Clinical efficacy and prognostic factors analysis of surgical treatment for patients with limb bone metastasis of lung cancer

LIU Xiaoqiong; WANG Yichun; SHE Diankun; ZHAHG Yuhang; ZHOU Guangxin; WANG Rui

doi:10.3969/j.issn.1009-0460.2025.07.013

Abstract：Objective To investigate the clinical efficacy and prognostic factors of surgical treatment for patients with limb bone metastasis of lung cancer.Methods Retrospective analysis was conducted on data from 45 lung cancer patients with limb bone metastasis who were treated in the Oncology Department of Jinling Hospital affiliated to Nanjing University School of Medicine and subsequently underwent surgical treatment in the Orthopedics Dpeartment from January 2016 to December 2023.Among the patients,there were 25 males(55.6%)and 20 females(44.4%);The pathological types were mainly adenocarcinoma(35 cases,77.8%)and squamous cell carcinoma(10 cases,22.2%).The sites of bone metastasis included 31 cases(68.9%)of femur and 14 cases(31.1%)of humerus,among which 21 cases(46.7%)had pathological fractures(10 cases of femur and 11 cases of humerus).The main surgical methods were tumor scraping combined with bone cement filling intramedullary nail/steel plate reconstruction(33 cases,73.3%)and tumor resection and tumor-type prosthesis replacement(12 cases,26.7%).The surgical complications were recorded,and functional status before and after surgery were assessed using the visual analogue scale(VAS),Enneking functional score,and Karnofsky performance status(KPS).Survival analysis was performed using the Kaplan-Meier method to plot survival curves.Prognostic factors were preliminarily screened through univariate analysis(P<0.2),and the identified factors were subsequently incorporated into a Cox proportional hazards regression model for multivariate analysis.Results The postoperative VAS scores[expressed as median(25th percentile,75th percentile)]of the patients were significantly lower than the preoperative scores[7(6,8)vs.2(2,3),P<0.001].At 3 months postoperatively,both the Enneking functional scores[9(6.5,13.5)vs.25(22,26)]and KPS scores[40(30,40)vs.70(60,70)]showed significant improvement(all P<0.001).Tumor-type prosthesis replacement demonstrated a greater improvement in VAS scores compared to intramedullary nail/plate reconstruction with bone cement filling[6(5,7)vs.4(3,6),P=0.002],while no statistically significant differences were observed in the improvement of Enneking functional scores(15.34±3.99 vs.12.85±4.72,P=0.085)or KPS scores(28.79±12.44 vs.32.5±6.22,P=0.330)between the two surgical approaches.The median follow-up time was 12(5-76)months,with 6-month,1-year,and 2-year survival rates of 95.6%,51.1%,and 19.1%,respectively.Multivariate analysis revealed that having more than one bone metastasis was an independent risk factor affecting prognosis(OR=9.930,95%CI:2.295-42.962,P=0.002).The postoperative complication rate was 11.1%(5/45),including delayed wound healing(2 cases),deep vein thrombosis(2 cases),and internal fixation fracture(1 case),all of which were alleviated after targeted treatment.Conclusion Surgical treatment for limb bone metastases from lung cancer can effectively relieve pain,improve limb function,and enhance patients'quality of life and postoperative complications are manageable.The number of bone metastases is identified as an independent risk factor influencing surgical outcomes,underscoring that prophylactic intervention and early diagnosis remain critical to improve prognosis in patients with limb bone metastasis from lung cancer.