Surgery for metastases - survival and the long tail

[JimJimJimJim]

The role of orthopedic (bone) surgery in patients with skeletal metastases is to treat spinal cord compression and existing or impending pathological fractures in an effort to relieve pain and restore function.

Most often it is performed to relieve symptoms from spinal compression, or from broken, or at risk leg bones.

It is done to give you a better quality of life, not to extend your life.

So a question that arises in the minds of men is:

Am I likely to live long enough so that the extra problems of an operation are worth it?

This study was done to give some guidance as to the time that men lived after had surgery for their bone metastases.

Remember that these men were mostly in a pretty bad way, or at high risk, to need the surgery in the first place.

Survival time is better for men under 70. More bone metastases, and more other metastases led to poorer results.

I sometimes explain to men without much statistical knowledge that studies most usually report the median survival time - the time that half the men have died. Also, I explain that the spread of results is not even, and most often is much longer than most people expect. Statisticians call this a "long tail" because that is what it looks like when the graph is drawn.

I mention that here because you can see in the abstract below that the median survival is just half a year. So, half of the men lived longer than half a year. The last of these men died 16 years later - an excellent example of a long tail.

If you are interested, the full paper (with a survival graph) is free. If you cannot find it on PubMed, ask Jim Marshall to send you a copy.

Acta Orthop. 2012 Feb;83(1):74-9. Epub 2011 Dec 29.

Surgery of skeletal metastases in 306 patients with prostate cancer.

Weiss RJ, Forsberg JA, Wedin R.

Source

Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. rudiger.weiss@karolinska.se

Abstract

PURPOSE:

Skeletal metastases are common in patients with prostate cancer, and they can be a source of considerable morbidity. We analyzed patient survival after surgery for skeletal metastases and identified risk factors for reoperation and complications.

PATIENTS AND METHODS:

This study included 306 patients with prostate cancer operated for skeletal metastases during 1989-2010. Kaplan-Meier analysis was used to calculate survival. Cox multiple regression analysis was performed to study risk factors, and results were expressed as hazard ratios (HRs).

RESULTS:

The median age at surgery was 72 (49-94) years. The median survival after surgery was 0.5 (0-16) years. The cumulative 1-, 2-, and 3-year survival after surgery was 29% (95% CI: 24-34), 14% (10-18), and 8% (5-11). Age over 70 years (HR 1.4), generalized metastases (HR 2.4), and multiple skeletal metastases (HR 2.3) resulted in an increased risk of death after surgery. Patients with lesions in the humerus (HR 0.6) had a lower death rate. The reoperation rate was 9% (n = 31). The reasons for reoperation were deep wound infection (n = 10), hematoma (n = 7), material (implant) failure (n = 3), wound dehiscence (n = 3), increasing neurological symptoms (n = 2), prosthetic dislocation (n = 2), and others (n = 4).

INTERPRETATION:

This study involves the largest reported cohort of patients operated for skeletal lesions from prostate cancer. Our survival data and analysis of predictors for survival help to set appropriate expectations for the patients, families, and medical staff.

PMID: 22206449

This extract can be found on http://PubMed.com, and is in the public domain.

On PubMed.com there will be a link to the full paper (often $30, sometimes free - this one is FREE).

Any highlighting (except the title) is not by the author, but by Jim Marshall.

Jim is not a doctor.