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Biz C, Khamisy-Farah R, Puce L, Szarpak L, Converti M, Ceylan Hİ, Crimì A, Bragazzi NL, Ruggieri P. Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview. Biomedicines 2024; 12:974. [PMID: 38790936 PMCID: PMC11118756 DOI: 10.3390/biomedicines12050974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
In the biomedical field, the differentiation between sex and gender is crucial for enhancing the understanding of human health and personalizing medical treatments, particularly within the domain of orthopedics. This distinction, often overlooked or misunderstood, is vital for dissecting and treating musculoskeletal conditions effectively. This review delves into the sex- and gender-specific physiology of bones, cartilage, ligaments, and tendons, highlighting how hormonal differences impact the musculoskeletal system's structure and function, and exploring the physiopathology of orthopedic conditions from an epidemiological, molecular, and clinical perspective, shedding light on the discrepancies in disease manifestation across sexes. Examples such as the higher rates of deformities (adolescent idiopathic and adult degenerative scoliosis and hallux valgus) in females and osteoporosis in postmenopausal women illustrate the critical role of sex and gender in orthopedic health. Additionally, the review addresses the morbidity-mortality paradox, where women, despite appearing less healthy on frailty indexes, show lower mortality rates, highlighting the complex interplay between biological and social determinants of health. Injuries and chronic orthopedic conditions such osteoarthritis exhibit gender- and sex-specific prevalence and progression patterns, necessitating a nuanced approach to treatment that considers these differences to optimize outcomes. Moreover, the review underscores the importance of recognizing the unique needs of sexual minority and gender-diverse individuals in orthopedic care, emphasizing the impact of gender-affirming hormone therapy on aspects like bone health and perioperative risks. To foster advancements in sex- and gender-specific orthopedics, we advocate for the strategic disaggregation of data by sex and gender and the inclusion of "Sexual Orientation and Gender Identity" (SOGI) data in research and clinical practice. Such measures can enrich clinical insights, ensure tailored patient care, and promote inclusivity within orthopedic treatments, ultimately enhancing the precision and effectiveness of care for diverse patient populations. Integrating sex and gender considerations into orthopedic research and practice is paramount for addressing the complex and varied needs of patients. By embracing this comprehensive approach, orthopedic medicine can move towards more personalized, effective, and inclusive treatment strategies, thereby improving patient outcomes and advancing the field.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, 35128 Padova, Italy; (A.C.); (P.R.)
| | - Rola Khamisy-Farah
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
- Clalit Health Service, Akko 2412001, Israel
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy;
| | - Lukasz Szarpak
- Department of Clinical Research and Development, LUXMED Group, 02-676 Warsaw, Poland;
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Manlio Converti
- Department of Mental Health, Local Health Unit ASL Napoli 2 Nord, 80027 Naples, Italy;
| | - Halil İbrahim Ceylan
- Department of Physical Education of Sports Teaching, Faculty of Kazim Karabekir Education, Atatürk University, Erzurum 25030, Turkey;
| | - Alberto Crimì
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, 35128 Padova, Italy; (A.C.); (P.R.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
- Department of Food and Drugs, University of Parma, 43125 Parma, Italy
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padova, 35128 Padova, Italy; (A.C.); (P.R.)
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Zhang Y, Xiao L, LYu L, Zhang L. Construction of a predictive model for bone metastasis from first primary lung adenocarcinoma within 3 cm based on machine learning algorithm: a retrospective study. PeerJ 2024; 12:e17098. [PMID: 38495760 PMCID: PMC10944632 DOI: 10.7717/peerj.17098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024] Open
Abstract
Background Adenocarcinoma, the most prevalent histological subtype of non-small cell lung cancer, is associated with a significantly higher likelihood of bone metastasis compared to other subtypes. The presence of bone metastasis has a profound adverse impact on patient prognosis. However, to date, there is a lack of accurate bone metastasis prediction models. As a result, this study aims to employ machine learning algorithms for predicting the risk of bone metastasis in patients. Method We collected a dataset comprising 19,454 cases of solitary, primary lung adenocarcinoma with pulmonary nodules measuring less than 3 cm. These cases were diagnosed between 2010 and 2015 and were sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Utilizing clinical feature indicators, we developed predictive models using seven machine learning algorithms, namely extreme gradient boosting (XGBoost), logistic regression (LR), light gradient boosting machine (LightGBM), Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GNB), multilayer perceptron (MLP) and support vector machine (SVM). Results The results demonstrated that XGBoost exhibited superior performance among the four algorithms (training set: AUC: 0.913; test set: AUC: 0.853). Furthermore, for convenient application, we created an online scoring system accessible at the following URL: https://www.xsmartanalysis.com/model/predict/?mid=731symbol=7Fr16wX56AR9Mk233917, which is based on the highest performing model. Conclusion XGBoost proves to be an effective algorithm for predicting the occurrence of bone metastasis in patients with solitary, primary lung adenocarcinoma featuring pulmonary nodules below 3 cm in size. Moreover, its robust clinical applicability enhances its potential utility.
