Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis

• Published in: Journal of orthopaedic surgery and research Vol. 20; no. 1; pp. 706 - 11
• Main Authors: Chen, Chih-Wei, Su, Chih-Chi, Chen, Jyun-Hao, Wang, Jaw-Lin, Tseng, Tzu-Hao, Groot, Olivier Q.
• Format: Journal Article
• Language: English
• Published: London BioMed Central 26.07.2025; BioMed Central Ltd; BMC
• Subjects: Adult; Aged; Bone Neoplasms - mortality; Bone Neoplasms - secondary; Bone Neoplasms - surgery; Bone Neoplasms - therapy; Care and treatment; Cohort Studies; Comorbidity; Diseases; Female; Follow-Up Studies; Humans; Lower Extremity - pathology; Male; Medical centers; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Metastases of lower extremities; Metastases of upper extremities; Metastasis; Metastatic bone disease; Middle Aged; Orthopedics; Retrospective Studies; Surgical Orthopedics; Survival; Survival Rate - trends; Taiwan - epidemiology; Treatment Outcome; Upper Extremity - pathology; Taiwan; Metastatic bone disease; Metastases of lower extremities; Survival; Metastases of upper extremities
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-025-06079-2

Background The rising prevalence of metastatic bone disease (MBDex) of the extremities substantially affects patient quality of life due to skeletal-related events. Determining whether surgical intervention benefits patient survival is crucial in the management of MBDex. However, there is currently limited evidence regarding the survival impact of upper versus lower extremity involvement. This study aims to evaluate differences in survival outcomes regarding metastatic site, and the impact of operative versus nonoperative management. Methods This retrospective cohort study evaluated 1,719 patients with a two-year follow-up period after treatment for MBDex at a major tertiary medical center in Taiwan from 2010 to 2018. Inclusion criteria included patients aged over 20 who underwent operative or nonoperative management. Exclusion criteria involved patients with concurrent upper and lower extremity metastases. Kaplan–Meier curves and multivariate Cox regression models were used to analyze survival and prognostic factors. Results Compared to upper MBDex, lower MBDex patients have poorer pretreatment Eastern Cooperative Oncology Group (ECOG) performance status. Lower MBDex was associated with worse two-year survival, particularly among those receiving nonoperative management. Common prognostic factors included ECOG performance status, Charlson’s comorbidities, primary tumor type, and albumin levels, while previous systemic treatment and the presence of visceral and brain metastases were specifically detrimental in lower MBDex. Conclusions Lower MBDex is associated with poorer survival outcomes. Operative management is associated with survival benefit in lower MBDex, a benefit not as pronounced in upper MBDex. These findings highlight the importance of differentiating between upper and lower extremity metastases in survival analyses and prediction.