Wu CC

Journal volume & issue
Vol. Volume 14
pp. 1661 – 1671

Abstract

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Jen-Ta Shih,1,2 Tsu-Te Yeh,1 Pei-Hung Shen,1 Chih-Chien Wang,1 Sheng-Hao Wang,1 Wu-Chien Chien,3– 6 Chi-Hsiang Chung,3– 5 Chia-Chun Wu1 1Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 2Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; 3School of Public Health, National Defense Medical Center, Taipei, Taiwan; 4Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 5Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; 6Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, TaiwanCorrespondence: Chia-Chun WuDepartment of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Road, Neihu Dist, Taipei City, 11472, TaiwanTel +886-953-086-492Fax +886-2-8792-7186Email [email protected]: With recent advances in surgical techniques and instruments, orthopedic surgeons are better equipped to treat metastatic bone disease. There has also been considerable progress in the non-surgical treatment of cancers, specifically in improving the survival rate of patients with advanced cancer. However, it remains unclear whether surgical resection of a metastatic bone lesion poses additional risk to the survival of patients with advanced cancer.Patients and Methods: This study utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2015. Patients aged ≥ 18 years, who had been recently diagnosed with bone metastases (BM), were enrolled and assigned to either the surgery or non-surgery groups. The demographic characteristics were analyzed, and the adjusted hazard ratios (aHR) of mortality were calculated using Cox regression analysis.Results: Of the 4,549,226 individuals in the inpatient database of the NHIRD, 83,536 patients with BM were enrolled in this study. Among them, 8802 underwent surgical resection for skeletal metastatic lesion and 66,098 did not. Altogether, 28,691 patients died, including 2798 (31.8%) in the surgery group and 25,893 (39.2%) in the non-surgery group. The aHR for mortality was 0.7-fold lower in the surgery group (p < 0.001).Conclusion: This study demonstrates that surgical resection of metastatic bone lesions did not pose any additional risk to survival outcomes. Thus, we believe that surgery, if indicated, could have a competitive role in the management of metastatic bone disease.Keywords: bone metastasis, surgical resection, mortality, bone resorption inhibitor

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