Survival Benefits of Primary Tumor Surgery in Diverse Cancer Types with Synchronous Bone Metastases: A Retrospective Real-World Analysis Using Propensity Score Matching from a 3P Medicine Perspective

Abstract

Abstract Background: Bone metastasis (BM) is a common occurrence significantly impacting their quality of life and overall survival, and the role of primary site surgery (PTS) is also mentioned. However, the specific diagnostic and treatment model for PTS needs to be elucidated in order to transition from reactive medicine toward a step-by-step approach to predictive, preventive, and personalized medicine (PPPM). This study aims to investigate the potential survival advantages associated with PTS in patients with varying cancer types presenting concurrent BMs. Methods: A comprehensive analysis was conducted on patients exhibiting exclusive BM, encompassing data from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2010 to 2019. Specifically, we focused on BMs originating from multiple cancers, and patients were categorized into PTS group or its absence (No PTS). Employing propensity score matching (PSM), we meticulously compared the overall survival (OS) and cancer-specific survival (CSS) rates between these two cohorts. Additionally, we examined survival outcomes after patients experienced diverse surgical and treatment modalities. Furthermore, we conducted subgroup analysis to explore target populations suitable for PTS. Results: 53,015 patients were encompassed within this study. Breast cancer, renal cell carcinoma, bladder cancer, and lung cancer patients with BM were more inclined to undergo PTS. Across different cancer types, the choice of surgical approach and extent of resection exhibited heterogeneity in survival prognosis. Substantial enhancement in survival was observed in patients presenting early-stage and lower-grade metastases upon undergoing PTS.