Development of a score that predicts survival among patients with bone metastasis revealing solid tumor

Bone metastases revealing solid tumors require a multidisciplinary treatment that may include aggressive surgery. Nevertheless, decision making is very difficult because of lack of reliable guidance for life expectancy. Therefore, we had conducted a retrospective study to analyze prognostic factors in this vulnerable population.

We reviewed the medical charts of 119 consecutive patients with solid tumors treated between August 1999 and December 2007. Survival was estimated using Kaplan-Meier method. Prognostic factors were assessed with Log-rank test and Cox model. There were 77 men and 42 women.

The median age was 57 (range, 29-84). The most frequent primaries were lung (51 cases), unknown primary (42 cases), and breast (six cases). The median overall survival was 118 days (1-2,815). Six independent prognostic factors were identified by multivariate analysis: Karnosky index < 80% (HR = 1.92), albuminemia < 38 g/l (HR = 2.60), natremia < 135 mEq/l (HR = 2.78), platelet count > 500,000/mm(3) (HR = 2.71), cutaneous metastasis (HR = 4.6), and pleural metastasis (HR = 4.76). For example, patients with < or =2 of these prognostic factors experienced a median overall survival of 196 days (1-2,875) and their risk of death within the 90 days was 15/77. On the contrary, the patients with more than two poor prognostic factors experienced a median overall survival of about 80 days (1-834) and their risk of early death was 22/32. We had proposed an easily obtained at bedside score that needs further validation on independent cohort.