Background
Methods
Study design and population
Data collection
Statistical analysis
Results
Participant characteristics
Variables | 3-year follow-up | 5-year follow-up | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total (n = 425) | Alive (n = 306) | Dead (n = 119) | Statistics | P | Total (n = 320) | Alive (n = 180) | Dead (n = 140) | Statistics | P | |
Metastasis type, n (%) | χ2 = 7.89 | 0.019 | χ2 = 8.98 | 0.011 | ||||||
Liver | 62 (14.59) | 52 (16.99) | 10 (8.40) | 44 (13.75) | 33 (18.33) | 11 (7.86) | ||||
Bone | 289 (68.00) | 208 (67.97) | 81 (68.07) | 223 (69.69) | 123 (68.33) | 100 (71.43) | ||||
Liver and Bone | 74 (17.41) | 46 (15.03) | 28 (23.53) | 53 (16.56) | 24 (13.33) | 29 (20.71) | ||||
Age, n (%) | χ2 = 0.01 | 0.923 | χ2 = 0.24 | 0.626 | ||||||
< 3 years | 252 (59.29) | 181 (59.15) | 71 (59.66) | 190 (59.38) | 109 (60.56) | 81 (57.86) | ||||
≥ 3 years | 173 (40.71) | 125 (40.85) | 48 (40.34) | 130 (40.63) | 71 (39.44) | 59 (42.14) | ||||
Sex, n (%) | χ2 = 0.24 | 0.627 | χ2 = 0.06 | 0.810 | ||||||
Female | 192 (45.18) | 136 (44.44) | 56 (47.06) | 151 (47.19) | 86 (47.78) | 65 (46.43) | ||||
Male | 233 (54.82) | 170 (55.56) | 63 (52.94) | 169 (52.81) | 94 (52.22) | 75 (53.57) | ||||
Race, n (%) | χ2 = 0.09 | 0.957 | χ2 = 0.55 | 0.759 | ||||||
Black | 64 (15.06) | 46 (15.03) | 18 (15.13) | 56 (17.50) | 34 (18.89) | 22 (15.71) | ||||
White | 314 (73.88) | 227 (74.18) | 87 (73.11) | 228 (71.25) | 126 (70.00) | 102 (72.86) | ||||
Others | 47 (11.06) | 33 (10.78) | 14 (11.76) | 36 (11.25) | 20 (11.11) | 16 (11.43) | ||||
Tumor site, n (%) | χ2 = 5.14 | 0.162 | χ2 = 5.72 | 0.126 | ||||||
Soft tissue | 68 (16.00) | 56 (18.30) | 12 (10.08) | 51 (15.94) | 36 (20.00) | 15 (10.71) | ||||
Adrenal gland | 296 (69.65) | 210 (68.63) | 86 (72.27) | 226 (70.63) | 123 (68.33) | 103 (73.57) | ||||
Retroperitoneum | 39 (9.18) | 25 (8.17) | 14 (11.76) | 28 (8.75) | 13 (7.22) | 15 (10.71) | ||||
Others | 22 (5.18) | 15 (4.90) | 7 (5.88) | 15 (4.69) | 8 (4.44) | 7 (5.00) | ||||
Tumor size, n (%) | χ2 = 10.05 | 0.007 | χ2 = 15.74 | < 0.001 | ||||||
< 5 cm | 71 (16.71) | 62 (20.26) | 9 (7.56) | 49 (15.31) | 38 (21.11) | 11 (7.86) | ||||
≥ 5 cm | 217 (51.06) | 151 (49.35) | 66 (55.46) | 184 (57.50) | 105 (58.33) | 79 (56.43) | ||||
Unknown | 137 (32.24) | 93 (30.39) | 44 (36.97) | 87 (27.19) | 37 (20.56) | 50 (35.71) | ||||
Grade, n (%) | χ2 = 4.96 | 0.084 | χ2 = 4.85 | 0.089 | ||||||
Grade I/II/III | 223 (52.47) | 168 (54.90) | 55 (46.22) | 167 (52.19) | 101 (56.11) | 66 (47.14) | ||||
Grade IV | 30 (7.06) | 17 (5.56) | 13 (10.92) | 24 (7.50) | 9 (5.00) | 15 (10.71) | ||||