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Affiliation(s)
- Yu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Lixia Xiao
- Department of Thoracic Surgery, Feicheng Hospital Affiliated to Shandong First Medical University, Taian, Shandong, China
| | - Lan LYu
- Department of Plastic Surgery, Feicheng Hospital Affiliated to Shandong First Medical University, Taian, Shandong, China
| | - Liwei Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Chen L, Yu L, Li X, Tian Z, Lin X. Value of CT Radiomics and Clinical Features in Predicting Bone Metastases in Patients with NSCLC. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7642511. [PMID: 36051936 PMCID: PMC9424036 DOI: 10.1155/2022/7642511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/17/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
Abstract
Objective To explore the CT radiomic features and clinical imaging features of the primary tumor in patients with nonsmall cell lung cancer (NSCLC) before treatment and their predictive value for the occurrence of bone metastases. Methods From June 2017 to June 2021, 195 patients with NSCLC who were pathologically diagnosed without any treatment in the Cancer Hospital Affiliated to Hainan Medical College were retrospectively analyzed, and they were divided into a bone metastasis group and a nonbone metastasis group. The relationship between clinical imaging features and bone metastasis in patients was analyzed by the t-test, rank sum test, and χ 2 test. At the same time, ITK software was used to extract the radiomic characteristics of the primary tumor of the patients, and the patients were randomly divided into a training group and a validation group in a ratio of 7 : 3. The training model was validated in the validation group, and the performance of the model for predicting bone metastases in NSCLC patients was verified by the ROC curve, and a multivariate logistic regression prediction model was established based on the omics parameters extracted from the best prediction model combined with clinical image features. Results Seven features were screened from the primary tumor by LASSO to establish a model for predicting metastasis. The area under the curve was 0.82 and 0.73 in the training and validation sets. The best omics signature and univariate analysis suggested clinical imaging factors (P < 0.05) associated with bone metastases were included in multivariate binary logistic analysis to obtain clinical characteristics of the primary tumor such as gender (OR = 0.141, 95% CI: 0.022-0.919, P = 0.04), increased Cyfra21-1 (OR = 0.12, 95% CI: 0.018-0.782, P = 0.027), Fe content in blood (OR = 0.774, 95% CI: 0.626-0.958, P = 0.018), CT signs such as lesion homogeneity (OR = 0.052, 95% CI: 0.006-0.419, P = 0.006), pleural indentation sign (OR = 0.007, 95% CI: 0.001-0.696, P = 0.034), and omics characteristics glszm_Small Area High Gray Level Emphasis (OR = 0.016, 95% CI: 0.001-0.286, P = 0.005) were independent risk factors for bone metastasis in patients. Conclusion The prediction model established based on radiomics and clinical imaging features has high predictive performance for the occurrence of bone metastasis in NSCLC patients.
