Background/Objectives: Metastatic bone disease (MBD) poses an increasing challenge in orthopaedic oncology due to prolonged survival. While clinical prognostic factors are well established, the role of socio-economic determinants remains unclear, particularly within universal healthcare systems. Methods: We retrospectively analysed 243 patients who underwent surgery for MBD (excluding spine) between 2005 and 2024 at a German sarcoma centre. Socio-economic indicators were derived from national databases and linked to patients’ residential districts. Survival was analysed using Kaplan–Meier estimates and Cox regression, adjusting for clinical confounders. Results: Median postoperative survival was 22 months. Several socio-economic indicators—income, education, and employment—were associated with survival in univariate analysis. In multivariate models, only residential area size remained independently significant (p= 0.047). Patients from villages (<2000 inhabitants) and large cities (>100,000) had poorer survival than those from small or medium-sized towns. This effect persisted after adjustment for tumour type, pathological fractures, and year of surgery. Conclusions: Within a universal healthcare system, residential area size was associated with survival after surgery for MBD, suggesting that regional disparities may persist despite equal formal access to care. Further studies integrating individual-level socioeconomic data are needed to identify mechanisms and guide interventions to reduce geographic inequalities.
背景/目的：随着患者生存期延长，转移性骨病（MBD）在骨肿瘤科领域构成日益严峻的挑战。虽然临床预后因素已较为明确，但社会经济决定因素的作用仍不清楚，尤其在全民医保体系内。方法：我们回顾性分析了2005年至2024年间在德国某肉瘤中心接受MBD手术（脊柱除外）的243例患者。社会经济指标来源于国家数据库，并与患者居住区域进行关联。采用Kaplan-Meier估计和Cox回归分析生存情况，并对临床混杂因素进行校正。结果：术后中位生存期为22个月。单因素分析显示收入、教育水平和就业状况等多项社会经济指标与生存期相关。在多变量模型中，仅居住区域规模保持独立显著性（p=0.047）。来自村庄（<2000居民）与大都市（>10万居民）的患者，其生存期较中小城镇患者更差。该效应在校正肿瘤类型、病理性骨折及手术年份后依然存在。结论：在全民医保体系内，居住区域规模与MBD术后生存期相关，这表明即使享有平等的正式医疗准入，地区差异仍可能持续存在。需要整合个体层面社会经济数据的进一步研究，以明确作用机制并指导干预措施，从而减少地域不平等。
肿瘤(癌症)患者之家