title: The negative prognostic impact of bone metastasis with a tumor mass.
abstract: OBJECTIVE
  Typically, bone metastasis causes osteolytic and osteoblastic lesions resulting from the interactions of tumor cells with osteoclasts and osteoblasts. In addition to these interactions, tumor tissues may grow inside bones and cause mass lesions. In the present study, we aimed to demonstrate the negative impact of a tumor mass in a large cohort of patients with bone metastatic cancer.
  
  
  METHODS
  Data from 335 patients with bone metastases were retrospectively reviewed. For the analysis, all patients were divided into three subgroups with respect to the type of bone metastasis: osteolytic, osteoblastic, or mixed. The patients were subsequently categorized as having bone metastasis with or without a tumor mass, and statistically significant differences in median survival and 2-year overall survival were observed between these patients (the median survival and 2-year overall survival were respectively 3 months and 16% in patients with a tumor mass and 11 months and 26% in patients without a tumor mass; p<0.001).
  
  
  RESULTS
  According to multivariate analysis, the presence of bone metastasis with a tumor mass was found to be an independent prognostic factor (p=0.011, hazard ratio: 1.62, 95% confidence interval: 1.11-1.76). Bone metastasis with a tumor mass was more strongly associated with osteolytic lesions, other primary diseases (except for primary breast and prostate cancers), and spinal cord compression.
  
  
  CONCLUSIONS
  Bone metastasis with a tumor mass is a strong and independent negative prognostic factor for survival in cancer patients.
authors.affiliation: Department of Radiation Oncology, Sivas, Turkey.
authors.forename: Birsen
authors.initials: B
authors.lastname: Yücel
authors.affiliation: Department of Radiation Oncology, Sivas, Turkey.
authors.forename: Mustafa Gürol
authors.initials: MG
authors.lastname: Celasun
authors.affiliation: Department of Radiology, Sivas, Turkey.
authors.forename: Bilge
authors.initials: B
authors.lastname: Öztoprak
authors.affiliation: Department of Nuclear Medicine, Sivas, Turkey.
authors.forename: Zekiye
authors.initials: Z
authors.lastname: Hasbek
authors.affiliation: Department of Radiation Oncology, Sivas, Turkey.
authors.forename: Seher
authors.initials: S
authors.lastname: Bahar
authors.affiliation: Department of Medical Oncology, Sivas, Turkey.
authors.forename: Turgut
authors.initials: T
authors.lastname: Kaçan
authors.affiliation: Department of Medical Oncology, Sivas, Turkey.
authors.forename: Aykut
authors.initials: A
authors.lastname: Bahçeci
authors.affiliation: Department of Medical Oncology, Sivas, Turkey.
authors.forename: Mehmet Metin
authors.initials: MM
authors.lastname: Şeker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010006:Osteoblasts / Q000473:pathology; D010010:Osteoclasts / Q000473:pathology; D011379:Prognosis; D012016:Reference Values; D013117:Spinal Cord Compression / Q000209:etiology; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult