Incidence of surgical interventions for metastatic bone disease in the extremities: a population-based cohort study

Figures & data

Figure 1. Flow diagram illustrating identification of the cohort of patients treated operatively for metastatic bone disease of the extremities in the Capital Region of Denmark (total population 1.81 million) from 19 May 2014 to 18 May 2016. MDT: highly specialised multidisciplinary team; MTC: musculoskeletal tumor center; SSG: secondary surgical centers.

Table 1. Table describing and comparing the preoperative data of the cohort of patients treated operatively for metastatic bone disease of the extremities in the Capital Region of Denmark (total population 1.81 million) from 19 May 2014 to 18 May 2016.

Preoperative variables	All patients (data/missing)	Musculoskeletal tumour centre	Secondary specialised centre	p value between cohorts
No. of patients/lesions	168	95	73
Female/Male	84/84	43/52	41/32	p = .213^#
Age at surgery mean (range)	68 (32–90)	64 (32–89)	71 (49–90)	p < .001*
Primary cancer	175
Breast	43	23	20
Lung	33	15	18
Renal	26	12	14
Prostate	26	19	7
Myeloma	20	14	6
Unknown	3	0	3
Fracture	(n = 168/0)	(n = 95/0)	(n = 73/0)	p < .001^#
Complete	125	60	65
Impending	43	35	8
Karnofsky score	(n = 168/0)	(n = 95/0)	(n = 73/0)	p = .324*
Mean (range)	74 (20–100)	76 (20–100)	73 (20–100)
> =70	108	63	45	p = .643^#
<70	60	32	28
ASA group	(n = 166/2)	(n = 95/0)	(n = 71/2)
Mean (range)	3 (1–4)	2.45 (1–4)	2.83 (1–4)	p < .001*
Group 1	7	5	2	p < .001^#
Group 2	66	43	20
Group 3	86	46	37
Group 4	14	1	12
Group 1 + 2	70	48	22	p = .018^#
Group 3 + 4	96	47	49
Bone Metastases	(n = 168/0)	(n = 95/0)	(n = 73/0)	p = .220^#
Single bone	44	28	16
Multiple in extremities	15	11	4
Multiple incl. spinal w/o neuro. deficit	103	52	51
Multiple incl. spinal w neuro. Deficit	6	4	2
Solitary lesion	44	28	16	p = .353^#
Multiple bones	124	67	57
Visceral	(n = 168/0)	(n = 95/0)	(n = 73/0)	p < .001^#
Yes	68	26	42
No	100	69	31
Days from diagnose to surgery	(n = 168/0)	(n = 95/0)	(n = 73/0)
Mean (Days)	1554 (0–14040)	1644 (0–14040)	1437 (0–8301)	p = .272*
Debut of cancer	(n = 168/0)	(n = 95/0)	(n = 73/0)	p =  .889^#
Yes	28	15	13
No	140	80	60
Debut of cancer relapse	(n = 141/27)	(n = 82/13)	(n = 59/14)	p = .891^#
Yes	21	13	8
No	120	69	51
Irradiation of metastasis prior to surgery	(n = 168/0)	(n = 95/0)	(n = 73/0)	p = .416^#
Yes	36	23	13
No	132	72	60

#Chi² test; *Mann–Whitney-Wilcoxon test.

Bold values in the table provides total sum score.

Figure 2. Figure illustrating the anatomical sites of treated metastatic lesions and method of surgical management of the cohort of patients treated operatively for metastatic bone disease of the extremities in the Capital Region of Denmark (total population 1.81 million) from 19 May 2014 to 18 May 2016. rTSA: reverse total shoulder arthroplasty; THA: Total Hip Arthroplasty.

Figure 3. Kaplan–Meier survival analysis showing cumulated overall survival for a population-based cohort of patients having surgery for metastatic bone disease in the extremities in the Capital Region of Denmark (total population 1.81 million) stratified for treatment center. Patients were only included into analysis at index surgery during the study (n = 164). Overall one-year survival for the entire cohort was 41% (95% C.I.: 33%–48%) and 46% (95% C.I.:36%–56%) versus 35% (95% C.I.: 24%–46%) for patients treated at a musculoskeletal tumor center or a secondary surgical center, respectively (p < .001).