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Affiliation(s)
- Lu Chen
- Hainan Cancer Hospital (Affiliated Cancer Hospital of Hainan Medical College), Nuclear Medicine Department, Haikou, China
| | - Lijuan Yu
- Hainan Cancer Hospital (Affiliated Cancer Hospital of Hainan Medical College), Nuclear Medicine Department, Haikou, China
| | - Xueyan Li
- Hainan Cancer Hospital (Affiliated Cancer Hospital of Hainan Medical College), Nuclear Medicine Department, Haikou, China
| | - Zhanyu Tian
- College of Bioinformatics, Hainan Medical University, Haikou, China
| | - Xiuyan Lin
- Hainan Cancer Hospital (Affiliated Cancer Hospital of Hainan Medical College), Nuclear Medicine Department, Haikou, China
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Ryan C, Stoltzfus KC, Horn S, Chen H, Louie AV, Lehrer EJ, Trifiletti DM, Fox EJ, Abraham JA, Zaorsky NG. Epidemiology of bone metastases. Bone 2022; 158:115783. [PMID: 33276151 DOI: 10.1016/j.bone.2020.115783] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/29/2020] [Accepted: 11/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND This study evaluated the incidence of de novo bone metastasis across all primary cancer sites and their impact on survival by primary cancer site, age, race, and sex. QUESTIONS/PURPOSES Our objectives were (I) characterize the epidemiology of de novo bone metastasis with respect to patient demographics, (II) characterize the incidence by primary site, age, and sex (2010-2015), and (III) compare survival of de novo metastatic cancer patients with and without bone metastasis. METHODS This is a retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 2010-2015. Incidence rates by year of diagnosis, annual percentage changes, Kaplan-Meier, univariate and multiple Cox regression models are included in the analysis. RESULTS Of patients with cancer in the SEER database, 5.1% were diagnosed with metastasis to bone, equaling ~18.8 per 100,000 bone metastasis diagnoses in the US per year (2010-2015). For adults >25, lung cancer is the most common primary site (2015 rate: 8.7 per 100,000) with de novo bone metastases, then prostate and breast primaries (2015 rates: 3.19 and 2.38 per 100,000, respectively). For patients <20 years old, endocrine cancers and soft tissue sarcomas are the most common primaries. Incidence is increasing for prostate (Annual Percentage Change (APC) = 4.6%, P < 0.001) and stomach (APC = 5.0%, P = 0.001) cancers. The presence of de novo bone metastasis was associated with a limited reduction in overall survival (HR = 1.02, 95%, CI = [1.01-1.03], p < 0.001) when compared to patients with other non-bone metastases. CONCLUSION The presence of bone metastasis versus metastasis to other sites has disease site-specific impact on survival. The incidence of de novo bone metastasis varies by age, sex, and primary disease site.
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Affiliation(s)
- Casey Ryan
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Samantha Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, Netherlands
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Edward J Fox
- Penn State Hershey Bone and Joint Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - John A Abraham
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA. https://twitter.com/NicholasZaorsky
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Matsushima-Nishiwaki R, Yamada N, Hattori Y, Hosokawa Y, Tachi J, Hori T, Kozawa O. SERMs (selective estrogen receptor modulator), acting as estrogen receptor β agonists in hepatocellular carcinoma cells, inhibit the transforming growth factor-α-induced migration via specific inhibition of AKT signaling pathway. PLoS One 2022; 17:e0262485. [PMID: 35007301 PMCID: PMC8746762 DOI: 10.1371/journal.pone.0262485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/27/2021] [Indexed: 01/18/2023] Open
Abstract
Selective estrogen receptor modulator (SERM) interacts with estrogen receptors and acts as both an agonist or an antagonist, depending on the target tissue. SERM is widely used as a safer hormone replacement therapeutic medicine for postmenopausal osteoporosis. Regarding hepatocellular carcinoma (HCC), accumulating evidence indicates gender differences in the development, and that men are at higher morbidity risk than premenopausal women, suggesting that estrogen protects against HCC. However, it remains unclear whether SERM affects the HCC progression. Previously, we have shown that transforming growth factor (TGF)-α promotes the migration of HCC cells via p38 mitogen-activated protein kinases (MAPK), c-Jun N-terminal kinase and AKT. In the present study, we investigated whether SERM such as tamoxifen, raloxifene and bazedoxifene, affects the HCC cell migration using human HCC-derived HuH7 cells. Raloxifene and bazedoxifene but not tamoxifen, significantly suppressed the TGF-α-induced HuH7 cell migration. ERB041 and DPN, estrogen receptor (ER) β agonists, inhibited the TGF-α-induced cell migration whereas PPT, an ERα agonist, did not show the suppressive effect on the cell migration. ERB041 attenuated the TGF-α-induced phosphorylation of AKT without affecting the phosphorylation of p38 MAPK and c-Jun N-terminal kinase. Raloxifene and bazedoxifene also inhibited the phosphorylation of AKT by TGF-α. Furthermore, PHTPP, an ERβ antagonist, significantly reversed the suppression by both raloxifene and bazedoxifene of the TGF-α-induced cell migration. Taken together, our results strongly indicate that raloxifene and bazedoxifene, SERMs, suppress the TGF-α-induced migration of HCC cells through ERβ-mediated inhibition of the AKT signaling pathway.
