title: Incidence and outcome of bone metastatic disease at University Malaya Medical Centre.
abstract: BACKGROUND
  Morbidity and mortality from malignant diseases are usually the result of metastasis. The bone is the third most common site of metastasis.
  
  
  METHODS
  This is a retrospective study of patients with metastatic bone disease who were referred to the Orthopaedic Department of University Malaya Medical Centre, Malaysia, between January 2004 and October 2009.
  
  
  RESULTS
  A total of 151 patients (51.0% men, 49.0% women) had metastatic bone disease, with the highest incidence at the age range of 50-59 years. The commonest primary cancer was breast (23.3%), followed by lung (21.2%), prostate (9.3%), thyroid (7.3%) and renal cell carcinoma (5.3%); unknown primary cancer was 6.6%. There was long bone involvement in 52.7% of cases, axial bone in 44.5%, and both long and axial bones in 2.8%. The majority (90.1%) were symptomatic, with pain as the commonest symptom. 106 (70.2%) patients had pathological fractures. Neurological deficit was reported in 90.7% of patients, with 41.1% having extraskeletal metastases. 67.8% of the lesions were osteolytic, 24.3% were sclerotic, and 7.9%, mixed. Palliative and therapeutic interventions were undertaken for 62.0% of patients. The mean survival times were: breast 21.0; thyroid 20.7; prostate 20.3; lung 16.0; and unknown primary cancer 32.6 months.
  
  
  CONCLUSIONS
  In our study, breast and lung cancers were the commonest primary cancers in metastatic bone disease. Most patients had more than one site of involvement, pain at presentation and pathological fractures. Surgery is beneficial to relieve pain and improve function and neurology. Duration of survival depends on the type of primary cancer and whether systemic metastasis is present.
authors: NOCERAL, Department of Orthopaedics, University Malaya Medical Centre, Kuala Lumpur 50603, Malaysia. drvivek69@gmail.com.
authors: Vivek Ajit
authors: VA
authors: Singh
authors: Amber
authors: A
authors: Haseeb
authors: Alla Allden H Ali
authors: AA
authors: Alkubaisi
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001859:Bone Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000473:pathology; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
references: Acta Orthop Scand. 2000 Dec;71(6):585-90
references: 11145385
references: J Clin Oncol. 2009 Sep 10;27(26):4247-53
references: 19667264
references: Cancer Treat Rev. 2001 Jun;27(3):165-76
references: 11417967
references: Paraplegia. 1969 Nov;7(3):179-92
references: 5360915
references: Ann Neurol. 1977 Nov;2(5):409-13
references: 365073
references: Cancer Res. 1979 May;39(5):1552-62
references: 427797
references: Curr Probl Cancer. 1979 Nov;4(5):4-37
references: 391494
references: Spine (Phila Pa 1976). 1985 Jan-Feb;10(1):19-20
references: 3983700
references: Instr Course Lect. 1986;35:357-81
references: 3819423
references: J Clin Oncol. 1989 Oct;7(10):1485-91
references: 2778479
references: Clin Orthop Relat Res. 1989 Dec;(249):256-64
references: 2684463
references: J Clin Oncol. 1991 Mar;9(3):509-24
references: 1705581
references: Pain. 1991 Apr;45(1):45-8
references: 1861877
references: Breast Cancer Res Treat. 1992;21(3):173-80
references: 1515652
references: J Clin Oncol. 1993 Jan;11(1):59-65
references: 8418243
references: Spine (Phila Pa 1976). 1996 Sep 15;21(18):2143-8
references: 8893440
references: Pain. 1997 Jan;69(1-2):1-18
references: 9060007
references: Eur J Cancer. 1998 May;34(6):820-4
references: 9797692
references: Curr Opin Oncol. 1998 Aug;10 Suppl 1:S7-13
references: 9801853
references: J Bone Joint Surg Br. 1999 Jan;81(1):1-2
references: 10067992
references: Cancer Treat Rev. 1998 Dec;24(6):425-32
references: 10189409
references: Thyroid. 2000 Mar;10(3):261-8
references: 10779141
references: Lancet. 1999 May 15;353(9165):1695-700
references: 10335806
references: J Natl Cancer Inst. 2005 Jan 5;97(1):59-69
references: 15632381
references: Semin Neurol. 2004 Dec;24(4):375-83
references: 15637649
references: World J Urol. 2005 Feb;23(1):14-8
references: 15666171
references: Crit Rev Oncol Hematol. 2005 Jun;54(3):243-50
references: 15890271
references: Crit Rev Oncol Hematol. 2005 Dec;56(3):365-78
references: 15978828
references: Clin Oncol (R Coll Radiol). 2006 Feb;18(1):67-9
references: 16477922
references: Clin Cancer Res. 2006 Oct 15;12(20 Pt 2):6243s-6249s
references: 17062708
references: Eur Urol. 2007 Jul;52(1):163-8
references: 17098353
references: Lung Cancer. 2007 Aug;57(2):229-32
references: 17451841
references: Singapore Med J. 2008 Nov;49(11):904-11
references: 19037557
references: Spine (Phila Pa 1976). 2001 Feb 1;26(3):298-306
references: 11224867