Factors associated with skeletal‐related events in patients with bone metastatic melanoma: A retrospective study of 481 patients

• Published in: Journal of surgical oncology Vol. 130; no. 2; pp. 310 - 321
• Main Authors: Shimizu, Michelle R., Groot, Tom M., Twining, Peter K., Kobes, Tim, Ferrone, Marco, Raskin, Kevin, Jutte, Paul C., Cohen, Sonia, Lozano‐Calderon, Santiago, Groot, Olivier Q., Schwab, Joseph H.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-08-2024
• Subjects: Adult; Aged; bone metastasis; Bone Neoplasms - secondary; Female; Follow-Up Studies; Fractures; Fractures, Spontaneous - etiology; Hemoglobin; Humans; Hypercalcemia - etiology; Male; Melanoma; Melanoma - pathology; Melanoma - secondary; Metastasis; metastatic melanoma; Middle Aged; predictors; Prognosis; Retrospective Studies; Risk Factors; skeletal metastases; skeletal‐related events; Skin Neoplasms - pathology; Survival Rate; predictors; skeletal metastases; skeletal‐related events; bone metastasis; metastatic melanoma
• ISSN: 0022-4790; 1096-9098; 1096-9098
• DOI: 10.1002/jso.27731

Objectives
Metastatic bone disease is estimated to develop in up to 17% of patients with melanoma, compromising skeleton integrity resulting in skeletal‐related events (SREs), which impair quality of life and reduce survival. The objective of the study was to investigate (1) the proportion of melanoma patients developing SREs following diagnosis of bone metastasis and (2) the predictors for SREs in this patient cohort.
Methods
Four hundred and eighty‐one patients with bone metastatic melanoma from two tertiary centers in the United States from 2008 to 2018 were included. The primary outcome was 90‐day and 1‐year occurrence of a SRE, including pathological fractures of bones, cord compression, hypercalcemia, radiotherapy, and surgery. Fine‐Gray regression analysis was performed for overall SREs and pathological fracture, with death as a competing risk.
Results
By 1‐year, 52% (258/481) of patients experienced SREs, and 28% (137/481) had a pathological fracture. At 90‐day, lytic lesions, bone pain, elevated calcium and absolute lymphocyte, and decreased albumin and hemoglobin were associated with higher SRE risk. The same factors, except for decreased hemoglobin, were shown to predict development of SREs at 1‐year.
Conclusion
The high incidence of SREs and pathological fractures warrants vigilance using the identified factors in this study and preventative measures during clinical oncological care.