Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis
Abstract Background The rising prevalence of metastatic bone disease (MBDex) of the extremities substantially affects patient quality of life due to skeletal-related events. Determining whether surgical intervention benefits patient survival is crucial in the management of MBDex. However, there is c...
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BMC
2025-07-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-06079-2 |
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| author | Chih-Wei Chen Chih-Chi Su Jyun-Hao Chen Jaw-Lin Wang Tzu-Hao Tseng Olivier Q. Groot |
| author_facet | Chih-Wei Chen Chih-Chi Su Jyun-Hao Chen Jaw-Lin Wang Tzu-Hao Tseng Olivier Q. Groot |
| author_sort | Chih-Wei Chen |
| collection | DOAJ |
| description | Abstract Background The rising prevalence of metastatic bone disease (MBDex) of the extremities substantially affects patient quality of life due to skeletal-related events. Determining whether surgical intervention benefits patient survival is crucial in the management of MBDex. However, there is currently limited evidence regarding the survival impact of upper versus lower extremity involvement. This study aims to evaluate differences in survival outcomes regarding metastatic site, and the impact of operative versus nonoperative management. Methods This retrospective cohort study evaluated 1,719 patients with a two-year follow-up period after treatment for MBDex at a major tertiary medical center in Taiwan from 2010 to 2018. Inclusion criteria included patients aged over 20 who underwent operative or nonoperative management. Exclusion criteria involved patients with concurrent upper and lower extremity metastases. Kaplan–Meier curves and multivariate Cox regression models were used to analyze survival and prognostic factors. Results Compared to upper MBDex, lower MBDex patients have poorer pretreatment Eastern Cooperative Oncology Group (ECOG) performance status. Lower MBDex was associated with worse two-year survival, particularly among those receiving nonoperative management. Common prognostic factors included ECOG performance status, Charlson’s comorbidities, primary tumor type, and albumin levels, while previous systemic treatment and the presence of visceral and brain metastases were specifically detrimental in lower MBDex. Conclusions Lower MBDex is associated with poorer survival outcomes. Operative management is associated with survival benefit in lower MBDex, a benefit not as pronounced in upper MBDex. These findings highlight the importance of differentiating between upper and lower extremity metastases in survival analyses and prediction. |
| format | Article |
| id | doaj-art-8dcf5c4dec9b4cd9a8c5de8007ef42ca |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-8dcf5c4dec9b4cd9a8c5de8007ef42ca2025-08-20T04:03:03ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-07-0120111110.1186/s13018-025-06079-2Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysisChih-Wei Chen0Chih-Chi Su1Jyun-Hao Chen2Jaw-Lin Wang3Tzu-Hao Tseng4Olivier Q. Groot5Department of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Medical Education, National Taiwan University HospitalDepartment of Biomedical Engineering, National Taiwan UniversityDepartment of Orthopaedic Surgery, National Taiwan University HospitalDepartment of Orthopaedics, University Medical Center UtrechtAbstract Background The rising prevalence of metastatic bone disease (MBDex) of the extremities substantially affects patient quality of life due to skeletal-related events. Determining whether surgical intervention benefits patient survival is crucial in the management of MBDex. However, there is currently limited evidence regarding the survival impact of upper versus lower extremity involvement. This study aims to evaluate differences in survival outcomes regarding metastatic site, and the impact of operative versus nonoperative management. Methods This retrospective cohort study evaluated 1,719 patients with a two-year follow-up period after treatment for MBDex at a major tertiary medical center in Taiwan from 2010 to 2018. Inclusion criteria included patients aged over 20 who underwent operative or nonoperative management. Exclusion criteria involved patients with concurrent upper and lower extremity metastases. Kaplan–Meier curves and multivariate Cox regression models were used to analyze survival and prognostic factors. Results Compared to upper MBDex, lower MBDex patients have poorer pretreatment Eastern Cooperative Oncology Group (ECOG) performance status. Lower MBDex was associated with worse two-year survival, particularly among those receiving nonoperative management. Common prognostic factors included ECOG performance status, Charlson’s comorbidities, primary tumor type, and albumin levels, while previous systemic treatment and the presence of visceral and brain metastases were specifically detrimental in lower MBDex. Conclusions Lower MBDex is associated with poorer survival outcomes. Operative management is associated with survival benefit in lower MBDex, a benefit not as pronounced in upper MBDex. These findings highlight the importance of differentiating between upper and lower extremity metastases in survival analyses and prediction.https://doi.org/10.1186/s13018-025-06079-2Metastatic bone diseaseMetastases of lower extremitiesMetastases of upper extremitiesSurvival |
| spellingShingle | Chih-Wei Chen Chih-Chi Su Jyun-Hao Chen Jaw-Lin Wang Tzu-Hao Tseng Olivier Q. Groot Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis Journal of Orthopaedic Surgery and Research Metastatic bone disease Metastases of lower extremities Metastases of upper extremities Survival |
| title | Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis |
| title_full | Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis |
| title_fullStr | Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis |
| title_full_unstemmed | Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis |
| title_short | Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis |
| title_sort | differential survival outcomes in upper versus lower extremity metastatic bone disease a retrospective comparative cohort analysis |
| topic | Metastatic bone disease Metastases of lower extremities Metastases of upper extremities Survival |
| url | https://doi.org/10.1186/s13018-025-06079-2 |
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