European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2026
Impact of pathological fracture on outcomes after surgery for metastatic femoral bone tumors: A multi-institutional study by the Tokai Musculoskeletal Tumor Consortium.
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Sakai Tomohisa, Ikuta Kunihiro, Shimoyama Tetsuo, Hagi Tomohito, Aiba Hisaki, Nagano Akihito, Tanaka Takaaki, Wasa Junji, Shido Yoji, Hosono Kozo, Kozawa Eiji, Kawanami Katsuhisa, Imagama Shiro, Nishida Yoshihiro
Аннотация
INTRODUCTION: The prognostic impact of pathological fractures in patients undergoing surgery for metastatic femoral bone tumors remains controversial.
MATERIALS AND METHODS: We retrospectively analyzed 176 patients (187 femurs) who underwent surgical management for metastatic femoral bone tumors at institutions affiliated with the Tokai Musculoskeletal Tumor Consortium. Overall survival (OS) was evaluated on a per-patient basis, whereas pathological fracture status and surgical procedures were assessed on a per-femur basis. Postoperative ambulatory function was examined as a measure of functional outcome. Multivariate Cox proportional hazards regression analysis identified independent prognostic factors. Subgroup analyses were performed in poor-prognosis cohorts, including patients treated with internal fixation and those with a modified Katagiri score ≥ 7.
RESULTS: The OS rates at 1 and 2 years postoperatively were 71.0% and 58.1%, respectively. Multivariate analysis identified age ≥ 65 years (p = 0.015), presence of visceral metastasis (p < 0.001), abnormal laboratory findings (p = 0.006), and postoperative decline in ambulatory function (p = 0.015) as independent predictors of poorer survival. Pathological fracture was not significantly associated with OS on univariate analysis (p = 0.66), including in subgroups of patients who underwent internal fixation and those with a modified Katagiri score ≥ 7. Although surgery after a pathological fracture showed a trend toward postoperative functional decline, this association did not reach statistical significance (p = 0.09).
CONCLUSIONS: Among patients with a relatively favorable prognosis undergoing surgery for metastatic femoral bone tumors, pathological fracture may indirectly affect outcomes through postoperative functional deterioration rather than directly affecting survival.
MATERIALS AND METHODS: We retrospectively analyzed 176 patients (187 femurs) who underwent surgical management for metastatic femoral bone tumors at institutions affiliated with the Tokai Musculoskeletal Tumor Consortium. Overall survival (OS) was evaluated on a per-patient basis, whereas pathological fracture status and surgical procedures were assessed on a per-femur basis. Postoperative ambulatory function was examined as a measure of functional outcome. Multivariate Cox proportional hazards regression analysis identified independent prognostic factors. Subgroup analyses were performed in poor-prognosis cohorts, including patients treated with internal fixation and those with a modified Katagiri score ≥ 7.
RESULTS: The OS rates at 1 and 2 years postoperatively were 71.0% and 58.1%, respectively. Multivariate analysis identified age ≥ 65 years (p = 0.015), presence of visceral metastasis (p < 0.001), abnormal laboratory findings (p = 0.006), and postoperative decline in ambulatory function (p = 0.015) as independent predictors of poorer survival. Pathological fracture was not significantly associated with OS on univariate analysis (p = 0.66), including in subgroups of patients who underwent internal fixation and those with a modified Katagiri score ≥ 7. Although surgery after a pathological fracture showed a trend toward postoperative functional decline, this association did not reach statistical significance (p = 0.09).
CONCLUSIONS: Among patients with a relatively favorable prognosis undergoing surgery for metastatic femoral bone tumors, pathological fracture may indirectly affect outcomes through postoperative functional deterioration rather than directly affecting survival.