C-reactive protein and tumour diagnosis predict survival in patients treated surgically for long bone metastases
- 4 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Orthopaedics
- Vol. 45 (5), 1337-1346
- https://doi.org/10.1007/s00264-020-04921-2
Abstract
Purpose Surgical options for long bone metastases include intramedullary nail fixation or prosthetic reconstruction. Patients with a short life expectancy may benefit from less invasive surgery such as intramedullary nail fixation, while patients with a long life expectancy could be treated with more invasive surgery such as prosthetic reconstruction. The purpose of our study was to analyze the survival of patients treated surgically for long bone metastases, determining the prognostic factors affecting survival and analyzing the surgical complications and reoperation rates. Based on our results, we developed a prognostic score that helps to choose the best treatment for these patients. In addition, we compared the performance of our prognostic score with other previous prognostic models. Method We investigated prospectively potential clinical and laboratory prognostic factors in 159 patients with metastatic bone disease who underwent surgery with intramedullary nail fixation or prosthetic reconstruction. Clinical data were collected, recording the following data: age and sex of patients, primary tumour and time of diagnosis, number (single or multiple) and presentation (synchronous or metachronous) of bone metastases, presence of visceral metastases. The following laboratory data were analyzed: hemoglobin, leukocyte counts, lymphocyte counts, platelets count, alkaline phosphatase, and C-reactive protein. Results Our study showed that pathological C-reactive protein and primary tumour diagnosis were significant negative independent prognostic factors at 12-month survival. Based on our results, we created a score using C-reactive protein and primary tumour diagnosis, creating three different prognostic groups: (A) good prognosis primary tumour and physiological CRP with probability of survival at 12 months of 88.9 [80.1–98.5]; (B) bad prognosis primary tumour and physiological CRP or good prognosis primary tumour and pathological CRP with a probability of survival at 12 months of 56.7 [45.4–70.7]; (C) bad prognosis primary tumour and pathological CRP with a probability of survival at 12 months of 12.5 [5.0–28.3]. Using ROC multiple analysis, our score (AUC = 0.816) was the most accurate in predicting a 12-month survival compared to previous prognostic models. Discussion Patients treated surgically for long bone metastases with a life expectancy over 12 months should be treated with more durable reconstruction, while patients with a life expectancy less than 12 months should be treated with less invasive surgery. The diagnosis of primary cancer and C-reactive protein are two very simple data which every orthopaedic surgeon in any community hospital can easily rely on for any decision-making in the surgical treatment of a complex patient as with a patient with skeletal metastases. Conclusion Our prognostic score based on only two simple variables (C-reactive protein and primary tumour diagnosis) was able to predict the 12-month survival of patients treated surgically for long bone metastases and could be helpful in choosing the best treatment for these patients.Keywords
This publication has 38 references indexed in Scilit:
- Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasisSurgical Oncology, 2013
- Endoprostheses Last Longer Than Intramedullary Devices in Proximal Femur MetastasesClinical Orthopaedics and Related Research, 2012
- Survival analysis of patients with femoral metastasesJournal of Surgical Oncology, 2011
- Estimating Survival in Patients with Operable Skeletal Metastases: An Application of a Bayesian Belief NetworkPLOS ONE, 2011
- An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome StudyBritish Journal of Cancer, 2011
- Surgery for pathological proximal femoral fractures, excluding femoral head and neck fracturesInternational Orthopaedics, 2010
- Survival in Patients Operated on for Pathologic Fracture: Implications for End-of-Life Orthopedic CareJournal of Clinical Oncology, 2005
- C-reactive protein is significantly associated with prostate-specific antigen and metastatic disease in prostate cancerBJU International, 2005
- Treatment of Impending and Actual Pathological Femoral Fractures with the Long Gamma Nail in The NetherlandsThe European Journal of Surgery, 2000
- Metastatic Disease in Long Bones A Proposed Scoring System for Diagnosing Impending Pathologic FracturesClinical Orthopaedics and Related Research, 1989