Mahmoud Abumarzouq*, Umar Zayyanu Usman, Wan Faisham Wan Ismail, Mohd Imran Yusof
Background: Surgical intervention for metastatic bone lesions has shown to have a satisfactory outcome. However, several factors can affect the survival of patients with metastatic bone disease. This review aims to evaluate the prognostic factors that affect the survival of patients with bone metastatic disease.
Methods: A retrospective study was conducted on 40 patients with bone metastatic disease who underwent surgical treatment between 2007 and 2015 at the oncology unit of the orthopaedic department at Hospital Universiti Sains Malaysia. Prognostic factors affecting the median survival rate were evaluated. The performance status questionnaire of the Eastern Cooperative Oncology Group (ECOG) was used to assess the patient's quality of life at three, six, and twelve months post-operatively. The survival rate was calculated using the Kaplan-Meier method.
Results: After evaluating 250 patient folders with metastatic bone disease, 40 cases met the inclusion criteria for this study. The study population consisted of 29 females and 11 males, with 70% of patients being under 60 years of age. The majority of patients were Malays (36 patients) and Chinese (4 patients). The most common primary tumour was breast cancer (42.5%), followed by thyroid cancer (17.5%, n=7).
The median survival for all patients was 36 months. Survival analysis revealed that age (p=0.028), chemotherapy (p=0.003), location of metastasis (p=0.021), surgical treatment for bone lesions (p=0.038), and quality of life assessed by ECOG questionnaire at three, six, and twelve months after surgery (p=0.001) were significant prognostic factors affecting survival of patients with metastatic bone disease.
Conclusions: Surgical intervention is a significant prognostic factor affecting survival in patients with metastatic bone disease. Patients with shorter life expectancies may require less invasive surgery, whereas those with longer survival estimates may require more extensive and durable reconstructive surgery. Other factors, such as age, location of lesions, number of bone lesions, and chemotherapy, also influence survival. The study further revealed that the ECOG performance status (0-2 and 3-5) of patients at three, six, and twelve months post-surgery is a statistically significant factor affecting survival.
Overall, the study underscores the importance of considering various prognostic factors when managing patients with metastatic bone disease. These findings may help guide clinical decision-making and improve the overall prognosis and quality of life of patients with this condition.
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