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Risk Factors for Postoperative Deep Infection After Malignant Bone Tumor Surgery of the Extremities.
四肢恶性骨肿瘤术后深部感染的危险因素。
- 影响因子:1.90
- DOI:10.21873/anticanres.14344
- 作者列表:"Langit MB","Miwa S","Yamamoto N","Hayashi K","Takeuchi A","Igarashi K","Tada K","Higuchi T","Yonezawa H","Morinaga S","Araki Y","Asano Y","Tsuchiya H
- 发表时间:2020-06-01
Abstract
BACKGROUND/AIM:Previous studies have identified pelvic tumors as a risk factor for surgical site infections (SSI). However, risk factors for extremity tumors are still unclear. This study investigated risk factors for postoperative deep infection in malignant bone tumors of the extremities. PATIENTS AND METHODS:Data from 238 patients with 256 malignant bone tumor surgeries were reviewed. Univariate analysis and multiple logistic regression determined risk factors for deep infection. RESULTS:Deep infection was found in 23 of 256 cases (9.0%). Tibial tumor (OR=6.04; 95%CI=2.14-17.05; p<0.001) and operative time ≥5 hours (OR=3.25; 95%CI=1.15-9.23; p=0.027) were independent risk factors for deep infection. CONCLUSION:Tibial tumor and operative time ≥5 hours are independent risk factors for deep infection after surgery of malignant bone tumor of extremities. Strategies to minimize risk of infection in the tibia and decreasing operative time should be implemented, along with other measures to decrease SSI.
摘要
背景/目的: 以前的研究已经确定盆腔肿瘤是手术部位感染 (SSI) 的危险因素。然而,四肢肿瘤的危险因素仍不清楚。本研究探讨四肢恶性骨肿瘤术后深部感染的危险因素。 患者与方法: 回顾性分析 238 例恶性骨肿瘤患者 256 例的临床资料。单因素分析和多因素logistic回归确定深部感染的危险因素。 结果: 256 例中深部感染 23 例 (9.0%)。胫骨肿瘤 (OR = 6.04; 95% CI = 2.14-17.05; p<0.001) 和手术时间 ≥ 5 小时 (OR = 3.25; 95% CI = 1.15-9.23; p = 0.027) 是深部感染的独立危险因素。 结论: 胫骨肿瘤和手术时间 ≥ 5 h是四肢恶性骨肿瘤术后深部感染的独立危险因素。应实施尽量减少胫骨感染风险和减少手术时间的策略,同时采取其他措施降低SSI。
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METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.
骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。