Prevalence of primary malignant tumours, rates of pathological fracture, and mortality in the setting of metastatic bone disease

Abstract

AimsThe modern prevalence of primary tumours causing metastatic bone disease is ill-defined in the oncological literature. Therefore, the purpose of this study is to identify the prevalence of primary tumours in the setting of metastatic bone disease, as well as reported rates of pathological fracture, postoperative complications, 90-day mortality, and 360-day mortality for each primary tumour subtype.MethodsThe Premier Healthcare Database was queried to identify all patients who were diagnosed with metastatic bone disease from January 2015 to December 2020. The prevalence of all primary tumour subtypes was tabulated. Rates of long bone pathological fracture, 90-day mortality, and 360-day mortality following surgical treatment of pathological fracture were assessed for each primary tumour subtype. Patient characteristics and postoperative outcomes were analyzed based upon whether patients had impending fractures treated prophylactically versus treated completed fractures.ResultsIn total, 407,893 unique patients with metastatic bone disease were identified. Of the 14 primary tumours assessed, metastatic bone disease most frequently originated from lung (24.8%), prostatic (19.4%), breast (19.3%), gastrointestinal (9.4%), and urological (6.5%) malignancies. The top five malignant tumours resulting in long bone pathological fracture were renal (5.8%), myeloma (3.4%), female reproductive (3.2%), lung (2.8%), and breast (2.7%). Following treatment of pathological fractures of long bones, 90-day mortality rates were greatest for lung (12.1%), central nervous system (10.5%), lymphoma (10.4%), gastrointestinal (10.1%), and non-renal urinary (10.0%) malignancies. Finally, our study demonstrates improved 90-day and 360-day survival in patients treated for impending pathological fracture compared to completed fracture, as well as significantly lower rates of deep vein thrombosis, pulmonary embolism, urinary tract infection, and blood transfusion.ConclusionThis study defines the contemporary characteristics of primary malignancies resulting in metastatic bone disease. These data should be considered by surgeons when prognosticating patient outcomes during treatment of their metastatic bone disease.Cite this article: Bone Jt Open 2023;4(6):424–431.

The Use of a Training 3d-Model in the Treatment of a Patient With a Pathological Fracture of the Proximal Part of the Femur (Case From Practice)

“…У разі раку молочної чи передміхурової залоз симптоми, пов'язані з метастазами, часто є першою ознакою захворювання [11,12]. Деякі пацієнти можуть мати патологічні переломи й ускладнення через них: наприклад, неврологічні порушення за умов метастаз у хребті (адже загальновідомо, що хребет є найпоширенішим місцем метастазування) [13,14].…”

Hemibody Irradiation for Bone Metastases: A Systematic Review and Meta-Analysis

“…A 2020 study of the SEER database from 2010 to 2013 reported that 5% of patients have bone metastases at presentation, with the highest prevalence in breast and prostate cancer patients [ 1 ]. A 2023 study of the Premier Healthcare Database from January 2015 to December 2020 found that the primary sites among patients with bone metastases were the lungs (25%), prostate (19%), and breasts (19%) [ 2 ]. A 2015 study based on the Oncology Services Comprehensive Electronic Records database found that breast cancer patients experience a significant symptom burden from bone metastases, including pain, fatigue, sleeping problems, and neuropathic symptoms [ 3 ].…”

“…A 2015 study based on the Oncology Services Comprehensive Electronic Records database found that breast cancer patients experience a significant symptom burden from bone metastases, including pain, fatigue, sleeping problems, and neuropathic symptoms [ 3 ]. In the Premier Healthcare Database study, the 90-day mortality after a pathological fracture was about 10% [ 2 ].…”