CLINICAL PROGNOSTIC FACTORS FOR SURVIVAL OF PATIENTS UNDERGOING EPR RECONSTRUCTION FOR BONE TUMOURS: DOES DEEP INFECTION IMPROVE PATIENT SURVIVAL?

Introduction Despite the advances in adjuvant chemotherapy and surgical techniques, the diagnosis of a bone tumour still carries with it a significant risk of mortality. This study investigates factors affecting survival, in patients treated for malignant tumours of bone using Endoprosthetic replacement (EPR). Methods Our tertiary referral musculoskeletal tumour unit has taken referrals over 40 years. Electronic patient records have been prospectively kept on all patients seen since 1986 and data has been entered retrospectively for patients seen between 1966 and 1986. A consecutive series of 1264 patients underwent endoprosthetic reconstruction; after 158 patients were excluded, 1106 patients were left in the study group. Factors including diagnosis, size of tumour, surgical margins, percentage tumour necrosis following chemotherapy, tumour site, local recurrence, decade of reconstruction, fracture and post-operative deep infection were analysed. Results Overall population survival was 58.4% at 5 years, 50.5% at 10 years and 44.6% at 20 years. Significant prognostic factors on cox-regression analysis included locally recurrent disease (p Patients diagnosed with a deep infection within 2.5 years from implantation had 63.2% 10 year survival, compared to 49.4% in the non infected group. When stratified by diagnosis this was significant in patients with myeloma (p=0.01) and a showed strong trend in those with osteosarcoma (p=0.1). Trends towards better survival with Staphylococcal infections (p=0.2) were not demonstrated with other organisms. Discussion and conclusion Several known prognostic factors were demonstrated for malignant bone tumours but there was evidence for increased survival after deep post-operative infection. The authors feel the results of this study and other recent evidence warrant further investigation.