Clin Orthop Surg.  2017 Mar;9(1):116-125. 10.4055/cios.2017.9.1.116.

Outcome after Surgery for Metastases to the Pelvic Bone: A Single Institutional Experience

• Krishnan C
• Han I
• Kim HS

• KMID: 2412313
• DOI: http://doi.org/10.4055/cios.2017.9.1.116

Abstract

BACKGROUND
The pelvic bone is the most common site of bone metastases following the axial skeleton. Surgery on the pelvic bone is a demanding procedure. Few studies have been published on the surgical outcomes of metastasis to the pelvic bone with only small numbers of patients involved. This study sought to analyze the complications, local progression and survival after surgery for metastasis to the pelvic bone on a larger cohort of patients.
METHODS
We analyzed 83 patients who underwent surgery for metastases to the pelvic bone between the years 2000 and 2015. There were 41 men and 42 women with a mean age of 55 years. Possible factors that might be associated with complications, local progression and survival were investigated with regard to patient demographics and disease-related and treatment-related variables.
RESULTS
The overall complication rate was 16% (13/83). Advanced age (> 55 years, p = 0.034) and low preoperative serum albumin levels (≤ 39 g/L, p = 0.001) were associated with increased complication rates. In patients with periacetabular disease, the complication rate was higher in those who underwent total hip replacement arthroplasty (THR) than those who did not (p = 0.030). Local progression rate was 46% (37/83). The overall median time to local progression was 26 ± 14.3 months. The median time from local progression to death was 13 months (range, 0 to 81 months). The local progression-free survival was 52.6% ± 6.4% at 2 years and 36.4%± 7.6% at 5 years, respectively. Presence of skip lesions (p = 0.017) and presence of visceral metastasis (p = 0.027) were found to be significantly associated with local progression. The median survival of all patients was 24 months. The 2-year and 3-year survival rates were 52.5% ± 5.9% and 35.6% ± 6%, respectively. Metastasis from the kidney, breast, or thyroid or of hematolymphoid origin (p = 0.014), absence of visceral metastasis (p = 0.017) and higher preoperative serum albumin levels (p = 0.009) were associated with a prolonged survival.
CONCLUSIONS
Advanced age and low serum albumin levels were associated with high complication rates. Local progression after surgery for metastases to the pelvic bone was affected by the presence of skip lesions, not by surgical margins. Primary cancer type, serum albumin level and visceral metastasis influenced survival.

Keyword

Pelvic bones; Neoplasm metastasis; Bone neoplasms; Surgery; Disease progression

MeSH Terms

Abdominal Neoplasms/*secondary
Acetabulum
Adolescent
Adult
Age Factors
Aged
Arthroplasty, Replacement, Hip/adverse effects
Blood Loss, Surgical
Bone Neoplasms/*secondary/*surgery/therapy
Child
Disease Progression
Disease-Free Survival
*Embolization, Therapeutic
Female
Humans
Length of Stay
Male
Margins of Excision
Metastasectomy/*adverse effects
Middle Aged
*Pelvic Bones
Postoperative Complications/*etiology
Preoperative Period
Retrospective Studies
Serum Albumin/metabolism
Survival Rate
Treatment Outcome
Young Adult
Serum Albumin

Figure

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  Fig. 1 Kaplan-Meier curve of local progression-free survival. The median local progression-free survival of the entire group was 26 months. The 2-year and 5-year local progression survival rates were 52.6% and 36.4%, respectively.

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  Fig. 2 Kaplan-Meier curve of overall survival. The median survival of the entire group was 24 months. The 2-year and 3-year survival rates were 52.5% and 35.6%, respectively.

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