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What Factors Are Associated With Early Mortality in Patients Undergoing Femur Surgery for Metastatic Lung Cancer?

Kim, June Hyuk MD; Seo, Sung Wook MD; Chung, Chae Hoon MD

Clinical Orthopaedics and Related Research®: September 2018 - Volume 476 - Issue 9 - p 1815–1822
doi: 10.1007/s11999.0000000000000101
2017 INTERNATIONAL SOCIETY OF LIMB SALVAGE PROCEEDINGS
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Background Pathologic fractures of the femur resulting from metastasis severely increase mortality in patients with nonsmall cell lung cancer (NSCLC). However, factors associated with early mortality after surgery have not been elucidated.

Questions/purposes The purpose of this study was to identify clinical and laboratory factors available to surgeons before surgery for a metastatic femur in patients with metastatic lung cancer that might be associated with mortality at 1 and 3 months.

Methods Between 2010 and 2014 we treated 126 patients for pathologic fracture of the femur caused by NSCLC. Of those, complete data sets for the parameters of interest (including clinical factors, laboratory factors, and survivorship) were available in 105 (83%). The factors we considered included sex, age, fracture location, surgical procedure, postoperative complications, blood cell counts, serum biomarkers, genetic alterations of primary cancer, chemotherapeutic agents, preoperative radiation therapy, pleural effusion, bone and internal organ metastasis, performance scores, and medical center where the treatment was performed. Multivariate logistic regression was performed to identify factors associated with mortality at 1 and 3 months.

Results Intertrochanteric location was associated with a higher risk of death (odds ratio [OR], 17.0; 95% confidence interval [CI], 2.65-109.5), lower serum albumin level was associated with an increased risk of death (OR, 0.13; 95% CI, 0.028-0.60), and availability of a suitable chemotherapeutic target agent was associated with a lower risk of death (OR, 0.28; 95% CI, 0.08-0.91) within 3 months of surgery. Undergoing reconstruction with an endoprosthesis was associated with a higher risk of death (OR, 48.3; 95% CI, 1.7-1329) and elevated serum leukocyte count (OR, 1.2; 95% CI, 1.0-1.4) and elevated alanine aminotransferase (ALT) were associated with a higher risk of death (OR, 1.1; 95% CI, 1.0-1.2) within 1 month of surgery.

Conclusions Although the risk factors for early mortality need to be validated by prospective studies, surgical options need to be reconsidered in patients with femoral metastases from NSCLS showing high ALT or leukocytosis on the preoperative blood test.

Level of Evidence Level III, prognostic study.

J. H. Kim, Orthopaedic Oncology Clinic, National Cancer Center, Goyang-Si, Korea

S. W. Seo, C. H. Chung, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

S. W. Seo Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea email: sungwseo@skku.edu

This study is partially supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education and Science Technology (2016R1E1A1A0191433; SWS).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that both institutions approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Received August 01, 2017

Received in revised form October 04, 2017

Accepted November 22, 2017

© 2018 Lippincott Williams & Wilkins LWW
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