四肢骨转移瘤外科治疗指南
中华骨科杂志, 2019,39(24) : 1485-1495. DOI: 10.3760/cma.j.issn.0253-2352.2019.24.001
骨骼是恶性肿瘤最常见的转移部位，仅次于肺和肝脏，骨转移瘤的总体发生率为32.5%，其发病率约为原发恶性骨肿瘤的35~40倍。随着恶性肿瘤诊疗水平的提高，新技术、新疗法的临床应用，患者的生存期不断延长，骨转移瘤发病率越来越高[1,2,3]。四肢骨是转移瘤的好发部位，常见于四肢近端骨，股骨、肱骨、骨盆和胫骨约占64%、21%、9%、3%[3]。文献报道四肢骨转移瘤主要来源于乳腺癌（28.0%~30.5%）、肺癌（11.0%~17.0%）、肾癌（12.3%~15.0%）、前列腺癌（8.0%~17.5%）[2,4]。四肢骨转移瘤可引起疼痛、活动障碍、高钙血症、甚至病理性骨折，后者是导致骨转移瘤患者死亡的重要相关事件。四肢骨转移瘤外科治疗的目的：缓解疼痛、恢复功能、提高生活质量，治疗骨相关事件[5,6]。目前四肢骨转移瘤的外科治疗还存在许多问题，如认识不统一、目的和适应证不明确、术前评估和治疗方案不规范、缺少多学科协作。研究表明对满足手术适应证的四肢骨转移患者，采用合理的手术方式可缓解疼痛、改善肢体功能、提高患者生存质量、延长生存时间[7,8,9]。为此，中华医学会骨科学分会骨肿瘤学组组织全国二十余位专家，在原先共识的基础上，根据近年来国内外四肢转移瘤外科治疗的最新进展，借鉴国外相关指南，遵循循证医学原则，制定本指南。
一、目的
旨在通过循证医学的方法，为四肢骨转移瘤的外科治疗措施提供可靠的临床依据，规范诊疗行为，进一步提高疗效，改善患者生存期的生活质量及预后。
二、涵盖内容及目标使用者
四肢骨转移瘤外科治疗指南的内容主要包括四肢转移瘤外科干预指征，术前评估与决策，围手术期处理，手术治疗、微创治疗及并发症等问题。其目标使用者为骨肿瘤外科医生，同时为肿瘤内科医生及放疗科医生提供参考。
三、文献的等级评定标准与推荐等级
评定标准：参照Grading of Recommendations Assessment，Development, and Evaluation（GRADE）工作组和其他工作组的相关方法来评估研究证据的质量。结合研究设计和其他证据特征综合判定研究的证据级别，使确定的证据质量级别更符合真实情况，为了易于理解，我们采用3级分类标准。
1级：①差异有统计学意义的高质量随机对照研究，或虽然差异无统计学意义、但可信区间很窄的高质量随机对照研究；②1级研究的系统综述（前提是这些纳入的研究其结果具有同质性）。
2级：①质量稍次的随机对照研究（如随访率<80%、非盲法对照、随机化分组不合适）；②前瞻性对照研究；③研究结果不同质的1级研究或2级研究的系统综述；④病例对照研究；⑤回顾性对照研究；⑥所有2级研究的系统综述。
3级：①病例系列研究；②专家意见。
推荐等级：与文献等级评定相对应，分为强度递减的3级推荐。
四、利益声明及版权归属
参与本指南编写的专家组成员在指南编写过程中均无涉及任何经济或非经济利益冲突，与医药公司无任何利益关系，获得的科研基金及临床研究项目与本指南的制定无利益冲突；编写过程中所需经费由指南编委会自筹。本指南版权归中华医学会骨科学分会骨肿瘤学组所有。
一、X线、CT和MRI在四肢骨转移瘤诊断中的作用
在骨转移瘤的检查中推荐常规行X线、CT和MR检查（2级推荐）。
X线检查诊断骨转移瘤的敏感性较低，但影像空间分辨率高，是筛查骨转移瘤的基础方法。X线表现为溶骨性、成骨性及混合性三种改变，前者最常见，表现为虫蛀样或地图状骨质破坏，边界不清，无硬化和骨膜反应；成骨性破坏可见斑点状、片状致密影，甚至象牙质样，骨小梁紊乱、增厚、粗糙，受累骨体积可增大；混合性破坏兼有溶骨和成骨特点。CT分辨率和敏感性较高，可显示早期病变以及骨破坏的细微改变。MRI有较高的敏感性和特异性，可以准确地显示转移瘤侵犯的部位和范围，尤其是髓内和周围软组织情况[10]。
二、同位素骨扫描和PET-CT在四肢骨转移瘤诊断中的作用
骨转移瘤诊断中建议行同位素骨扫描或（和）PET-CT检查以明确病灶位置和数量（2级推荐）。
同位素骨扫描和PET-CT可以协助骨转移瘤的诊断。同位素骨扫描敏感性高，但特异性较差，主要用于骨转移瘤的筛查，有助于确诊转移灶的部位和数量。PET-CT能够对原发灶和转移灶辅助定性和准确定位，可以早期诊断，敏感性、特异性较高，并可同时检查全身器官、淋巴结及软组织，全面评估肿瘤病变范围[11,12,13,14,15,16,17,18,19,20,21]。
三、肿瘤标志物在四肢骨转移瘤诊断中的作用
部分肿瘤标志物可作为四肢骨转移瘤诊断的辅助检查，协助判断肿瘤来源（2级推荐）。
部分标志物可以作为查找原发病灶的线索。美国临床生化委员会和欧洲肿瘤标志物专家组推荐常用的非小细胞肺癌标志物有鳞状上皮细胞癌抗原、癌胚抗原、细胞角蛋白片段19，小细胞肺癌标志物有胃泌素释放肽前体和神经元特异性烯醇化酶[22,23,24,25,26,27,28,29,30,31,32,33,34]。临床表现为成骨转移的男性患者，推荐行前列腺特异性抗原（PSA）检查[35,36]。甲胎蛋白对于肝癌的诊断也有一定价值[37,38]。
四、四肢骨转移瘤患者行术前活检的意义
既往无恶性肿瘤病史、肿瘤原发灶不明，或恶性肿瘤病史明确、仅出现单发骨破坏者，应考虑活检以明确诊断。对于首次穿刺活检未能明确诊断的病例，可以再次穿刺活检或切开活检（2级推荐）。
病理学检查，对明确骨转移瘤的来源十分重要，但有时还需要病史、影像学和病理三结合来综合判断。对于既往无恶性肿瘤病史、肿瘤原发灶不明，或恶性肿瘤病史明确、但仅出现单发骨破坏者，应当通过穿刺活检行病理检查来明确诊断；既往有恶性肿瘤病史，就诊时全身多发转移患者，可不行活检[5]。但对于生存期较长的恶性肿瘤患者，如果出现新发骨病灶，则建议进行穿刺活检，因约15%~18%的新发骨病灶可能是其他新发肿瘤或非肿瘤病变，而不是原发肿瘤骨转移[39,40]。研究表明骨肿瘤穿刺活检的准确率可达到80%~97%[41,42,43,44]。对于初次穿刺活检未能明确诊断的病例，有必要再次穿刺或切开活检[45]。
五、如何对四肢骨转移瘤患者进行生存期评估？
对四肢骨转移瘤患者，推荐采用Katagiri评分系统来预测患者生存期（2级推荐）。
目前有不少评估系统用来评估骨转移瘤患者的预后和生存期，如修订的Katagiri评分系统[46,47]、SSG score[3]、PATHFx model[48,49]、OPT Model[50]、Janssen nomogram[51]和SPRING nomogram[52]。考虑评分统计方便简单，本指南推荐修订的Katagiri评分系统来预测四肢骨转移瘤患者的生存期[49,53,54,55,56,57]（表1）。