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Affiliation(s)
| | - Noriko Yamada
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuria Hattori
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yui Hosokawa
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junko Tachi
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takamitsu Hori
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Osamu Kozawa
- Department of Pharmacology, Gifu University Graduate School of Medicine, Gifu, Japan
- * E-mail:
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Beekman KM, Regenboog M, Nederveen AJ, Bravenboer N, den Heijer M, Bisschop PH, Hollak CE, Akkerman EM, Maas M. Gender- and Age-Associated Differences in Bone Marrow Adipose Tissue and Bone Marrow Fat Unsaturation Throughout the Skeleton, Quantified Using Chemical Shift Encoding-Based Water-Fat MRI. Front Endocrinol (Lausanne) 2022; 13:815835. [PMID: 35574007 PMCID: PMC9094426 DOI: 10.3389/fendo.2022.815835] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/17/2022] [Indexed: 01/17/2023] Open
Abstract
Bone marrow adipose tissue (BMAT) is a dynamic tissue which is associated with osteoporosis, bone metastasis, and primary bone tumors. The aim of this study is to determine region-specific variations and age- and gender-specific differences in BMAT and BMAT composition in healthy subjects. In this cross-sectional study, we included 40 healthy subjects (26 male: mean age 49 years, range 22-75 years; 14 female: mean age 50 years, range 29-71) and determined the bone marrow signal fat fraction and bone marrow unsaturation in the spine (C3-L5), pelvis, femora, and tibiae using chemical shift encoding-based water-fat imaging (WFI) with multiple gradient echoes (mGRE). Regions of interest covered the individual vertebral bodies, pelvis and proximal epimetaphysis, diaphysis, and distal epimetaphysis of the femur and tibia. The spinal fat fraction increased from cervical to lumbar vertebral bodies (mean fat fraction ( ± SD or (IQR): cervical spine 0.37 ± 0.1; thoracic spine 0.41 ± 0.08. lumbar spine 0.46 ± 0.01; p < 0.001). The femoral fat fraction increased from proximal to distal (proximal 0.78 ± 0.09; diaphysis 0.86 (0.15); distal 0.93 ± 0.02; p < 0.001), while within the tibia the fat fraction decreased from proximal to distal (proximal 0.92 ± 0.01; diaphysis 0.91 (0.02); distal 0.90 ± 0.01; p < 0.001). In female subjects, age was associated with fat fraction in the spine, pelvis, and proximal femur (ρ = 0.88 p < 0.001; ρ = 0.87 p < 0.001; ρ = 0.63 p = 0.02; ρ = 0.74 p = 0.002, respectively), while in male subjects age was only associated with spinal fat fraction (ρ = 0.40 p = 0.04). Fat fraction and unsaturation were negatively associated within the spine (r = -0.40 p = 0.01), while in the extremities fat fraction and unsaturation were positively associated (distal femur: r = 0.42 p = 0.01; proximal tibia: r = 0.47, p = 0.002; distal tibia: r = 0.35 p = 0.03), both independent of age and gender. In conclusion, we confirm the distinct, age- and gender-dependent, distribution of BMAT throughout the human skeleton and we show that, contradicting previous animal studies, bone marrow unsaturation in human subjects is highest within the axial skeleton compared to the appendicular skeleton. Furthermore, we show that BMAT unsaturation was negatively correlated with BMAT within the spine, while in the appendicular skeleton, BMAT and BMAT unsaturation were positively associated.
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Affiliation(s)
- Kerensa M. Beekman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
- Department of Endocrinology, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Vrije Universiteit University, Amsterdam, Netherlands
| | - Martine Regenboog
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Research Laboratory Bone and Calcium Metabolism, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Vrije Universiteit University, Amsterdam, Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, Netherlands
| | - Martin den Heijer
- Department of Endocrinology, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Vrije Universiteit University, Amsterdam, Netherlands
| | - Peter H. Bisschop
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Carla E. Hollak
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Erik M. Akkerman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Mario Maas,
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Zacharia B, Joy J, Subramaniam D, Pai PK. Factors Affecting Life Expectancy After Bone Metastasis in Adults - Results of a 5-year Prospective Study. Indian J Surg Oncol 2021; 12:759-769. [PMID: 35110900 PMCID: PMC8764008 DOI: 10.1007/s13193-021-01426-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 08/21/2021] [Indexed: 11/28/2022] Open
Abstract
There is a scarcity of literature available regarding the factors affecting life expectancy in bone metastasis (BM). Our objective is to evaluate the factors affecting life expectancy in adult patients with BM. In this prospective cohort study for over 5 years, 111 adults with BM were included in the analysis. The life expectancy was calculated from the time of diagnosis of BM to death. Statistical analysis was done using the SPSS statistical program. The Pearson chi-square test was used to analyze the significance and life expectancy was represented on the Kaplan Meier curve. The overall median survival time was 9 months. The patients with a primary malignancy detected along with BM had a median survival of 9 months. Those without a known primary at the time of diagnosis survived for a median period of 8 months and those with known primary for 14 months (P-value 0.01). The median survival of patients with BM from the lung, breast, and prostate was 6, 14, and 24 months, respectively (P-value 0.001). Only 22% of patients with extraskeletal metastasis in addition to BM survived more than 6 months (P-value 0.013). Patients with neurological deficits had a median survival of 2 months (P-value 0.0001). There was no statistically significant association between gender and the mode of treatment and survival. There was a significant association between life expectancy and mode of presentation, the primary site of origin, presence of extraskeletal secondary, BM with unknown primary, and symptoms on presentation in patients with BM.
