Surgery for a Pathologic Fracture | Prognostic Factors for Survival

 

Patient selection: Patient with cancer causing a pathologic fracture requiring orthopedic surgery

 

Parameters associated with a median survival of <= 7 months:

(1) primary site of the cancer

(2) ECOG performance scale

(3) number of bone metastases

(4) visceral metastases

(5) hemoglobin

Parameter	Finding	Points
primary site of the cancer	breast, renal or prostate	0
	lung	1
	other	1
ECOG performance scale	0, 1 or 2	0
	3 or 4	1
number of bone metastases	1	0
	>= 2 (multiple)	1
visceral metastases	none	0
	present	1
hemoglobin	> 10 g/dL	0
	<= 10 g/dL	1

 

where:

• A patient with a pathologic fracture has to have at least 1 bone metastasis.

• The hemoglobin is based on the untransfused status.

 

number of risk factors for a short survival =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 5

• A patient with a low hemoglobin or lung cancer may have a median survival < 4 months.

• A survival <= 3 months was short, 3.01 to <= 9 intermediate, and > 9 months long.