Management of Metastatic Disease in Long Bones

Assessing the diagnostic value of oncological biomarkers for identifying primary malignancies in skeletal metastatic disease

INTRODUCTION

Distinguishing primary malignancies from metastases is the primary objective of diagnosing bone tumors of unknown etiology. For metastatic bone disease, recognizing the primary disease is pivotal to plan appropriate treatment. Despite uncertainties, oncological biomarkers are commonly utilized for early diagnostics.

METHODS

Laboratory biomarkers were retrospectively collected from electronic patient records of 193 individuals after oncologic examinations for unknown skeletal lesions during a 3-year period. Blood cell count, creatinine, PSA, Ca19-9, Ca15-3, Ca12-5, CEA, S-Prot, myeloma light chains and their ratio were assessed and analyzed statistically.

RESULTS

An elevation in biomarker values was observed across all cancer types, indicating lack of specificity. Patients with increased CEA mostly had breast (29 %, NS) or lung (24 %, p=<0.001) cancer, those with elevated Ca15-3 breast cancer (63 %, p=<0.001) or lung cancer (16 %, p = 0.042). Only 13 % of patients with increased Ca12-5 exhibited gynecological carcinomas (p = 0.025), and 36 % of those with increased Ca19-9 levels had gastrointestinal cancer (p = 0.012). In multivariate analysis, Ca12-5 alone reached significance in lung cancer (p = 0.008). PSA was elevated in patients with prostate cancer (p = 0.015), but only 74 % of those with increased PSA had prostate cancer. The markers S-Prot (p=<0.001) and light chain ratio (p = 0.004) signified myeloma. However, increased values were found among all disease groups, including those with benign lesions.

CONCLUSIONS

Carcinoma biomarkers (CEA, Ca12-5, Ca19-9, and Ca15-3) lack specificity, and are not helpful in association with skeletal metastases. PSA and myeloma variables may be useful in selected cases but should be restricted to cases where prostate cancer or multiple myeloma is suspected.

Fixation Principles for Pathologic Fractures in Metasatic Disease

The management of pathologic fractures differs from nonpathologic fractures with respect to preoperative evaluation, surgical strategies, adjuvant therapies, and complication rates. These issues must be understood to provide appropriate musculoskeletal care for patients with metastatic disease.