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Affiliation(s)
- Balaji Zacharia
- Department of Orthopedics, Government Medical College, Kozhikkode, Kerala 673008 India
| | - Jerin Joy
- Department of Orthopedics, Government Medical College, Kozhikkode, Kerala 673008 India
| | | | - Puneeth Katapadi Pai
- Department of Orthopedics, Government Medical College, Kozhikkode, Kerala 673008 India
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Zhang S, Guo J, Zhang H, Li H, Hassan MOO, Zhang L. Metastasis pattern and prognosis in men with esophageal cancer patients: A SEER-based study. Medicine (Baltimore) 2021; 100:e26496. [PMID: 34160464 PMCID: PMC8238299 DOI: 10.1097/md.0000000000026496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/30/2021] [Indexed: 01/04/2023] Open
Abstract
Esophageal cancer (EC) is relatively common; at the time of diagnosis, 50% of cases present with distant metastases, and most patients are men. This study aimed to examine and compare the clinicopathological characteristics and metastatic patterns of male EC (MEC) and female EC (FEC). In addition, risk factors associated with MEC prognosis were evaluated.The present study population was extracted from the Surveillance Epidemiology and End Results database. MEC characteristics and factors associated with prognosis were evaluated using descriptive analysis, the Kaplan-Meier method, and the Cox regression model.A total of 12,558 MEC cases were included; among them, 3454 cases had distant organ metastases. Overall, 27.5% of the entire cohort were patients with distant organ metastases. Compared with patients with non-metastatic MEC, patients with metastatic MEC were more likely to be aged ≤60 years, of Black and White race, have a primary lesion in the overlapping esophagus segments, and have a diagnosis of adenocarcinoma of poorly differentiated and undifferentiated grade that was treated with radiotherapy and chemotherapy rather than surgery; moreover, they were also more likely to be married and insured. In addition, patients with MEC were more likely to be aged ≤60 years, White race, and diagnosed with a primary lesion in the lower third of the esophagus and overlapping esophagus segments, and treated without chemotherapy, compared with those with FEC. Patients in the former group were also more likely than those in the latter group to be unmarried and have bone metastasis only and lung metastasis only. Liver, lung, and bone metastases separately, and simultaneous liver and lung metastases were associated with poor survival in MEC patients.Metastatic MEC is associated with clinicopathological characteristics and metastatic patterns different from those associated with non-metastatic MEC and metastatic FEC. Metastatic MEC and FEC patients may have similar prognoses. Distant organ metastasis may be associated with poor prognosis in patients with MEC and FEC.