Unknown | 172 (40.47) | 121 (39.54) | 51 (42.86) | 129 (40.31) | 70 (38.89) | 59 (42.14) | ||||
Surgery for the primary site, n (%) | χ2 = 0.26 | 0.609 | χ2 = 1.27 | 0.260 | ||||||
No | 111 (26.12) | 82 (26.80) | 29 (24.37) | 76 (23.75) | 47 (26.11) | 29 (20.71) | ||||
Yes | 314 (73.88) | 224 (73.20) | 90 (75.63) | 244 (76.25) | 133 (73.89) | 111 (79.29) | ||||
Surgery for other regional or distant sites, n (%) | χ2 = 4.19 | 0.041 | χ2 = 4.49 | 0.034 | ||||||
No | 338 (79.53) | 251 (82.03) | 87 (73.11) | 255 (79.69) | 151 (83.89) | 104 (74.29) | ||||
Yes | 87 (20.47) | 55 (17.97) | 32 (26.89) | 65 (20.31) | 29 (16.11) | 36 (25.71) | ||||
Chemotherapy, n (%) | - | 0.510 | - | 0.761 | ||||||
No/unknown | 11 (2.59) | 7 (2.29) | 4 (3.36) | 11 (3.44) | 7 (3.89) | 4 (2.86) | ||||
Yes | 414 (97.41) | 299 (97.71) | 115 (96.64) | 309 (96.56) | 173 (96.11) | 136 (97.14) | ||||
Radiation, n (%) | χ2 = 0.01 | 0.945 | χ2 = 0.22 | 0.642 | ||||||
No/unknown | 231 (54.35) | 166 (54.25) | 65 (54.62) | 167 (52.19) | 96 (53.33) | 71 (50.71) | ||||
Yes | 194 (45.65) | 140 (45.75) | 54 (45.38) | 153 (47.81) | 84 (46.67) | 69 (49.29) | ||||
Brain metastasis, n (%) | χ2 = 5.69 | 0.017 | χ2 = 6.79 | 0.009 | ||||||
No | 384 (90.35) | 283 (92.48) | 101 (84.87) | 286 (89.38) | 168 (93.33) | 118 (84.29) | ||||
Yes | 41 (9.65) | 23 (7.52) | 18 (15.13) | 34 (10.63) | 12 (6.67) | 22 (15.71) | ||||
Lung metastasis, n (%) | χ2 = 10.65 | 0.001 | χ2 = 4.18 | 0.041 | ||||||
No | 377 (88.71) | 281 (91.83) | 96 (80.67) | 279 (87.19) | 163 (90.56) | 116 (82.86) | ||||
Yes | 48 (11.29) | 25 (8.17) | 23 (19.33) | 41 (12.81) | 17 (9.44) | 24 (17.14) | ||||
Follow-up time, months, M (Q1, Q3) | 36.00 (27.00, 36.00) | 36.00 (36.00, 36.00) | 14.00 (10.00, 22.00) | Z = -20.23 | < 0.001 | 60.00 (19.00, 60.00) | 60.00 (60.00, 60.00) | 17.00 (10.00, 27.00) | Z = -16.93 | < 0.001 |
Characteristics of patients with bone or liver metastasis
Variables | 3-year follow-up | 5-year follow-up | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Liver metastasis alone (n = 62) | Bone metastasis alone (n = 289) | Bone metastasis and liver metastasis (n = 74) | Statistics | P | Liver metastasis alone(n = 44) | Bone metastasis alone (n = 223) | Bone metastasis and liver metastasis (n = 53) | Statistics | P | |
Age, n (%) | χ2 = 46.59 | < 0.001 | χ2 = 29.56 | < 0.001 | ||||||
< 3 years old | 60 (96.77) | 145 (50.17) | 47 (63.51) | 42 (95.45) | 115 (51.57) | 33 (62.26) | ||||
≥ 3 years old | 2 (3.23) | 144 (49.83) | 27 (36.49) | 2 (4.55) | 108 (48.43) | 20 (37.74) | ||||
