Surgery of skeletal metastases in 306 patients with prostate cancer

Figures & data

Table 1. Baseline characteristics of study patients at first surgery

	No.
Patients	306
1 operation	258 (84%)
2 operations	44 (15%)
3 operations	4 (1%)
Median age	72 (49–94)
Age group
< 60 years	27 (9%)
60–69 years	90 (29%)
> 70 years	189 (62%)
Metastases
Single skeletal	20 (7%)
Multiple skeletal	224 (73%)
Generalized	62 (20%)
Pathological fractures
Spinal
Yes	80 (45%)
No	96 (55%)
Non-spinal
Yes	123 (95%)
No	7 (5%)

Table 2. Anatomical locations and surgical procedures

	No.
Anatomical locations	358
Spine	193 (54%)
Cervical	1
Thoracic	165
Lumbar	27
Femur	106 (30%)
Femoral neck	37
Trochanteric	27
Subtrochanteric	33
Diaphysis	9
Humerus	28 (8%)
Proximal	9
Diaphysis	17
Distal	2
Pelvis	28 (8%)
Tibia	2 (1%)
Radius	1 (0%)
Surgical procedures	358
Spinal
Decompression	70 (36%)
Decompression + bone cement	11 (6%)
Decompression + stabilization	112 (58%)
Non-spinal
Prosthesis	95 (58%)
Osteosynthesis	66 (40%)
Other	4 (2%)
Bone cement
Yes	125 (35%)
No	233 (65%)
Curetage
Yes	26 (7%)
No	332 (93%)

Figure 1. Pre- and postoperative neurological function in 191 patients with spinal metastases, graded according to Frankel (A = complete paraplegia, B = no motor function, C = motor function useless, D = slight motor deficit, and E = no motor deficit).

Figure 2. Cumulative survival (with 95% CI) of 306 prostate cancer patients after surgery for skeletal metastases.

Table 3. Risk of (1) death and (2) any complication after surgery for skeletal metastases in 306 patients with prostate cancer

	Simple Cox regression ^a			Multiple Cox regression ^b
Endpoint	HR	(95% CI)	p-value	HR	(95% CI)	p-value
Death (1)
Age
> 70 years	1.3	(1.0–1.6)	0.07	1.4	(1.1–1.9)	0.01
< 70 years	Ref.			Ref.
Anatomical location
Femur	1.3	(1.0–1.7)	0.05	1.2	(0.9–1.6)	0.4
Humerus	0.7	(0.4–1.1)	0.09	0.6	(0.4–1.0)	0.05
All other	Ref.			Ref.
Type of fracture
Pathological	1.3	(1.0–1.7)	0.04	1.3	(1.0–1.8)	0.06
Impending	Ref.			Ref.
Metastases
Generalized	2.1	(1.2–3.6)	0.006	2.4	(1.4–4.2)	0.002
Multiple skeletal	2.2	(1.3–3.6)	0.002	2.3	(1.4–3.8)	0.001
Single skeletal	Ref.			Ref.
Any complication(2)
Anatomical location
Pelvis	2.3	(1.3–4.3)	0.007	2.3	(1.2–4.2)	0.01
All other	Ref.			Ref.

^aCrude HR. ^b Adjusted HR.

HR: hazard ratio; CI: confidence interval.

Table 4. Reoperations (n = 31)

Reason for reoperation	No., primary metastasis	Median time to reoperation (months)	Treatment
Deep wound infection	5, spine
	3, pelvis
	2, femur	1.3	Wound revision
Hematoma	7, spine	0	Drainage
Material failure	3, femur	2.5	Total joint replacement
Wound dehiscence	3, spine	1	Secondary wound closure
Increasing neurological
symptoms	2, spine	0	Extended laminectomy
Prosthetic dislocation	2, pelvis	0.5	Open reduction Extraction of prosthesis
Non-union	1, femur	24	Total joint arthroplasty
Periprosthetic fracture	1, femur	5.6	Osteosynthesis
Poor initial fixation	1, femur	0.5	Osteosynthesis
Technical error	1, spine	0.2	Extended laminectomy

Table 5. Complications treated non-surgically (n = 54)

Type of complication	No., primary metastasis	Median time to complication, months
Superficial wound infection	14, spine
	2, femur
	1, pelvis	0.2
Prosthetic dislocation	8, femur
	7, pelvis
	1, humerus	0.5
Pulmonary embolism	2, spine
	2, femur
	1, pelvis	0.1
Pneumonia	4, spine
	1, femur	0.1
Heart failure	2, spine
	1, femur	0
Myocardial infarction	1, spine
	1, pelvis	0
Wound dehiscence	2, spine	1.6
Perioperative hypoxia
(hemiparesis)	1, femur	0
Radial nerve palsy	1, humerus	0
Stroke	1, spine	0
Deep wound infection	1, femur	0