Clinical Determinants of Survival after Pathological Fracture in Metastatic Bone Disease
23rd General Meeting of the International Society of Limb Salvage (ISOLS) , Vienna, Avusturya, 23 - 26 Eylül 2026, ss.1, (Özet Bildiri)
- Yayın Türü: Bildiri / Özet Bildiri
- Basıldığı Şehir: Vienna
- Basıldığı Ülke: Avusturya
- Sayfa Sayıları: ss.1
- Ondokuz Mayıs Üniversitesi Adresli: Evet
Özet
Clinical Determinants of Survival after Pathological Fracture in Metastatic Bone Disease Furkan Erdoğan1, Tolgahan Cengiz1, İsmail Buyukceran1, Yakup Sancar Baris2, Ebru Kelsaka3, Nevzat Dabak1 1Ondokuz Mayis University, Department of Orthopedics and Traumatology, Samsun, Turkey, 2Ondokuz Mayis University, Department of Pathology, Samsun, Turkey, 3Ondokuz Mayis University, Department of Anesthesiology and Reanimation, Samsun, Turkey Introduction: Pathological fracture in metastatic bone disease (MBD) represents a pivotal clinical event that often mandates surgery. Because the extent of reconstruction should match expected survival, identifying robust post-fracture prognostic determinants—particularly for early mortality—is essential for surgical decision-making. We aimed to quantify survival and early mortality after surgery for appendicular pathological fractures due to MBD and to evaluate associated clinical and tumor-related factors. Methods: We retrospectively reviewed 140 consecutive patients who underwent surgery for appendicular pathological fractures secondary to MBD at a single tertiary center (2004–2022). Overall survival (OS) was calculated from fracture date to death/last follow-up. Early mortality was assessed at 30 and 90 days. Covariates included primary tumor type, metastatic burden (oligometastatic ≤5 vs polymetastatic >5 metastatic foci), time from primary cancer diagnosis to fracture (≤5 vs >5 months), visceral metastasis, and ECOG performance status. Survival was analyzed using Kaplan–Meier and log-rank tests; independent predictors were evaluated with multivariable Cox regression. Early mortality was assessed by logistic regression. To examine late outcomes beyond early postoperative risk, a 90-day landmark Cox analysis was performed among patients surviving ≥90 days. Results: During follow-up, 134/140 patients (95.7%) died. Median OS after fracture was 5.4 months (95% CI 4.42–5.58), with 12- and 24-month survival rates of 33% and 15%, respectively. In multivariable Cox analysis, polymetastatic disease was associated with increased mortality (HR 1.73, 95% CI 1.13–2.65; p=0.011), whereas a diagnosis-to-fracture interval >5 months was associated with reduced mortality (HR 0.62, 95% CI 0.40–0.96; p=0.034). Primary tumor type remained independently significant (overall p=0.001). Thirty- and ninety-day mortality rates were 2.9% (4/140) and 21.4% (30/140). In the 90-day landmark analysis, polymetastatic disease continued to predict higher late mortality (HR 1.85; p=0.016), while diagnosis-to-fracture >5 months predicted lower late mortality (HR 0.53; p=0.013). Conclusion: Survival after surgical treatment of appendicular pathological fractures in MBD is limited. Polymetastatic burden consistently predicts worse early and late outcomes, while longer diagnosis-to-fracture interval is associated with improved survival. Primary tumor type is a key determinant and should be integrated into individualized surgical planning and perioperative risk stratification. Keywords: Metastatic bone disease, Pathological fracture, survival prediction.