What Predicts a Subsequent Skeletal-related Event, and How Do Factors Associated With Mortality Differ After an...

Area of Science:

• Oncology
• Orthopedics
• Radiology

Background:

• Metastatic bone disease poses significant challenges due to debilitating symptoms and poor prognosis.
• Improved treatments lead to longer survival, increasing the risk of prolonged skeletal-related events.
• Prognostic factors for initial skeletal-related events may not apply to subsequent events.

Purpose of the Study:

• Identify factors associated with a higher risk of subsequent skeletal-related events, considering death as a competing risk.
• Compare factors associated with mortality between patients with initial and subsequent skeletal-related events.

Main Methods:

• Retrospective study of 3814 adult patients treated for bone metastasis between 2010-2018.
• Utilized a comprehensive institutional medical database for longitudinal data integration.
• Applied competing risk and Cox proportional hazards models to analyze factors.

Main Results:

• Independent risk factors for subsequent skeletal-related events include older age, male sex, aggressive tumor types, elevated alkaline phosphatase, and brain metastases.
• 83% of mortality-associated factors showed similar associations in both initial and subsequent event groups.
• Factors like elevated international normalized ratio had a stronger association with mortality in the subsequent event group.

Conclusions:

• Older age, male sex, aggressive tumors, elevated alkaline phosphatase, and brain metastases are associated with increased risk of subsequent skeletal-related events.
• Recommend intensified surveillance and early detection strategies for at-risk patients.
• Findings can inform the development of predictive models for better clinical management.