Impact of pathological fracture on outcomes after surgery for metastatic femoral bone tumors: A multi-institutional study by the Tokai Musculoskeletal Tumor Consortium.

INTRODUCTION The prognostic impact of pathological fractures in patients undergoing surgery for metastatic femoral bone tumors remains controversial.

Materials And Methods

We retrospectively analyzed 176 patients (187 femurs) who underwent surgical management for metastatic femoral bone tumors at institutions affiliated with the Tokai Musculoskeletal Tumor Consortium. Overall survival (OS) was evaluated on a per-patient basis, whereas pathological fracture status and surgical procedures were assessed on a per-femur basis. Postoperative ambulatory function was examined as a measure of functional outcome. Multivariate Cox proportional hazards regression analysis identified independent prognostic factors. Subgroup analyses were performed in poor-prognosis cohorts, including patients treated with internal fixation and those with a modified Katagiri score ≥ 7.

Results

The OS rates at 1 and 2 years postoperatively were 71.0% and 58.1%, respectively. Multivariate analysis identified age ≥ 65 years (p = 0.015), presence of visceral metastasis (p < 0.001), abnormal laboratory findings (p = 0.006), and postoperative decline in ambulatory function (p = 0.015) as independent predictors of poorer survival. Pathological fracture was not significantly associated with OS on univariate analysis (p = 0.66), including in subgroups of patients who underwent internal fixation and those with a modified Katagiri score ≥ 7. Although surgery after a pathological fracture showed a trend toward postoperative functional decline, this association did not reach statistical significance (p = 0.09).

Conclusions

Among patients with a relatively favorable prognosis undergoing surgery for metastatic femoral bone tumors, pathological fracture may indirectly affect outcomes through postoperative functional deterioration rather than directly affecting survival.