| 预后因素 | 评分 | ||
|---|---|---|---|
| 原发肿瘤类型 | |||
| 缓慢生长 | 激素依赖性的乳腺癌和前列腺癌、甲状腺癌、多发骨髓瘤、恶性淋巴瘤 | 0 | |
| 中等生长 | 接受靶向药物治疗的肺癌、非激素依赖型的乳腺癌和前列腺癌、肾细胞癌、子宫内膜癌、卵巢癌、肉瘤 | 2 | |
| 快速生长 | 未接受靶向药物治疗的肺癌、结直肠癌、胃癌、胰腺癌、头颈部恶性肿瘤、食管癌、其他的泌尿系恶性肿瘤、黑色素瘤、肝细胞癌、膀胱癌、宫颈癌、其他未知来源的恶性肿瘤 | 3 | |
| 内脏或颅内转移 | |||
| 结节性内脏或颅内转移 | 1 | ||
| 播散性转移a | 2 | ||
| 实验室检查 | |||
| 异常b | 1 | ||
| 严重异常c | 2 | ||
| ECOG评分 | 3分或4分 | 1 | |
| 前期化疗 | - | 1 | |
| 多发骨转移 | - | 1 | |
注：a播散性转移：胸腔、腹腔、软脑膜转移；b异常：CRP≥0.4 mg/dl，LDH≥250 IU/L，血清白蛋白<3.7 g/dl；c严重异常：血小板<100000/μl，血清钙≥10.3 mg/dl，总胆红素≥1.4 μmol/L
Katagiri评分系统是对原发肿瘤类型、内脏或颅内转移、ECOG评分、前期化疗、多发骨转移5个方面分别赋值并进行累加，根据累计得分情况，评估骨转移瘤患者生存期、指导治疗[46]。2014年，Katagiri对该评分系统进行了修订，将实验室检查分为异常和严重异常两个等级，并纳入影响预后的因素中[47]。修订后的评分系统提高了骨肿瘤患者生存期评估的准确性。评分≥7分的患者，评估为短期生存，6个月的生存率为27%，1年的生存率为6%，2年的生存率为2%；评分4~6分的患者，评估为中等期生存，6个月的生存率为74%，1年的生存率为49%，2年的生存率为28%；评分≤3分的患者，评估为长期生存，6个月的生存率为98%，1年的生存率为91%，2年的生存率为78%。
六、如何评估四肢骨转移瘤患者病理性骨折风险？
推荐采用Mirels评分系统评估四肢骨转移瘤患者的病理性骨折风险（2级推荐）。
目前，评估四肢骨转移瘤患者病理性骨折风险最常用的是Mirels评分系统[58,59]（表2）。该评分系统包括病灶位置（上肢、下肢、转子周围）、疼痛程度（轻度、中度、重度）、病变类型(溶骨型、成骨型、混合型)、皮质破坏程度（<1/3、1/3~2/3、>2/3）4个变量，总分12分，当评分≤ 7分时表明病理性骨折风险较低（<4%），不建议手术治疗，8分时骨折风险为15%，而9分时骨折风险达到33%，当评分≥9分时应进行预防性内固定。近年来，基于CT的骨质刚度分析评价方法，即对病变骨CT扫描，利用图像分析软件分析计算每个骨截面的平均骨密度，通过弹性模量与骨密度计算公式计算出骨的结构刚度。具有较高的敏感性和特异性，受到学者们的关注，但仍需大数据建模并进一步临床研究加以验证[60]。
七、四肢骨转移瘤濒临骨折患者外科治疗的必要性
推荐对濒临骨折的患者进行手术干预，以缓解疼痛、维持肢体功能、改善生活质量（2级推荐）。
病理性骨折是四肢骨转移瘤的严重并发症，是导致患者死亡的重要相关事件，可缩短患者生存时间，并严重影响患者生存质量[61,62]。因此，对于四肢骨转移瘤濒临骨折患者，应综合考虑病理性骨折的风险和患者预期生存时间，积极进行预防性固定或广泛切除假体重建。对于濒临骨折患者，预防性固定能够缓解疼痛、维持肢体功能、改善生活质量[5,63,64,65]。同时，预防性内固定手术较广泛切除假体重建手术相对容易，手术时间较短，创伤小。但不是所有濒临骨折的患者均需要手术干预，夹板、石膏、支具等外固定亦有一定的价值，尤其是上肢非负重骨[66,67]。
八、四肢骨转移瘤病理性骨折的手术时机
四肢骨转移瘤病理性骨折的患者，除非开放性或合并血管、神经损伤等紧急情况，推荐明确诊断后根据患者的具体情况确定不同的治疗方案（2级推荐）。
四肢骨转移瘤病理性骨折的患者，除非开放性或合并血管、神经损伤等紧急情况，一般予对症处理并完善必要的检查。明确原发灶后，根据患者一般情况、预期生存期、骨折部位、骨质条件、肿瘤包块大小、周围重要组织结构受累范围等确定不同治疗方案[68,69,70,71]并进行规范化治疗。
九、对于原发肿瘤已良好控制的单一骨转移瘤患者应彻底切除转移灶
对于原发恶性肿瘤已治愈多年、或原发肿瘤良好控制，多数学者认为孤立性转移灶应当采取彻底性切除手术（2级推荐）。
多数文献报道对于原发肿瘤已良好控制、全身单一部位骨转移的恶性肿瘤患者，骨转移灶的彻底切除可以延长患者的生存时间[72,73,74]。
十、不同类型骨转移瘤的手术方式选择
推荐肾癌骨转移选择相对彻底性手术，减少患者生存期内局部复发等并发症、期望延长生存时间（2级推荐）；乳腺癌、前列腺癌骨转移患者，虽然尚无统计学意义的证据证实彻底手术能够延长生存时间，但是建议术式相对彻底；肺癌部分亚型应用靶向治疗明显改善预后，术式建议相对彻底（3级推荐）。
随着靶向治疗和生物治疗进展、手术技术水平提高、综合治疗措施的进步，许多恶性肿瘤的生存期均得到延长[74,75,76,77,78,79,80,81]。
对于孤立性肾癌骨转移灶应行彻底手术切除并重建或内固定，多发病变彻底切除可以减少局部复发的风险[82]。
前列腺癌骨转移推荐彻底切除以减少局部并发症[83,84,85,86,87,88]。
由于靶向治疗和生物治疗的临床应用，部分肺腺癌生存期得以延长，对于有条件且生物治疗有效的肺腺癌骨转移患者，可以尝试相对彻底性手术方式[89,90]。
十一、不同部位长骨转移瘤手术方式的选择
.jspx)
专家讨论推荐不同部位长骨转移瘤的手术方式选择（3级推荐，表3）。
点击查看表格
表3
不同部位长骨转移瘤术式选择
表3
不同部位长骨转移瘤术式选择
| 股骨 | 近端 | 假体重建 |
|---|---|---|
| 骨干 | 骨水泥填充内固定/节段假体 | |
| 远端 | 假体重建 | |
| 近端 | 假体重建 | |
| 肱骨 | 骨干 | 骨水泥填充内固定/节段假体 |
| 远端 | 假体重建或内固定 | |
| 近端 | 假体重建/钢板固定 | |
| 胫骨 | 骨干 | 骨水泥填充内固定/节段假体 |
| 远端 | 截肢/放疗 | |
| 尺桡骨 | - | 假体/钢板骨水泥/放疗加支具 |
专家推荐，长骨骨端转移瘤一般行瘤段切除、假体重建；骨干转移瘤行骨水泥填充坚强内固定或节段假体重建。
