Profile of Surgically-treated Metastatic Extremity Bone Tumours at a University Hospital in Hong Kong

Abstract

Background/Purpose: Metastatic deposits in bones increase overall morbidity in cancer patients. The orthopaedic oncologist aims at controlling the skeletal morbidity as a way of reducing the overall morbidity in the survival period of the cancer patient. This study investigated the characteristics of metastatic extremity bone tumours requiring surgical treatment, with a view to setting a template for a local database of extremity metastatic bone tumours in Hong Kong. Methods: A retrospective review of metastatic extremity bone tumours treated surgically at a university hospital in Hong Kong, from January 2006 to December 2015, is presented. Results: In total, 126 patients were studied. The lung (28.6%) was the most common source of metastasis to the extremity bones. The femur (70.1%) was most commonly involved. Pathological fractures (47.4%) were the most common indications for surgery. Intramedullary nailing (57.3%) was the most common surgical treatment. The overall postoperative complication rate was 8.7%. The mean duration of follow-up was 10.8 ± 4.1 months. Furthermore, 79.4% of the patients died within the study period, with mean duration of postoperative survival of 6.1 ± 1.1 months. Spinal compression (p = 0.001), indication for surgery (p = 0.001), age of the patient (p = 0.001), and option of surgical treatment (p = 0.000319) were found to have significantly affected the duration of postoperative survival. Conclusion: The surgical management of extremity bone metastasis is a key consideration in averting potentially crippling morbidity. Options of treatment need be carefully chosen in appropriate patients for a good outcome. 中 文 摘 要: 背景: 腫瘤的骨轉移增加了癌症患者的病況。骨科腫瘤學家旨在控制骨骼的病況來降低癌症病人的總病態。這項研究調查需要手術治療的轉移性肢端骨腫瘤的特點，以便建立香港的轉移性肢端骨腫瘤的本地數據庫模板。 方法: 回顧性研究由2006年1月至2015年12月在一所香港大學醫院手術治療的轉移性肢端骨腫瘤個案。 結果: 共有126例患者進行了研究。肺部（28.6%）是最常見轉移到肢體骨骼的來源。股骨（70.1%）是最常見出現骨轉移的位置。病理性骨折（47.4%）是最常見的手術適應症。髓內釘（57.3%）是常見的手術治療方法。整體術後併發症發生率為8.7%。平均隨訪時間為10.8 ± 4.1個月。79.4%的患者在研究期內死亡，平均術後生存期為6.1 ± 1.1個月。脊柱壓迫（P值 = 0.001）、手術適應症（P值 = 0.001）、患者年齡（P值 = 0.001）、手術方法的選擇（P值 = 0.000319）都顯著影響術後生存期。 結論: 手術治療肢體骨轉移是避免潛在的致殘發病率關鍵。要達到好的結果，需要為合適的病人仔細選擇治療的方法。 Keywords: bone metastasis, extremity, Hong Kong, outcome, surgical treatment