Sex, n (%) | χ2 = 0.57 | 0.752 | χ2 = 1.08 | 0.583 | ||||||
Female | 30 (48.39) | 127 (43.94) | 35 (47.30) | 23 (52.27) | 101 (45.29) | 27 (50.94) | ||||
Male | 32 (51.61) | 162 (56.06) | 39 (52.70) | 21 (47.73) | 122 (54.71) | 26 (49.06) | ||||
Race, n (%) | χ2 = 5.29 | 0.259 | χ2 = 4.10 | 0.393 | ||||||
Black | 4 (6.45) | 49 (16.96) | 11 (14.86) | 4 (9.09) | 44 (19.73) | 8 (15.09) | ||||
White | 52 (83.87) | 206 (71.28) | 56 (75.68) | 36 (81.82) | 153 (68.61) | 39 (73.58) | ||||
Others | 6 (9.68) | 34 (11.76) | 7 (9.46) | 4 (9.09) | 26 (11.66) | 6 (11.32) | ||||
Tumor site, n (%) | χ2 = 14.95 | 0.021 | - | 0.149 | ||||||
Soft tissue | 7 (11.29) | 52 (17.99) | 9 (12.16) | 4 (9.09) | 38 (17.04) | 9 (16.98) | ||||
Adrenal gland | 51 (82.26) | 190 (65.74) | 55 (74.32) | 36 (81.82) | 153 (68.61) | 37 (69.81) | ||||
Retroperitoneum | 1 (1.61) | 29 (10.03) | 9 (12.16) | 1 (2.27) | 20 (8.97) | 7 (13.21) | ||||
Others | 3 (4.84) | 18 (6.23) | 1 (1.35) | 3 (6.82) | 12 (5.38) | 0 (0.00) | ||||
Tumor size, n (%) | χ2 = 18.30 | 0.001 | χ2 = 13.79 | 0.008 | ||||||
< 5 cm | 20 (32.26) | 41 (14.19) | 10 (13.51) | 14 (31.82) | 31 (13.90) | 4 (7.55) | ||||
≥ 5 cm | 20 (32.26) | 162 (56.06) | 35 (47.30) | 18 (40.91) | 135 (60.54) | 31 (58.49) | ||||
Unknown | 22 (35.48) | 86 (29.76) | 29 (39.19) | 12 (27.27) | 57 (25.56) | 18 (33.96) | ||||
Grade, n (%) | χ2 = 2.27 | 0.687 | χ2 = 5.18 | 0.270 | ||||||
Grade I/II/III | 33 (53.23) | 156 (53.98) | 34 (45.95) | 24 (54.55) | 122 (54.71) | 21 (39.62) | ||||
Grade IV | 3 (4.84) | 20 (6.92) | 7 (9.46) | 2 (4.55) | 18 (8.07) | 4 (7.55) | ||||
Unknown | 26 (41.94) | 113 (39.10) | 33 (44.59) | 18 (40.91) | 83 (37.22) | 28 (52.83) | ||||
Surgery for the primary site, n (%) | χ2 = 31.41 | < 0.001 | χ2 = 18.30 | < 0.001 | ||||||
No | 32 (51.61) | 54 (18.69) | 25 (33.78) | 20 (45.45) | 39 (17.49) | 17 (32.08) | ||||
Yes | 30 (48.39) | 235 (81.31) | 49 (66.22) | 24 (54.55) | 184 (82.51) | 36 (67.92) | ||||
Surgery for other regional or distant sites, n (%) | χ2 = 0.90 | 0.639 | χ2 = 0.73 | 0.695 | ||||||
No | 49 (79.03) | 233 (80.62) | 56 (75.68) | 35 (79.55) | 180 (80.72) | 40 (75.47) | ||||
Yes | 13 (20.97) | 56 (19.38) | 18 (24.32) | 9 (20.45) | 43 (19.28) | 13 (24.53) | ||||
Chemotherapy, n (%) | - | < 0.001 | - | < 0.001 | ||||||
No/unknown | 7 (11.29) | 3 (1.04) | 1 (1.35) | 7 (15.91) | 3 (1.35) | 1 (1.89) | ||||
Yes | 55 (88.71) | 286 (98.96) | 73 (98.65) | 37 (84.09) | 220 (98.65) | 52 (98.11) | ||||
Radiation, n (%) | χ2 = 44.24 | < 0.001 | χ2 = 29.91 | < 0.001 | ||||||
No/unknown | 57 (91.94) | 132 (45.67) | 42 (56.76) | 39 (88.64) | 98 (43.95) | 30 (56.60) | ||||