十二、股骨骨端转移瘤濒临骨折或已发生病理性骨折的术式选择
股骨骨端转移瘤濒临骨折或已发生病理性骨折，或病变范围广泛累及关节面者，推荐肿瘤型人工假体重建术（2级推荐）。四肢长骨骨端转移瘤破坏范围较小者，推荐病灶刮除、骨水泥填充、内固定术（3级推荐）。
根据股骨骨端病变破坏的范围，选择不同的手术方法。对于病变范围广泛、关节面受累者，或者骨端已经发生病理性骨折者，选择肿瘤切除、肿瘤型人工假体重建术。病灶切除后肿瘤型人工假体重建术可提供即刻稳定性、允许早期负重、改善患肢功能；同时人工假体失效率较低，可以满足骨转移瘤患者生存期内的使用要求[5,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111]。对于四肢长骨骨端转移瘤病变范围较小者，可选择病灶刮除、骨水泥填充、内固定手术[3]。
十三、股骨干转移瘤濒临骨折或已发生病理性骨折的术式选择
股骨干转移瘤濒临骨折或已发生病理性骨折，推荐病灶刮除骨水泥填充内固定术，但当病变破坏严重者可行病灶切除、节段型假体重建术（2级推荐）。
文献报道对于股骨干转移瘤濒临骨折或已经发生病理性骨折的患者，病灶刮除灭活、骨水泥填充、钢板或髓内钉固定术，可以缓解疼痛，提供即刻稳定[6,99, 104, 107, 109,110]。与钢板固定相比，髓内钉固定术具有创伤小、出血少的优点，且可贯穿全骨长度，固定范围广泛，降低术后肿瘤进展导致病理性骨折的风险，机械稳定性好，可达到恶性肿瘤患者生存期内的使用要求[111,112,113,114,115]。钢板固定范围应足够，以避免生存期内局部二次手术。对于股骨干病变范围较大，骨缺损严重者，可行肿瘤切除后节段型假体重建术。节段型假体一般采用骨水泥固定，以提供即刻稳定和恢复肢体功能，提高患者生存期内的生活质量[116,117]。
十四、肱骨（骨端和骨干）转移瘤濒临骨折或已发生病理性骨折的术式选择
对于肱骨骨端破坏严重者选择假体重建，肱骨近端病灶较小时可行病灶刮除骨水泥填充钢板内固定，肱骨干转移瘤濒临骨折或病理性骨折，推荐病灶刮除骨水泥填充内固定术（2级推荐）。
依据肿瘤侵犯范围、残留骨质数量和部位、关节稳定性来决定手术方式。肱骨近端病灶较小时可行病灶刮除骨水泥填充钢板内固定术[118]。骨质破坏严重的肱骨近端转移瘤倾向于半肩关节假体重建术，肱骨干的病理性骨折倾向于病灶刮除、骨水泥填充、交锁髓内钉固定[65,119,120]或节段性假体重建术。肱骨远端病变如果骨质破坏严重，可以考虑广泛切除肱骨远端肿瘤型假体重建术[121,122]。
十五、四肢长骨转移瘤外科治疗并发症的防范措施
四肢骨转移瘤外科手术并发症发生率较高，需要临床医生严格选择适应证，防范并发症（2级推荐）。
与四肢普通骨折手术相比，长骨转移瘤手术并发症发生率较高，肱骨部位发生率为9%~22%[65,118, 123]，股骨部位发生率为10%~30%[3,70,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111]。与髓内钉内固定手术相比，假体重建手术局部复发和机械相关并发症发生率相对较低[72,94,97]。
十六、四肢骨转移瘤截肢手术的适应证
对于其他方法无法控制病灶进展，存在顽固性疼痛，主要神经、血管受累，软组织广泛侵犯，严重影响生活质量的四肢骨转移瘤患者，为提高生存质量，可采用截肢手术（2级推荐）。
截肢手术在四肢骨转移瘤中应用较少，但对于骨及周围软组织侵犯广泛、病灶切除后无法完成重建者，以及患肢主要血管、神经受累者，截肢术可作为一种选择[70, 124,125]。虽然截肢术不会延长患者生存时间，但对于其他方法无法控制肿瘤，且肿瘤带来严重肢体疼痛、功能障碍、出血或感染的四肢骨转移瘤患者，截肢术可以提高其生活质量[126,127]。截肢手术作为局部控制肿瘤，姑息性改善症状的治疗方式，应严格把握其适应证[128,129]。
十七、物理消融技术在四肢骨转移瘤病灶处理中的价值
物理消融技术可以减少手术中的肿瘤细胞播散和术中出血量（2级推荐）。
目前，最常用的物理消融技术为射频消融术和微波消融术。四肢长骨溶骨性转移病灶，消融结合预防性内固定可以达到缓解疼痛、减少术中出血、降低肿瘤细胞播散的目的，且未增加相关并发症的发生率[130,131]。该方法适用于血运丰富、软组织包块较大的溶骨性转移病灶。术前或术中采用消融技术破坏转移灶血运，可以达到减少术中出血的目的[132]。
十八、四肢长骨转移瘤患者术后是否配合放疗？
术后放疗对四肢骨转移瘤的治疗有一定益处，可以减轻疼痛、减少局部进展或复发，尤其对于生存期较长的患者建议请放疗专家进行评估配合放疗（2级推荐）。
四肢骨转移瘤濒临骨折或已发生病理性骨折，手术恢复稳定性后配合放疗，可以有效控制肿瘤局部进展、降低再次手术的风险、改善患者肢体功能[133,134]，减少术后复发[135,136]。
为了降低放疗对手术切口愈合的影响，放疗时机和剂量应由放疗科医师评估后决定[137]。
十九、骨吸收抑制剂在四肢骨转移瘤治疗中的作用
已经确诊恶性肿瘤骨转移者，建议应用双磷酸盐、地诺单抗治疗，以延缓、降低骨相关事件的发生（1级推荐）。双膦酸盐类药物近年来已成为溶骨性转移瘤的基础治疗，可以减轻骨疼痛、抑制肿瘤进展、预防病理性骨折[138,139,140,141,142,143,144,145,146,147,148,149,150,151]。地诺单抗可以很好地预防或延缓骨转移瘤患者骨相关事件的发生[152,153,154,155,156,157,158]。
四肢骨转移瘤外科治疗指南编写组人员名单
编写组组长：林建华
编写组副组长：牛晓辉、肖建如、李建民、邵增务、胡永成
参与制定人员（按姓氏拼音排序）：
毕文志 解放军301医院
蔡郑东 上海第一人民医院
郭 卫 北京大学人民医院
郭 征 空军医科大学西京医院
胡永成 天津医院
李振峰 山东大学齐鲁医院
李建民 山东大学齐鲁医院
林建华 福建医科大学附属第一医院
吕 智 山西医科大学附属第二医院
牛晓辉 北京积水潭医院
邵增务 华中科技大学协和医院
沈靖南 中山大学附属第一医院
汤小东 北京大学人民医院
屠重棋 四川大学华西医院
王国文 天津医科大学肿瘤医院
吴苏稼 东部战区总医院
肖建如 海军军医大学长征医院
杨 毅 北京大学人民医院
杨志平 山东大学齐鲁医院
叶招明 浙江大学医学院附属第二医院
于秀淳 中国人民解放军九六〇医院
于胜吉 中科院肿瘤医院
张 清 北京积水潭医院
张伟滨 上海瑞金医院
张晓晶 辽宁省肿瘤医院
朱 夏 福建医科大学附属第一医院
编写执笔人员：杨志平、林建华、胡永成
参考文献
[1]
.
Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)[J].
Lancet,
2015,
385(
9972):
977-
1010.
DOI: 10.1016/S0140-6736(14)62038-9.
[2]
.
Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37513025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries[J].
Lancet,
2018,
391(
10125):
1023-
1075.
DOI: 10.1016/S0140-6736(17)33326-3.
[3]
.
Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis[J].
Surg Oncol,
2013,
22(
2):
132-
138.
DOI: 10.1016/j.suronc.2013.02.008.
[4]
.
A scoping review on the surgical management of metastatic bone disease of the extremities[J].
BMC Musculoskelet Disord,
2018,
19(
1):
279.
DOI: 10.1186/s12891-018-2210-8.
[5]
骨转移瘤外科治疗专家共识[J].
中华骨科杂志,
2009,
29(
12):
1177-
1184.
. Expert consensus on surgical treatment of bone metastasis[J]. Chin J Orthop, 2009, 29(12): 1177-1184.
[6]
.
恶性肿瘤骨转移及骨相关疾病临床诊疗专家共识[M].
北京:
北京大学医学出版社,
2008:
1-
10.
. Common clinical guidelines of the diagnosis and treatment of malignant bone metastasis and bone related diseases[M]. Beijing: Peking University Medical Press, 2014: 1-10.
[7]
.
Skeletal metastases - the role of the orthopaedic and spinal surgeon[J].
Surg Oncol,
2012,
21(
3):
216-
222.
DOI: 10.1016/j.suronc.2012.04.001.
[8]
.
Metastatic disease of the femur: surgical treatment[J].
Clin Orthop Relat Res,
2003(
415
Suppl):
S230-
S244.
DOI: 10.1097/01.blo.0000093849.72468.82.
[9]
.
Benefits of early intramedullary nailing in femoral metastases[J].
Int Orthop,
2014,
38(
1):
129-
132.
DOI: 10.1007/s00264-013-2108-x.
[10]
.
Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy[J].
Eur Radiol,
2011,
21(
12):
2 604-
2617.
DOI: 10.1007/s00330-011-2221-4.
[11]
.
Evaluation of Prostate Cancer Bone Metastases with 18F-NaF and 18F-Fluorocholine PET/CT[J].
J Nucl Med,
2016,
57(
Suppl 3):
55S-
60S.
DOI: 10.2967/jnumed.115.169730.
[12]
.
Detection of bone metastases in breast cancer patients in the PET/CT era: Do we still need the bone scan?[J].
Rev Esp Med Nucl Imagen Mol,
2016,
35(
1):
3-
11.
DOI: 10.1016/j.remn.2015.08.006.
[13]
.
Bone marrow metastasis is an early stage of bone metastasis in breast cancer detected clinically by F18-FDG-PET/CT imaging[J].
Biomed Res Int,
2017,
2017:
9852632.
DOI: 10.1155/2017/9852632.
[14]
.
A meta-analysis of 18FDG-PET-CT, 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer[J].
Eur J Radiol,
2012,
81(
5):
1007-
1015.
DOI: 10.1016/j.ejrad.2011.01.126.
[15]
.
Comparison of 18F fluoride PET/CT and 99mTc-MDP bone scan in the detection of skeletal metastases in urinary bladder carcinoma[J].
Clin Nucl Med,
2013,
38(
8):
616-
621.
DOI: 10.1097/RLU.0b013e31828da5cc.
[16]
.
Positron emission tomography and bone metastases[J].
Semin Nucl Med,
2005,
35(
2):
135-
142.
DOI: 10.1053/j.semnuclmed.2004.11.005.
[17]
.
Comparison of bone and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography in the evaluation of bony metastases in lung cancer[J].
Mol Imaging Biol,
2003,
5(
1):
26-
31.
DOI: 10.1016/s1536-1632(03)00036-2.
[18]
.
Effectiveness of 18F-FDG-PET/CT vs bone scintigraphy in treatment response assessment of bone metastases in breast cancer[J].
Medicine (Baltimore),
2016,
95(
21):
e3753.
DOI: 10.1097/MD.0000000000003753.
[19]
.
Comparison of the diagnostic and prognostic values of 99mTc-MDP-planar bone scintigraphy, 131I-SPECT/CT and 18F-FDG-PET/CT for the detection of bone metastases from differentiated thyroid cancer[J].
Nucl Med Commun,
2012,
33(
12):
1232-
1242.
DOI: 10.1097/MNM.0b013e328358d9c0.
[20]
.
The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT[J].
J Nucl Med,
2006,
47(
2):
287-
297.
[21]
.
Metabolic activity in bone metastases of breast and prostate cancer were similar as studied by 18F-FDG PET/CT. The role of 99mTc-MDP[J].
Hell J Nucl Med,
2017,
20(
3):
237-
240.
DOI: 10.1967/s002449910608.
[22]
.
Assessment of a combined panel of six serum tumor markers for lung cancer[J].
Am J Respir Crit Care Med,
2016,
193(
4):
427-
437.
DOI: 10.1164/rccm.201404-0603OC.
[23]
.
单独与联合检测四项肺癌血清肿瘤标志物在肺癌诊断中的价值[J].
中华内科杂志,
2016,
55(
1):
25-
30.
DOI: 10.3760/cma.j.issn.0578-1426.2016.01.007.
. The diagnostic significance of single or combination lung cancer-related serum biomarkers in high risk lung cancer patients[J]. Zhonghua Nei Ke Za Zhi, 2016, 55(1): 25-30. DOI: 10.3760/cma.j.issn.0578-1426.2016.01.007.
[24]
.
Role of a serum-based biomarker panel in the early diagnosis of lung cancer for a cohort of high-risk patients[J].
Cancer,
2015,
121
Suppl 17:
3113-
3121.
DOI: 10.1002/cncr.29551.
[25]
.
Biomarkers along the continuum of care in lung cancer[J].
Scand J Clin Lab Invest Suppl,
2016,
245:
S40-
S45.
DOI: 10.1080/00365513.2016.1208446.
[26]
. China experts consensus on the diagnosis and treatment of advanced stage primary lung cancer (2016 version)[J]. Chinese Journal of Lung Cancer, 2016, 19(1):1-15. DOI: 10.3779/j.issn.1009-3419.2016.01.01.
[27]
.
Prognostic value of tumor markers, NSE, CA125 and SCC, in operable NSCLC patients[J].
Int J Mol Sci,
2013,
14(
6):
11145-
11156.
