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. 2024 Sep 16;13(9):497-506.
doi: 10.1302/2046-3758.139.BJR-2023-0372.R1.

Clinical, oncological, and prognostic differences of patients with subsequent skeletal-related events in bone metastases

Hsiang-Chieh Hsieh  1   2   3 , Hung-Kuan Yen  2   3   4 , Wen-Tung Hsieh  2   3 , Ching-Wei Lin  5   6 , Yu-Ting Pan  2   7 , Fu-Shan Jaw  1 , Stein J Janssen  8 , Wei-Hsin Lin  2 , Ming-Hsiao Hu  2   9 , Olivier Groot  10   11
Affiliations

Clinical, oncological, and prognostic differences of patients with subsequent skeletal-related events in bone metastases

Hsiang-Chieh Hsieh et al. Bone Joint Res. .

Abstract

Aims: Advances in treatment have extended the life expectancy of patients with metastatic bone disease (MBD). Patients could experience more skeletal-related events (SREs) as a result of this progress. Those who have already experienced a SRE could encounter another local management for a subsequent SRE, which is not part of the treatment for the initial SRE. However, there is a noted gap in research on the rate and characteristics of subsequent SREs requiring further localized treatment, obligating clinicians to extrapolate from experiences with initial SREs when confronting subsequent ones. This study aimed to investigate the proportion of MBD patients developing subsequent SREs requiring local treatment, examine if there are prognostic differences at the initial treatment between those with single versus subsequent SREs, and determine if clinical, oncological, and prognostic features differ between initial and subsequent SRE treatments.

Methods: This retrospective study included 3,814 adult patients who received local treatment - surgery and/or radiotherapy - for bone metastasis between 1 January 2010 and 31 December 2019. All included patients had at least one SRE requiring local treatment. A subsequent SRE was defined as a second SRE requiring local treatment. Clinical, oncological, and prognostic features were compared between single SREs and subsequent SREs using Mann-Whitney U test, Fisher's exact test, and Kaplan-Meier curve.

Results: Of the 3,814 patients with SREs, 3,159 (83%) patients had a single SRE and 655 (17%) patients developed a subsequent SRE. Patients who developed subsequent SREs generally had characteristics that favoured longer survival, such as higher BMI, higher albumin levels, fewer comorbidities, or lower neutrophil count. Once the patient got to the point of subsequent SRE, their clinical and oncological characteristics and one-year survival (28%) were not as good as those with only a single SRE (35%; p < 0.001), indicating that clinicians' experiences when treating the initial SRE are not similar when treating a subsequent SRE.

Conclusion: This study found that 17% of patients required treatments for a second, subsequent SRE, and the current clinical guideline did not provide a specific approach to this clinical condition. We observed that referencing the initial treatment, patients in the subsequent SRE group had longer six-week, 90-day, and one-year median survival than patients in the single SRE group. Once patients develop a subsequent SRE, they have a worse one-year survival rate than those who receive treatment for a single SRE. Future research should identify prognostic factors and assess the applicability of existing survival prediction models for better management of subsequent SREs.

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Conflict of interest statement

W-H. Lin and M-H. Hu report funding by an institutional research project at the National Taiwan University Hospital (No. 111-N0070), related to this study.

Figures

Fig. 1
Fig. 1
Flowchart of patient enrolment. SRE, skeletal-related event.
Fig. 2
Fig. 2
Illustration of three different survival durations, anchoring different starting points. In study question 2, we compared the blue and orange survival durations. In the corresponding sensitivity analysis eliminating the immortal bias time, we compared the blue and green survival durations. In study question 3, we compared the blue and red survival durations. SRE, skeletal-related event.
Fig. 3
Fig. 3
Kaplan–Meier curves with 95% CIs of overall survival stratified by patients in the single skeletal-related event (SRE) group and subsequent SRE group.
See this image and copyright information in PMC

References

    1. Arpornsuksant P, Morris CD, Forsberg JA, Levin AS. What factors are associated with local metastatic lesion progression after intramedullary nail stabilization? Clin Orthop Relat Res. 2022;480(5):932–945. doi: 10.1097/CORR.0000000000002104. - DOI - PMC - PubMed
    1. van der Vliet QMJ, Paulino Pereira NR, Janssen SJ, et al. What factors are associated with quality of life, pain interference, anxiety, and depression in patients with metastatic bone disease? Clin Orthop Relat Res. 2017;475(2):498–507. doi: 10.1007/s11999-016-5118-3. - DOI - PMC - PubMed
    1. Katagiri H, Takahashi M, Wakai K, Sugiura H, Kataoka T, Nakanishi K. Prognostic factors and a scoring system for patients with skeletal metastasis. J Bone Joint Surg Br. 2005;87-B(5):698–703. doi: 10.1302/0301-620X.87B5.15185. - DOI - PubMed
    1. Katagiri H, Okada R, Takagi T, et al. New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med. 2014;3(5):1359–1367. doi: 10.1002/cam4.292. - DOI - PMC - PubMed
    1. Jensen AØ, Jacobsen JB, Nørgaard M, Yong M, Fryzek JP, Sørensen HT. Incidence of bone metastases and skeletal-related events in breast cancer patients: a population-based cohort study in Denmark. BMC Cancer. 2011;11:29. doi: 10.1186/1471-2407-11-29. - DOI - PMC - PubMed