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Affiliation(s)
- Shengqiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Jida Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Hongyan Zhang
- Department of Physiology and Neurobiology, Mudanjiang Medical University, Mudanjiang, China
| | - Huawei Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
| | - Mohamed Osman Omar Hassan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
- Department of Cardiothoracic Surgery, Qena University Hospitals, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin
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De Giorgi A, Fabbian F, Cappadona R, Tiseo R, Molino C, Misurati E, Gambuti E, Savriè C, Boari B, Raparelli V, Manfredini R. Do Sex-Related Differences of Comorbidity Burden and/or In-Hospital Mortality Exist in Cancer Patients? A Retrospective Study in an Internal Medicine Setting. Life (Basel) 2021; 11:261. [PMID: 33810124 PMCID: PMC8004908 DOI: 10.3390/life11030261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022] Open
Abstract
Cancer represents important comorbidity, and data on outcomes are usually derived from selected oncologic units. Our aim was to evaluate possible sex-related differences and factors associated with in-hospital mortality (IHM) in a consecutive cohort of elderly patients with cancer admitted to internal medicine. We included all patients admitted to our department with a diagnosis of cancer during 2018. Based on the International Classification of Diseases, 9th Revision, Clinical Modification, demography, comorbidity burden, and diagnostic procedures were evaluated, with IHM as our outcome. We evaluated 955 subjects with cancer (23.9% of total hospital admissions), 42.9% were males, and the mean age was 76.4 ± 11.4 years. Metastatic cancer was diagnosed in 18.2%. The deceased group had a higher modified Elixhauser Index (17.6 ± 7.7 vs. 14 ± 7.3, p < 0.001), prevalence of cachexia (17.9% vs. 7.2%, p < 0.001), and presence of metastasis (27.8% vs. 16.3%, p = 0.001) than survivors. Females had a higher age (77.4 ± 11.4 vs. 75.5 ± 11.4, p = 0.013), and lower comorbidity (10.2 ± 5.9 vs. 12.0 ± 5.6, p < 0.001) than males. IHM was not significantly different among sex groups, but it was independently associated with cachexia and metastasis only in women. Comorbidities are highly prevalent in patients with cancer admitted to the internal medicine setting and are associated with an increased risk of all-cause mortality, especially in female elderly patients with advanced disease.
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Affiliation(s)
- Alfredo De Giorgi
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Fabio Fabbian
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Rosaria Cappadona
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Ruana Tiseo
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Christian Molino
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Elisa Misurati
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Edoardo Gambuti
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Caterina Savriè
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Benedetta Boari
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Roberto Manfredini
- Clinica Medica Unit, Azienda Ospedaliero-University of Ferrara, 44121 Ferrara, Italy; (A.D.G.); (R.T.); (C.M.); (E.M.); (E.G.); (C.S.); (B.B.)
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
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10
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Herget G, Saravi B, Schwarzkopf E, Wigand M, Südkamp N, Schmal H, Uhl M, Lang G. Clinicopathologic characteristics, metastasis-free survival, and skeletal-related events in 628 patients with skeletal metastases in a tertiary orthopedic and trauma center. World J Surg Oncol 2021; 19:62. [PMID: 33632256 PMCID: PMC7908692 DOI: 10.1186/s12957-021-02169-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Skeletal-related events (SREs) due to bone metastases (BM) significantly impact the morbidity and mortality of cancer patients. The present study sought to investigate clinicopathological characteristics, metastasis-free survival (MFS), and SREs in patients referred to a tertiary orthopedic and trauma center. Methods Data were retrieved from electronic health records (n=628). Survival curves were estimated utilizing the Kaplan–Meier method. The Cox regression model was used to determine factors influencing MFS based on estimated hazard ratios (HRs). Results Breast (55.8%) and lung (18.2%), and lung (32.9%) and prostate (16.8%) cancer were the most common cancer types in our cohort in women and men, respectively. Fifteen percent of patients presented with BM as the first manifestation of tumor disease, 23% had metastasis diagnosis on the same day of primary tumor diagnosis or within 3 months, and 62% developed BM at least 3 months after primary tumor diagnosis. Osteolytic BM were predominant (72.3%) and most commonly affecting the spine (23%). Overall median MFS was 45 months (32 (men) vs. 53 (women) months). MFS was shortest in the lung (median 15 months, 95% CI 8.05–19) and longest in breast cancer (median 82 months, 95% CI 65.29–94). Age (≥ 60 vs. < 60 years) and primary cancer grading of ≥2 vs. 1 revealed prognostic relevance. Conclusion Women with breast or lung cancer, men with lung or prostate cancer, age ≥60 years, male sex, and primary cancer grading ≥2 are associated with increased risk for MBD. Intensified follow-up programs may reduce the risk of SREs and associated morbidity and mortality.
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Affiliation(s)
- Georg Herget
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Babak Saravi
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
| | - Eugenia Schwarzkopf
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Mara Wigand
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Norbert Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Hagen Schmal
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.,Department of Orthopaedic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Markus Uhl
- Department of Radiology, Pediatric Radiology, and Interventional Radiology, St. Josefskrankenhaus, Sautierstraße 1, 79104, Freiburg, Germany
| | - Gernot Lang
- Department of Orthopedics and Trauma Surgery, Medical Centre-Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
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