DOI: 10.3390/ijms140611145.
[28]
.
Preoperative serum CYFRA 21-1 level as a prognostic factor in surgically treated adenocarcinoma of lung[J].
Lung Cancer,
2013,
79(
2):
156-
160.
DOI: 10.1016/j.lungcan.2012.11.006.
[29]
.
Preoperative CYFRA 21-1 and CEA as prognostic factors in patients with stage I non-small cell lung cancer[J].
Lung Cancer,
2011,
74(
1):
112-
117.
DOI: 10.1016/j.lungcan.2011.02.001.
[30]
.
Prognostic significance of tumour marker index based on preoperative CEA and CYFRA 21-1 in non-small cell lung cancer[J].
2010,
30(
7):
3099-
3102.
[31]
.
Preoperative CYFRA 21-1 and CEA as prognostic factors in patients with stage I non-small cell lung cancer: external validation of a prognostic score[J].
Tumour Biol,
2008,
29(
4):
272-
277.
DOI: 10.1159/000152945.
[32]
.
Preoperative CYFRA 21-1 levels as a prognostic factor in c-stage I non-small cell lung cancer[J].
Eur J Cardiothorac Surg,
2007,
32(
4):
648-
652.
DOI: 10.1016/j.ejcts.2007.06.032.
[33]
.
Meta-analysis of serum gastrin-releasing peptide precursor as a biomarker for diagnosis of small cell lung cancer[J].
Asian Pac J Cancer Prev,
2017,
18(
2):
391-
397.
DOI: 10.22034/APJCP.2017.18.2.391.
[34]
.
Serum pro-gastrin-releasing peptide in diagnosis of small cell lung cancer: A meta-analysis[J].
J Cancer Res Ther,
2016,
12(
Supple ment):
C260-
C263.
DOI: 10.4103/jcrt.JCRT_1118_16.
[35]
.
Routine bone scans in patients with prostate cancer related to serum prostate-specific antigen and alkaline phosphatase[J].
BJU Int,
2001,
88(
3):
226-
230.
DOI: 10.1046/j.1464-410x.2001.02275.x.
[36]
.
良性前列腺增生与前列腺癌患者血清总PSA水平与游离PSA比值的比较[J].
中华泌尿外科杂志,
2002,
23(
6):
354-
357.
. Serum total PSA and the ratio of free to total PSA in patients of benign prostatic hyperplasia and prostate cancer[J]. Chin J Urol, 2002, 23(6): 354-357.
[37]
.
Embryonal antigens and cancer of the liver in man. Association of serum alpha 1-fetoprotein with primary hepatoma[J].
C R Acad Hebd Seances Acad Sci D,
1967,
265(
1):
75-
78.
[38]
.
Elevated alpha-fetoprotein: differential diagnosis - hepatocellular carcinoma and other disorders[J].
Clin Liver Dis,
2015,
19(
2):
309-
323.
DOI: 10.1016/j.cld.2015.01.005.
[39]
.
Importance of biopsy of new bone lesions in patients with previous carcinoma[J].
Clin Orthop Relat Res,
2006,
451:
208-
211.
DOI: 10.1097/01.blo.0000229296.52216.77.
[40]
.
The need for bone biopsies in the diagnosis of new bone lesions in patients with a known primary malignancy: A comparative review of 117 biopsy cases[J].
J Bone Oncol,
2018,
14:
100213.
DOI: 10.1016/j.jbo.2018.100213.
[41]
.
Percutaneous biopsy of the musculoskeletal system: a review of 77 cases[J].
Can Assoc Radiol J,
1999,
50(
2):
121-
125.
[42]
.
Core needle biopsy for bone tumours[J].
Eur J Surg Oncol,
2001,
27(
7):
668-
671.
DOI: 10.1053/ejso.2001.1198.
[43]
.
Percutaneous needle biopsy of musculoskeletal lesions. 1. Effective accuracy and diagnostic utility. AJR American journal of roentgenology[J].
1992,
158(
4):
809-
812.
DOI: 10.2214/ajr.158.4.1546597.
[44]
.
Technique and results of CT-guided percutaneous bone biopsy[J].
Orthopade,
2001,
30(
8):
545-
550.
DOI: 10.1007/s001320170064.
[45]
.
Journalclub: utility of repeat core needle biopsy of musculoskeletal lesions with initially nondiagnostic findings[J].
AJR Am J Roentgenol,
2017,
208(
3):
609-
616.
DOI: 10.2214/AJR.16.16220.
[46]
.
Prognostic factors and a scoring system for patients with skeletal metastasis[J].
J Bone Joint Surg Br,
2005,
87(
5):
698-
703.
DOI: 10.1302/0301-620X.87B5.15185.
[47]
.
New prognostic factors and scoring system for patients with skeletal metastasis[J].
Cancer Med,
2014,
3(
5):
1359-
1367.
DOI: 10.1002/cam4.292.
[48]
.
Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network[J].
PLoS One,
2011,
6(
5):
e19956.
DOI: 10.1371/journal.pone.0019956.
[49]
.
Can a multivariate model for survival estimation in skeletal metastases (PATHFx) be externally validated using japanese patients?[J].
Clin Orthop Relat Res,
2017,
475(
9):
2263-
2270.
DOI: 10.1007/s11999-017-5389-3.
[50]
.
An easy-to-use prognostic model for survival estimation for patients with symptomatic long bone metastases[J].
J Bone Joint Surg Am,
2018,
100(
3):
196-
204.
DOI：10.2106/JBJS.16.01514.
[51]
.
2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?[J].
Clin Orthop Relat Res,
2015,
473(
10):
3112-
3121.
DOI: 10.1007/s11999-015-4446-z.
[52]
.
External validation and optimization of the SPRING model for prediction of survival after surgical treatment of bone metastases of the extremities[J].
Clin Orthop Relat Res,
2018,
476(
8):
1591-
1599.
DOI: 10.1097/01.blo.0000534678.44152.ee.
[53]
.
Treating metastatic disease: Which survival model is best suited for the clinic?[J].
Clin Orthop Relat Res,
2013,
471(
3):
843-
850.
DOI: 10.1007/s11999-012-2577-z.
[54]
.
How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations[J].
BMC Cancer,
2015,
15:
424.
DOI: 10.1186/s12885-015-1396-5.
[55]
.
External validation of the Bayesian Estimated Tools for Survival (BETS) models in patients with surgically treated skeletal metastases[J].
BMC Cancer,
2012,
12:
493.
DOI: 10.1186/1471-2407-12-493.
[56]
.
Can we estimate short- and intermediate-term survival in patients undergoing surgery for metastatic bone disease? [J].
Clin Orthop Relat Res,
2017,
475(
4):
1252-
1261.
DOI: 10.1007/s11999-016-5187-3.
[57]
.
Prediction of survival after surgical management of femoral metastatic bone disease - A comparison of prognostic models[J].
J Bone Oncol,
2019,
15:
100225.
DOI: 10.1016/j.jbo.2019.100225.
[58]
.
Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures[J].
Clin Orthop Relat Res,
1989(
249):
256-
264.
[59]
.
Critical evaluation of Mirels' rating system for impending pathologic fractures[J].
Clin Orthop Relat Res,
2003(
415
Suppl):
S201-
S207.
DOI: 10.1097/01.blo.0000093842.72468.73
[60]
.
Treatment planning and fracture prediction in patients with skeletal metastasis with ct-based rigidity analysis[J].
