[Clinical features of pathologically confirmed metastatic bone tumors--a report of 390 cases]

With the development of diagnostic techniques of imaging and pathology, early diagnosis of metastatic bone tumors has been greatly improved, but the clinical characteristics which are essential for diagnosis are rarely reported. In this article, the clinical features of pathologically confirmed metastatic bone tumors were analyzed for further improvement of early diagnosis and treatment.

Clinical data of 390 patients with pathologically confirmed metastatic bone tumors, treated from 1980 to 2003 at The First Affiliated Hospital of Sun Yat-sen University, were reviewed respectively to summarize the clinical features, including disease history, predilection sites, clinical manifestation, and imaging presentations.

Of the 390 patients, the ratio of men to women was 2.12:1; the median age was 55.7 years, and 81.5% of the patients were over 41 years old. The primary tumors were lung cancer (21.8%), prostate cancer (13.1%), breast cancer (7.4%), liver cancer (6.4%), gastrointestinal cancer (5.7%), and unknown cancers (24.6%). The common metastatic sites were spine (47.7%), pelvis (18.2%), femur (15.4%), and rib (12.6%). Multiple metastases occurred in 20.5% of the patients. The main symptoms were skeletal pain (53.3%), pathologic fractures (10.3%), dysfunction (4.9%), and paraplegia (2.1%). Primary tumor detected before metastasis accounted for 29.7% of the patients with a median metastatic time of 319 days, and the metastatic intervals were uncertain in 70.3% of the patients. Osteolytic types accounted for 80.7% of the cases in radiographic patterns, followed by osteosclerotic (10.5%) and mixed types.

Metastatic bone tumors most frequently occur in patients older than 41 years, and commonly originate from lung, prostate, breast, and liver. Vertebrae, pelvis, femur, and rib are the most common sites of metastases. The clinical manifestation is extensive and nonspecific. Most lesions present osteolytic patterns. Metastases with unknown origin account for 24%. In spite of complexity, the clinical features should be mastered for early diagnosis and treatment.