Background:Long bone metastases are common in patients with metastatic renal cell carcinoma (RCC). One potential surgical treatment option is resection and megaprosthetic reconstruction. However, implant complications and survival are poorly understood. This study analyzes patient and implant survival as well as associated risk factors.Methods:This is a retrospective study from a single academic center, analyzing 86 patients that underwent resection and megaprosthetic reconstruction performed between 1993 and 2017. The most common location of megaprosthetic reconstruction was the proximal femur (PFR) in 38% (33 of 86) of patients. We calculated overall patient survival and associated risk factors using the Kaplan–Meier method and implant survivorship using a competing risk analysis.Results:A total of 73% (63/86) of patients died of their disease after a median of 19 (IQR 9–37) months following surgery, and a median of 71 (IQR 31–132) months after the initial diagnosis of RCC. The overall survival probability was 29% (95% CI 18–40%) five years after surgery. The five-year risk of revision surgery (within a competing risk framework) was 18% (95% CI 11–28). A total of 8% (7 of 86) of patients underwent an exchange of the implant itself. Patients with total bone replacements had a higher revision risk (SHR 19.46 (95% CI 6.9–54.9),p< 0.01). Furthermore, the revision risk was higher with increasing reconstruction length per mm (SHR 1.01 (95% CI 1.01–1.02),p= 0.03) and prolonged surgical time per minute (SHR: 1.01 (95% CI 1.0–1.02),p< 0.01). Local postoperative radiation treatment (RTX) was associated with an increased risk for revisions (SHR 2.59 (95% CI 0.96–6.95),p= 0.06).Conclusions:Modular megaprostheses demonstrated a fairly low risk of implant revision although postoperative radiation therapy and total bone replacements are associated with an increased risk.
背景：长骨转移在转移性肾细胞癌患者中较为常见。一种潜在的手术治疗方案是切除联合巨型假体重建术。然而，目前对植入物并发症及生存率的了解尚不充分。本研究旨在分析患者及植入物的生存情况及其相关风险因素。 方法：本研究为单中心回顾性研究，分析了1993年至2017年间接受切除联合巨型假体重建术的86例患者。巨型假体重建最常见的部位是股骨近端，占患者的38%（86例中的33例）。我们采用Kaplan-Meier法计算患者总体生存率及相关风险因素，并运用竞争风险分析法评估植入物生存率。 结果：术后中位19个月（四分位距9-37个月），以及肾细胞癌初次诊断后中位71个月（四分位距31-132个月），共有73%（63/86）的患者死于本病。术后五年总体生存概率为29%（95%置信区间18-40%）。在竞争风险框架内，术后五年翻修手术风险为18%（95%置信区间11-28）。共有8%（86例中的7例）患者接受了植入物置换。接受全骨置换的患者翻修风险更高（亚分布风险比19.46，95%置信区间6.9-54.9，p<0.01）。此外，重建长度每增加1毫米（亚分布风险比1.01，95%置信区间1.01-1.02，p=0.03）和手术时间每延长1分钟（亚分布风险比1.01，95%置信区间1.0-1.02，p<0.01）均与翻修风险增加相关。术后局部放射治疗与翻修风险增加相关（亚分布风险比2.59，95%置信区间0.96-6.95，p=0.06）。 结论：模块化巨型假体显示出较低的植入物翻修风险，但术后放射治疗和全骨置换与风险增加相关。
肿瘤(癌症)患者之家