Clin Cancer Res,
2015,
21(
11):
2514-
2519.
DOI: 10.1158/1078-0432.CCR-14-2668.
[61]
.
Pathologic fractures correlate with reduced survival in patients with malignant bone disease[J].
Cancer,
2007,
110(
8):
1860-
1867.
DOI: 10.1002/cncr.22991.
[62]
.
The role of the orthopaedic surgeon in metastatic disease of the appendicular skeleton. Working Party on Metastatic Bone Disease in Breast Cancer in the UK[J].
J Bone Joint Surg Br,
1999,
81(
1):
1-
2.
DOI: 10.1302/0301-620x.81b1.9514.
[63]
.
Function and health status in surgically treated bone metastases[J].
Clin Orthop Relat Res,
2005,
438:
215-
220.
DOI: 10.1097/01.blo.0000170721.07088.2e.
[64]
.
Surgical treatment of metastatic tumors of the femur[J].
Medicina (Kaunas),
2010,
46(
5):
323-
328.
[65]
.
Complications and survival after surgical treatment of 214 metastatic lesions of the humerus[J].
J Shoulder Elbow Surg,
2012,
21(
8):
1049-
1055.
DOI: 10.1016/j.jse.2011.06.019.
[66]
.
Surgical interventions for cancer patients with impending or actual pathologic fractures[J].
Orthop Nurs,
2008,
27(
3):
160-
173.
DOI: 10.1097/01.NOR.0000320543.90115.d5.
[67]
.
The multi-modal approach to metastatic diseases//Bentley G, ed. European intructional lectures, vol. 12[M].
Berlin, Heidelberg:
Springer,
2012:
35-
44.
[68]
.
Metastatic fractures of long limb bones[J].
Orthop Traumatol Surg Res,
2017,
103(
1S):
S41-
S51.
DOI: 10.1016/j.otsr.2016.11.001.
[69]
.
Trends in the surgical treatment of pathological fractures of the long bones: based on a questionnaire among members of the Dutch Orthopaedic Society and the European Musculo-Skeletal Oncology Society (EMSOS)[J].
Bone Joint J,
2018,
100-B(
10):
1392-
1398.
DOI: 10.1302/0301-620X.100B10.BJJ-2018-0239.R1.
[70]
.
Surgical management of metastatic bone disease[J].
J Bone Joint Surg Am,
2009,
91(
6):
1503-
1516.
DOI: 10.2106/JBJS.H.00175.
[71]
.
Treatment of pathological fractures of the long bones[J].
EFORT Open Rev,
2017,
1(
5):
136-
145.
DOI: 10.1302/2058-5241.1.000008.
[72]
.
Prognostic role of en-bloc resection and late onset of bone metastasis in patients with bone-seeking carcinomas of the kidney, breast, lung, and prostate: SSG study on 672 operated skeletal metastases[J].
J Surg Oncol,
2014,
110(
4):
360-
365.
DOI: 10.1002/jso.23654.
[73]
.
Bone metastases from renal cell carcinoma: patient survival after surgical treatment[J].
BMC Musculoskelet Disord,
2010,
11:
145.
DOI: 10.1186/1471-2474-11-145.
[74]
.
Long-term patient survival after the surgical treatment of bone and soft-tissue metastases from renal cell carcinoma[J].
Bone Joint J,
2018,
100-B(
9):
1241-
1248.
DOI: 10.1302/0301-620X.100B9.BJJ-2017-1163.R3.
[75]
.
Patient survival after surgery for osseous metastases from renal cell carcinoma[J].
J Bone Joint Surg Am,
2007,
89(
8):
1794-
1801.
DOI: 10.2106/JBJS.F.00603.
[76]
.
Treatment and survival of osseous renal cell carcinoma metastases[J].
J Surg Oncol,
2012,
106(
7):
850-
855.
DOI: 10.1002/jso.23134.
[77]
.
Metastases of the pelvis: does resection improve survival?[J].
Orthopedics,
2011,
34(
7):
e236-
e244.
DOI: 10.3928/01477447-20110526-07.
[78]
.
Prognostic factors and surgical treatment of osseous metastases secondary to renal cell carcinoma[J].
Cancer,
1997,
80(
6):
1103-
1109.
[79]
.
Treatment of osseous metastases in patients with renal cell carcinoma[J].
Clin Orthop Relat Res,
2003(
409):
223-
231.
DOI:10.1097/01.blo.0000059580.08469.3e.
[80]
.
Prognosis of renal cell carcinoma with bone metastases: Experience from a large cancer centre[J].
Eur J Cancer,
2019,
107:
79-
85.
DOI: 10.1016/j.ejca.2018.10.023.
[81]
.
Survival and complications of skeletal reconstructions after surgical treatment of bony metastatic renal cell carcinoma[J].
Eur J Surg Oncol,
2015,
41(
7):
886-
892.
DOI: 10.1016/j.ejso.2015.04.008.
[82]
.
Treatment for long bone metastases based on a systematic literature review[J].
Eur J Orthop Surg Traumatol,
2017,
27(
2):
205-
211.
DOI: 10.1007/s00590-016-1857-9.
[83]
.
Incidence of bone metastases and survival after a diagnosis of bone metastases in breast cancer patients[J].
Cancer Epidemiol,
2014,
38(
4):
427-
434.
DOI: 10.1016/j.canep.2014.05.005.
[84]
.
Metastatic breast carcinoma confined to bone: portrait of a clinical entity[J].
Cancer,
2004,
101(
7):
1524-
1528.
DOI: 10.1002/cncr.20545.
[85]
.
Characterization of bone only metastasis patients with respect to tumor subtypes[J].
NPJ Breast Cancer,
2018,
4:
2.
DOI: 10.1038/s41523-018-0054-x.
[86]
.
Prognostic factors in patients with metastatic breast cancer with bone-only metastases[J].
Oncologist,
2018,
23(
11):
1282-
1288.
DOI: 10.1634/theoncologist.2018-0085.
[87]
.
Analysis of orthopedic surgery of bone metastases in breast cancer patients[J].
BMC Musculoskelet Disord,
2012,
13:
232.
DOI: 10.1186/1471-2474-13-232.
[88]
.
Factors associated with local recurrence after surgery for bone metastasis to the extremities[J].
J Surg Oncol,
2018,
117(
4):
797-
804.
DOI: 10.1002/jso.24880.
[89]
.
Predictors of survival in patients with bone metastasis of lung cancer[J].
Clin Orthop Relat Res,
2008,
466(
3):
729-
736.
DOI: 10.1007/s11999-007-0051-0.
[90]
.
Should the use of biologic agents in patients with renal and lung cancer affect our surgi cal management of femoral metastases?[J].
Clin Orthop Relat Res,
2019,
477(
4):
707-
714.
DOI: 10.1097/CORR.0000000000000434.
[91]
.
Diagnostic algorithm, prognostic factors and surgical treatment of metastatic cancer diseases of the long bones and spine[J].
EFORT Open Rev,
2017,
2(
9):
372-
381.
DOI: 10.1302/2058-5241.2.170006.
[92]
.
Endoprostheses last longer than intramedullary devices in proximal femur metastases[J].
Clin Orthop Relat Res,
2012,
470(
3):
684-
691.
DOI: 10.1007/s11999-011-2038-0.
[93]
.
Metastatic disease in long bones: Review of surgical treatment options[J].
