Background: (I) To determine whether patients with malignant bone tumors had a higher risk of dying from pneumonia compared with the general US population; (II) to identify the independent risk factor associated with fatal pneumonia among these patients.Methods: We identified 18,583 patients diagnosed with primary malignant bone tumors between 1973 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) database. Standardized mortality ratios (SMRs) were calculated based on the mortality data of the general population gathered by the National Center for Health Statistics, which provided the risk of death from pneumonia among cancer patients relative to that of the general population. Given that other causes of death were considered as competing events, we also designed the Fine-Gray model to identify demographic and tumor-related characteristics associated with a higher risk of dying from pneumonia among these patients.Results: Patients with primary malignant bone tumors had a higher risk of dying from pneumonia than the general population after adjusting the distribution difference of age, sex, and race among them (SMR =2.79; 95% CI: 2.17-3.59). The older age, Black and earlier period of diagnosis were found to be the independent prognostic factor for a higher risk of death from pneumonia for these patients. Additionally, amputation due to malignant bone tumors significantly increased the risk of death from pneumonia compared with nonsurgery. The highest mortality rate of pneumonia was observed among patients with chordoma. Interaction tests demonstrated that amputation only increased the relative risk of fatal pneumonia among patients with osteosarcoma. Throughout the follow-up period, the mortality rate of fatal pneumonia was the highest within the first year after diagnosis, and the highest relative suicide risks persisted over time in patients with osteosarcoma.Conclusions: To mitigate the risk of fatal pneumonia among patients with bone tumors, we call for longterm clinical monitoring of the lung condition among these patients, especially for those after amputation for bone tumors.

BackgroundAlthough clinicians and patients with extremity bone and soft tissue (EBST) are increasingly interested in limb salvage surgery (LSS), because of the minimal damage to physical appearance and function, however, there is still a lack of large-scale population studies on whether LSS improves the prognosis of patients.PurposeThe aim of this study was to compare the survival of patients with EBST sarcomas after receiving LSS and amputation.MethodsTo conduct the population-based study, we identified 6,717 patients with a histologically diagnosed bone sarcoma and 24,378 patients with a histologically diagnosed soft tissue sarcoma from the Surveillance, Epidemiology, and End Results database. We analyzed overall survival (OS), cancer-specific survival (CSS), and non-sarcoma survival (NSS) using the Kaplan–Meier method, log-rank test or Gray test, Cox regression model, propensity score-matched analysis, and landmark analysis.ResultsLSS could improve the prognosis in patients with most EBST subtypes, except for Ewing sarcomas and MPNST. However, in the subgroup without distant metastases, limb salvage increased CSS only for patients with osteosarcoma, Ewing sarcoma, and leiomyosarcoma, as well as NSS for patients with chondrosarcoma and synovial sarcoma. Landmark analysis further demonstrated that sarcoma survivors surviving <10 years could benefit from LSS but not for long-term survivors ≥10 years. Moreover, for patients with distant metastases, LSS could improve survival of osteosarcoma patients but worsen CSS among patients with MPNST. Landmark analysis further demonstrated that LSS improved survival among osteosarcomas patients with distant metastases only within 1 year after surgery. Moreover, patients receiving LSS and those receiving amputation had a high risk of dying from different non-sarcoma diseases during the postoperative follow-up.ConclusionsThe impact of limb salvage on the prognosis of patients depends on the pathological subtype and stage of EBST sarcomas.

Background Surgical treatment remains a challenge for the treatment of adolescent cervical kyphosis, anterior cervical fusion (ACF) can correct kyphosis with small trauma. To study the efficacy and application scope of ACF for the treatment of adolescent cervical kyphosis. Methods Patients younger than 18 years old who had undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for cervical kyphosis from 2013.1 to 2020.12 in our hospital were retrospectively analyzed. The visual analogue scale (VAS) score for neck pain and neck disability index (NDI) were recorded at preoperative and the last follow-up. The C2-7 Cobb angle, regional kyphosis angle (RKA), kyphosis index (KI), T1 slope (T1S), and C2-7 sagittal vertical axis (C2-7 SVA) were measured at preoperative, 1-week post-traction, 1-week postoperative, and last follow-up. Data were analyzed using the SPSS 25.0 software and p < 0.05 refers to a significant difference. Results A total of 11 patients were included, 6 with idiopathic, 1 with laminectomy, 2 with eosinophilic granuloma(EG), and 2 with trauma. All accepted skull-traction, the cervical kyphosis angle shows significant improvement at post-traction than preoperative. 9 patients accepted anterior cervical discectomy and fusion(ACDF), and 2 patients accepted anterior cervical corpectomy decompression and fusion(ACCF). The laminectomy patient occurred distal junctional kyphosis(DJK) at the last follow-up. The VAS score of neck pain and NDI at the last follow-up were smaller than preoperative (p<0.05). The cervical kyphosis angle shows significant improvement at postoperative and the last follow-up than preoperative and post-traction. There is no significant difference in cervical curvature between the postoperative and last follow-up. Conclusion ACF is suited to mild or moderate adolescent cervical kyphosis or can be corrected to mild or moderated by cervical traction. It is effective for improving clinical symptoms with small trauma. For patients with an intact posterior column, ACF is effective for restoring cervical lordosis. For patients without an intact posterior column, ACF-only is not enough, a combined approach should be considered and fused to the thoracic if necessary.