Surgery of skeletal metastases in 306 patients with prostate cancer.
OBJECTIVE
Skeletal metastases are common in patients with prostate cancer, and they can be a source of considerable morbidity. We analyzed patient survival after surgery for skeletal metastases and identified risk factors for reoperation and complications.


METHODS
This study included 306 patients with prostate cancer operated for skeletal metastases during 1989-2010. Kaplan-Meier analysis was used to calculate survival. Cox multiple regression analysis was performed to study risk factors, and results were expressed as hazard ratios (HRs).


RESULTS
The median age at surgery was 72 (49-94) years. The median survival after surgery was 0.5 (0-16) years. The cumulative 1-, 2-, and 3-year survival after surgery was 29% (95% CI: 24-34), 14% (10-18), and 8% (5-11). Age over 70 years (HR 1.4), generalized metastases (HR 2.4), and multiple skeletal metastases (HR 2.3) resulted in an increased risk of death after surgery. Patients with lesions in the humerus (HR 0.6) had a lower death rate. The reoperation rate was 9% (n = 31). The reasons for reoperation were deep wound infection (n = 10), hematoma (n = 7), material (implant) failure (n = 3), wound dehiscence (n = 3), increasing neurological symptoms (n = 2), prosthetic dislocation (n = 2), and others (n = 4).


CONCLUSIONS
This study involves the largest reported cohort of patients operated for skeletal lesions from prostate cancer. Our survival data and analysis of predictors for survival help to set appropriate expectations for the patients, families, and medical staff.
Department of Molecular Medicine and Surgery, Section of Orthopaedics and Sports Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. rudiger.weiss@karolinska.se
Rüdiger J
RJ
Weiss
Jonathan A
JA
Forsberg
Rikard
R
Wedin
D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology*; D012086:Reoperation; D012307:Risk Factors; D016138:Walking