Unfallchirurg,
2018,
121(
1):
37-
46.
DOI: 10.1007/s00113-016-0282-1.
[94]
.
Surgical treatment of skeletal metastatic lesions of the proximal femur: endoprosthesis or reconstruction nail?[J].
J Bone Joint Surg Br,
2005,
87(
12):
1653-
1657.
DOI: 10.1302/0301-620X.87B12.16629.
[95]
.
Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients[J].
J Trauma,
2009,
66(
4):
1158-
1163.
DOI: 10.1097/TA.0b013e3181622bca.
[96]
.
Prophylactic stabilization for bone metastases, myeloma, or lymphoma: do we need to protect the entire bone? [J].
Clin Orthop Relat Res,
2013,
471(
3):
706-
714.
DOI: 10.1007/s11999-012-2656-1.
[97]
.
Endoprostheses last longer than intramedullary devices in proximal femur metastases[J].
Clin Orthop Relat Res,
2012,
470(
3):
684-
691.
DOI: 10.1007/s11999-011-2038-0.
[98]
.
Endoprosthetic treatment is more durable for pathologic proximal femur fractures[J].
Clin Orthop Relat Res,
2012,
470(
3):
920-
926.
DOI: 10.1007/s11999-011-2047-z.
[99]
.
Protocol of surgical treatment of long bone pathological fractures[J].
Injury,
2010,
41(
11):
1161-
1167.
DOI: 10.1016/j.injury.2010.09.018.
[100]
.
Proximal femoral endoprosthesis for the treatment of metastatic[J].
Orthopedics,
2008,
31(
4):
361.
DOI: 10.3928/01477447-20080401-03.
[101]
.
Modular endoprosthetic replacement for tumours of the proximal femur[J].
J Bone Joint Surg Br,
2009,
91(
1):
108-
112.
DOI: 10.1302/0301-620X.91B1.20448.
[102]
.
Cemented endoprosthetic replacement for metastatic bone disease in the proximal femur[J].
J Arthroplasty,
2008,
23(
1):
112-
117.
DOI: 10.1016/j.arth.2006.11.016.
[103]
.
The use of massive endoprostheses for the treatment of bone metastases[J].
Sarcoma,
2007,
2007:
62151.
DOI: 10.1155/2007/62151.
[104]
.
Surgical treatment of metastatic fractures of the femur: a retrospective analysis of 142 patients[J].
J Trauma,
2009,
66(
4):
1158-
1163.
DOI: 10.1097/TA.0b013e3181622bca.
[105]
.
Proximal femoral re placement for metastatic bone disease[J].
Orthopedics,
2007,
30(
5):
384-
388.
DOI: 10.3928/01477447-20070501-09.
[106]
.
Results of the treatment of bone metastases with modular prosthetic replacement--analysis of 67 patients[J].
J Orthop Surg Res,
2016,
11:
20.
DOI: 10.1186/s13018-016-0353-6.
[107]
.
Metastatic fractures of the tibia[J].
Acta Orthop Belg,
2001,
67(
1):
54-
59.
[108]
.
股骨近端转移瘤病理性骨折20例外科治疗[J].
中国骨肿瘤骨病,
2010,
9(
6):
492-
494.
DOI: 10.3969/j.issn.1671-1971.2010.06.006.
. Surgical treatment of pathological fracture in 20 patients with proximal femoral metastatic tumor[J]. Chin J Bone Tumor & Bone Disease, 2010, 9(6): 492-494. DOI: 10.3969/j.issn.1671-1971.2010.06.006.
[109]
. Surgical Treatments of Metastasis in Limbs[J]. West China Medical Journal, 2007, 22(1): 80-82. DOI: 1002-0179(2007)01-0080-03.
[110]
.
61例肢体转移癌的外科治疗[J].
中国骨肿瘤骨病,
2004,
3(
6):
330-
334.
. Surgery of metastases in limbs of 61 patients[J]. Chin J Bone Tumor & Bone Disease, 2004, 3(6):330-334.
[111]
.
Modular tumor endoprostheses in surgical palliation of long-bone metastases: a reduction in tumor burden and a durable reconstruction[J].
World J Surg Oncol,
2014,
12:
330.
DOI: 10.1186/1477-7819-12-330.
[112]
.
Intramedullary nailing for treatment of pathologic femoral fractures due to metastases[J].
Injury,
2014,
45(
2):
412-
417.
DOI: 10.1016/j.injury.2013.09.025.
[113]
.
Treatment of impending and actual pathological femoral fractures with the long Gamma nail in The Netherlands[J].
Eur J Surg,
2000,
166(
3):
247-
254.
DOI: 10.1080/110241500750009366.
[114]
.
Intramedullary nails for long bone metastases: why do they fail? [J].
Orthopedics,
2011,
34(
4).
DOI: 10.3928/01477447-20110228-12.
[115]
.
The outcome of locking plate fixation for the treatment of periarticular metastases[J].
Acta Orthop Belg,
2011,
77(
3):
362-
370.
[116]
.
Outcomes of a modular intercalary endoprosthesis as treatment for segmental defects of the femur, tibia, and humerus[J].
Clin Orthop Relat Res,
2016,
474(
2):
539-
548.
DOI: 10.1007/s11999-015-4588-z.
[117]
.
Does the second-generation intercalary humeral spacer improve on the first?[J].
Clin Orthop Relat Res,
2008,
466(
6):
1309-
1317.
DOI: 10.1007/s11999-008-0246-z.
[118]
.
Fixation of pathological humeral fractures by the cemented plate technique[J].
J Bone Joint Surg Br,
2011,
93(
8):
1093-
1097.
DOI: 10.1302/0301-620X.93B8.26194.
[119]
.
Modular prostheses in the treatment of proximal humerus metastases: review of 40 cases[J].
J Orthop Traumatol,
2008,
9(
1):
5-
10.
DOI: 10.1007/s10195-008-0097-0.
[120]
.
Prognostic and risk factors in patients with metastatic bone disease of an upper extremity[J].
J Bone Oncol,
2018,
13:
71-
75.
DOI: 10.1016/j.jbo.2018.09.007.
[121]
.
Endoprosthetic elbow replacement in patients with solitary metastasis resulting from renal cell carcinoma[J].
J Shoulder Elbow Surg,
2004,
13(
6):
656-
663.
DOI: 10.1016/j.jse.2004.05.001.
[122]
.
Endoprosthetic replacement of the distal humerus following resection of bone tumours[J].
J Bone Joint Surg Br,
2007,
89(
11):
1498-
1503.
DOI: 10.1302/0301-620X.89B11.19577.
[123]
.
Surgical treatment of pathologic fractures of humerus[J].
Injury,
2010,
41(
11):
1112-
1116.
DOI: 10.1016/j.injury.2010.08.015.
[124]
.
Surgical treatment in bone metastases in the appendicular skeleton[J].
Rev Esp Cir Ortop Traumatol,
2018,
62(
3):
185-
189.
DOI: 10.1016/j.recot.2017.12.001.
[125]
.
Bone metastases of the hand[J].
Ann R Coll Surg Engl,
2017,
99(
7):
563-
567.
DOI: 10.1308/rcsann.2017.0096.
[126]
.
Is forequarter amputation justified for palliation of intractable cancer symptoms?[J].
Oncology,
2001,
60(
1):
55-
59.
DOI: 10.1159/000055297.
