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Öz

Amaç: Bu çalışmanın amacı ürolojik malignitelere bağlı semptomatik kemik metastazlarının cerrahi tedavisinin etkinliğini ve lokal kontrol elde edilebilirliğini değerlendirmektir.Çalışma planı: Bu çalışma 2002 ve 2013 yılları arasında ürolojik maliğniteye bağlı kemik metastazlarından ölen hastaların incelendiği retrospektif gözlemsel bir çalışmadır. Ürolojik malignitelere bağlı kaybedilen kemik metastazlı 70 hastanın (55 erkek, 15 bayan) kemik metastazlarının yeri ve sayısı, klinik ve histopatolojik özellikleri, ilk ve ardışık metastazlarının zamanı, metastaz sonrası yaşam süreleri, metastaz natürü (blastik, miks, litik), cerrahi rekonstrüksiyon tipi, sistemik etkileri ve iç organ metastaz durumu istatistiksel olarak analiz edildi.Bulgular: Primer tanılar 43 hastada (%61.42) böbrek hücreli karsinom, 15 hastada (%21.43) prostat karsinom, 12 hastada (17.15) mesane karsinomu idi. Osteolitik lezyonlar daha sık saptandı (n=61 %87). En yaygın uygulanan cerrahi tedavi sırasıyla ekstremitelerde geniş rezeksiyon ile prostetik replasman; geniş rezeksiyon ile ve/veya kemik çimento uygulamaları ile internal fiksasyondu (n=21). 65 hastaya ekstremite koruyucu prosedürler uygulanırken 2 hasta ampute edildi. Ortalama yaşam beklentisi böbrek hücreli karsinom hastalarında 13 ay, prostat karsinomlu hastalarda 16 ay, mesane karsinomlu hastada 11 ay olarak saptandı.Çıkarımlar: Ürolojik maligniteli hastalarda kemik metastazlarının varlığı, primer malignitenin tedavi planını değiştirmektedir. Ürolojik maligniteli hastalarda kemik metastazları geç tanı alabilmektedir. Bu hastaların metastaz açısından uzun yıllar takibi gerekmektedir

Anahtar Kelimeler

• Mesane karsinomu; kemik metastazı; prostat karsinomu; böbrek hücreli karsinomu; cerrahi tedavi

Surgical management of bone metastases from urological malignancies: an analysis of 70 cases

Abstract

Objective: The purpose of this study was to evaluate symptomatic bone metastases from urological malignancies and the efficacy of surgical treatment of bone metastases in achieving local tumor control.
Methods: This was a retrospective observational study of patients diagnosed with bone metastases from urological malignancies who died from their diseases between 2002 and 2013. Data on clinicopathology, number and sites of bone metastasis, time to first and subsequent metastasis, survival after metastasis, nature of metastasis (blastic, mixed, lytic), type of surgical reconstruction, systemic affections, and visceral organ metastasis for 70 bone metastases from deceased urological malignancies patients (55 male, 15 female) with evidence of bone metastasis were statistically analyzed.
Results: Forty-three patients (61.42%) had renal cell carcinoma (RCC), 15 patients (21.43%) had prostate cancer, and 12 patients (17.15%) had bladder carcinoma as primary diagnosis. Osteolytic lesions were most prevalent (n=61; 87%). The most common surgical modality for extremities was wide resection with prosthetic replacement (42 patients), followed by wide resection or wide resection with bone cement application with internal fixation (21 patients); 65 patients were treated with limb salvage procedures, and 2 patients were treated with amputation. Overall median survival was 13 months for RCC, 16 months for prostate carcinoma, and 11 months for bladder carcinoma patients.
Conclusion: Detection of bone metastases in patients with urological malignancies influences the treatment strategy. Diagnosis of bone metastases may be delayed in urologic malignities; thus, these patients receive long-term clinical follow-up.

Keywords

• Bladder carcinoma
• bone metastasis
• prostate carcinoma
• renal cell carcinoma
• surgical treatment

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