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Rigshospitalet - en del af Københavns Universitetshospital

Patient survival following joint replacement due to metastatic bone disease - comparison of overall patient and prostheses survival between cohorts treated in two different time-periods

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BACKGROUND: Improvements in medical treatment for cancer have increased survival of cancer patients. We hypothesize that improvement in cancer treatment is reflected in increased survival after surgical intervention for metastatic bone disease (MBD) and that subsequent revision surgery does not pose a risk for survival.

METHODS: We identified a retrospective consecutive cohort who received bone resection and reconstruction (BRR) with implants (including total joint replacements (with or without wide resection) or bone reconstruction with an intercalary spacer or revisions procedures for failed implants with BBR technique) due to MBD from 2003 to 2008 (early cohort) and 2009 to 2013 (late cohort) at a tertiary referral center. We registered epidemiological data, type of implant (primary or a revision implant), patient survival (Kaplan-Meier), implant survival (competing risk analysis) and complications to surgery.

RESULTS: Three hundred and eleven procedures were performed in 291 patients (289 primary BRR (270 patients, early cohort n = 130 late cohort n = 140) and 22 revision BRR (21 patients)). Overall survival was 44% (95% confidence intervals (95% CI): 39-50) and 32% (95% CI: 27-38) after 1 and 2 years. No difference in survival between the early and late cohort was found (p = .458), or between primary and revision BRR (p = .465). Time from diagnosis of cancer to surgery was shorter in the early cohort (p < .001). The cumulative incidence of failure of implant was 2% (95% CI: 0-3%) at 1 year and 3% (95% CI: 1-6%) at 2 years. One year cumulative implant failure for revision implants was 5% (95% CI: 0-13%) at 1 and 2 years. The risk of failure was not statistical significant between primary and revision implant (p = .293) in competing risk analysis.

DISCUSSION: We were not able to identify an increased survival after surgery for MBD over time, however, we found an increased interval from diagnosis to surgery for MBD. This study suggests that revision surgery for MBD does not pose a risk for survival.

TidsskriftActa oncologica
Udgave nummer6
Sider (fra-til)839-848
Antal sider10
StatusUdgivet - jun. 2018

ID: 56462081