[127]
.
Major amputations done with palliative intent in the treatment of local bony complications associated with advanced cancer[J].
J Surg Oncol,
2001,
47(
2):
121-
130.
DOI: 10.1002/jso.2930470212.
[128]
.
Major upper-limb amputations for malignant tumors[J].
J Hand Surg Am,
2012,
37(
6):
1235-
1241.
DOI: 10.1016/j.jhsa.2012.02.004.
[129]
.
Palliative forequarter amputation for metastatic carcinoma to the shoulder girdle region: indications, preoperative evaluation, surgical technique, and results[J].
J Surg Oncol,
2001,
77(
2):
105-
114.
DOI: 10.1002/jso.1079.
[130]
.
Bone radiofrequency ablation combined with prophylactic internal fixation for metastatic bone tumor of the femur from hepatocellular carcinoma[J].
Int J Clin Oncol,
2012,
17(
4):
417-
421.
DOI: 10.1007/s10147-011-0319-y.
[131]
.
Preoperative radiofrequency ablation in painful osteolytic long bone metastases[J].
Acta Orthop Belg,
2012,
78(
4):
523-
530.
[132]
.
Preoperative percutaneous microwave ablation of long bone metastases using a parallel medullary approach for reduction of operative blood loss[J].
J Vasc Interv Radiol,
2017,
28(
7):
1069-
1071.
DOI: 10.1016/j.jvir.2017.03.004.
[133]
.
Role of postoperative radiation therapy after stabilization of fractures caused by metastatic disease[J].
Int J Radiat Oncol Biol Phys,
1995,
31(
1):
43-
49.
DOI: 10.1016/0360-3016(94)E0310-G.
[134]
.
Radiotherapy, bisphosphonates and surgical stabilization of complete or impending pathologic fractures in patients with metastatic bone disease[J].
J Cancer,
2016,
7(
1):
121-
124.
DOI: 10.7150/jca.13377.
[135]
.
Postoperative radiation therapy for osseous metastasis: Outcomes and predictors of local failure[J].
Pract Radiat Oncol,
2015,
5(
5):
e531-
e536.
DOI: 10.1016/j.prro.2015.02.006.
[136]
.
Efficacy of postoperative radiation treatment for bone metastases in the extremities[J].
Radiother Oncol,
2017,
124(
1):
45-
48.
DOI: 10.1016/j.radonc.2017.05.010.
[137]
.
General principles of external beam radiation therapy for skeletal metastases[J].
Clin Orthop Relat Res,
2003(
415
Suppl):
S158-
S164.
DOI: 10.1097/01.blo.0000093057.96273.fb.
[138]
.
Management of bone disease in multiple myeloma[J].
Expert Rev Hematol,
2014,
7(
1):
113-
125.
DOI: 10.1586/17474086.2013.874943.
[139]
.
Bone health in cancer patients: ESMO Clinical Practice Guide lines[J].
Ann Oncol,
2014,
25
Suppl 3:
iii124-
iii137.
DOI: 10.1093/annonc/mdu103.
[140]
.
Risks and benefits of bisphosphonates[J].
Br J Cancer，
2008,
98(
11):
1736-
1740.
DOI: 10.1038/sj.bjc.6604382.
[141]
.
Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial[J].
Cancer,
2004,
100(
12):
2613-
2621.
DOI: 10.1002/cncr.20308.
[142]
.
Long-term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer[J].
J Natl Cancer Inst,
2004,
96(
11):
879-
882.
DOI: 10.1093/jnci/djh141.
[143]
.
Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel[J].
Ann Oncol,
2008,
19(
3):
420-
432.
DOI: 10.1093/annonc/mdm442.
[144]
.
Long-term prevention of skeletal complications of metastatic breast cancer with pamidronate. Protocol 19 Aredia Breast Cancer Study Group[J].
J Clin Oncol,
1998,
16(
6):
2038-
2044.
DOI: 10.1200/JCO.1998.16.6.2038.
[145]
.
Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial. Protocol 18 Aredia Breast Cancer Study Group[J].
J Clin Oncol,
1999,
17(
3):
846-
854.
DOI: 10.1200/JCO.1999.17.3.846.
[146]
.
Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Myeloma Aredia Study Group[J].
N Engl J Med,
1996,
334(
8):
488-
493.
DOI: 10.1056/NEJM199602223340802.
[147]
.
A randomized trial of the effect of clodronate on skeletal morbidity in multiple myeloma. MRC Working Party on Leukaemia in Adults[J].
Br J Haematol,
1998,
100(
2):
317-
325.
DOI: 10.1046/j.1365-2141.1998.00567.x.
[148]
.
Oral ibandronate reduces the risk of skeletal complications in breast cancer patients with metastatic bone disease: results from two randomised, placebo-controlled phase III studies[J].
Br J Cancer，
2004,
90(
6):
1133-
1137.
DOI: 10.1038/sj.bjc.6601663.
[149]
.
Oral ibandronic acid versus intravenous zoledronic acid in treatment of bone metastases from breast cancer: a randomised, open label, non-inferiority phase 3 trial[J].
Lancet Oncol,
2014,
15(
1):
114-
122.
DOI: 10.1016/S1470-2045(13)70539-4.
[150]
.
Intravenous ibandronate reduces the incidence of skeletal complications in patients with breast cancer and bone metastases[J].
Ann Oncol,
2003,
14(
9):
1399-
1405.
DOI: 10.1093/annonc/mdg367.
[151]
.
Bisphosphonates and other bone agents for breast cancer[J].
Cochrane Database Syst Rev,
2017,
10:
CD003474.
DOI: 10.1002/14651858.CD003474.pub4.
[152]
.
Meta-analysis comparing denosumab and zoledronic acid for treatment of bone metastases in patients with advanced solid tumours[J].
Eur J Cancer Care (Engl),
2017,
26(
6).
DOI: 10.1111/ecc.12541.
[153]
.
Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study[J].
Lancet,
2011,
377(
9768):
813-
822.
DOI: 10.1016/S0140-6736(10)62344-6.
[154]
.
Denosumab compared with zoledronic acid for the treatment of bone metastases in patients with advanced breast cancer: a randomized, double-blind study[J].
J Clin Oncol,
2010,
28(
35):
5132-
5139.
DOI: 10.1200/JCO.2010.29.7101.
[155]
.
Delaying skeletal-related events in a randomized phase 3 study of denosumab versus zoledronic acid in patients with advanced cancer: an analysis of data from patients with solid tumors[J].
Support Care Cancer,
2014,
22(
3):
679-
687.
DOI: 10.1007/s00520-013-2022-1.
[156]
.
Denosumab versus bisphosphonates in patients with advanced cancers-related bone metastasis: systematic review and meta-analysis of randomized controlled trials.
Support Care Cancer,
2018,
26(
4):
1029-
1038.
DOI: 10.1007/s00520-018-4060-1.
[157]
.
A comprehensive review of denosumab for bone metastasis in patients with solid tumors.
Curr Med Res Opin,
2016,
32(
1):
133-
145.
DOI: 10.1185/03007995.2015.1105795.
[158]
.
Randomized phase II trial of denosumab in patients with bone metastases from prostate cancer, breast cancer, or other neoplasms after intravenous bisphosphonates.
J Clin Oncol,
2009,
27(
10):
1564-
1571.
DOI: 10.1200/JCO.2008.19.2146.