Yes | 5 (8.06) | 157 (54.33) | 32 (43.24) | 5 (11.36) | 125 (56.05) | 23 (43.40) | ||||
Brain metastasis, n (%) | χ2 = 8.28 | 0.016 | χ2 = 6.12 | 0.047 | ||||||
No | 62 (100.00) | 258 (89.27) | 64 (86.49) | 44 (100.00) | 196 (87.89) | 46 (86.79) | ||||
Yes | 0 (0.00) | 31 (10.73) | 10 (13.51) | 0 (0.00) | 27 (12.11) | 7 (13.21) | ||||
Lung metastasis, n (%) | χ2 = 18.50 | < 0.001 | χ2 = 17.17 | < 0.001 | ||||||
No | 57 (91.94) | 265 (91.70) | 55 (74.32) | 40 (90.91) | 202 (90.58) | 37 (69.81) | ||||
Yes | 5 (8.06) | 24 (8.30) | 19 (25.68) | 4 (9.09) | 21 (9.42) | 16 (30.19) | ||||
Vital status, n (%) | χ2 = 7.89 | 0.019 | χ2 = 8.98 | 0.011 | ||||||
Alive | 52 (83.87) | 208 (71.97) | 46 (62.16) | 33 (75.00) | 123 (55.16) | 24 (45.28) | ||||
Dead | 10 (16.13) | 81 (28.03) | 28 (37.84) | 11 (25.00) | 100 (44.84) | 29 (54.72) |
Survival of patients with bone or liver metastasis
Variables | Model I | Model II | ||
---|---|---|---|---|
HR (95%CI) | P | HR (95%CI) | P | |
3-year CSS | ||||
Metastasis type | ||||
Liver | Ref | Ref | ||
Bone | 1.99 (1.01–3.94) | 0.049 | 2.30 (1.10–4.82) | 0.028 |
Liver and bone | 2.82 (1.36–5.86) | 0.006 | 2.35 (1.06–5.20) | 0.035 |
5-year CSS | ||||
Metastasis type | ||||
Liver | Ref | Ref | ||
Bone | 2.11 (1.10–4.03) | 0.024 | 2.32 (1.14–4.70) | 0.020 |
Liver and bone | 2.90 (1.43–5.86) | 0.003 | 2.33 (1.07–5.07) | 0.032 |
Excluding patients with brain metastasis alone | 3-year CSS | 5-year CSS | ||||
---|---|---|---|---|---|---|
Sample size | HR (95%CI) | P | Sample size | HR (95%CI) | P | |
Study population | 384 | 286 | ||||
Metastasis type | ||||||
Liver | 62 | Ref | 44 | Ref | ||
Bone | 258 | 2.42 (1.15–5.09) | 0.020 | 196 | 2.35 (1.15–4.80) | 0.019 |
Liver and bone | 64 | 2.52 (1.12–5.64) | 0.025 | 46 | 2.27 (1.04–4.99) | 0.041 |
Excluding patients with lung metastasis alone | Sample size | HR (95%CI) | P | Sample size | HR (95%CI) | P |
Study population | 377 | 279 | ||||
Metastasis type | ||||||
Liver | 57 | Ref | 40 | Ref | ||
Bone | 265 | 1.64 (0.73–3.66) | 0.232 | 202 | 1.77 (0.83–3.78) | 0.137 |
Liver and bone | 55 | 2.27 (0.96–5.40) | 0.063 | 37 | 2.56 (1.11–5.87) | 0.027 |
Association between treatments and CSS in patients with bone or liver metastasis
Variables | Bone metastasis | Liver metastasis | ||||||
---|---|---|---|---|---|---|---|---|
3-year CSS (n = 363) | 5-year CSS (n = 276) | 3-year CSS (n = 136) | 5-year CSS (n = 97) | |||||
HR (95%CI) | P | HR (95%CI) | P | HR (95%CI) | P | HR (95%CI) | P | |
Surgery for the primary site | ||||||||
No | Ref | Ref | Ref | Ref | ||||
Yes | 0.89 (0.57–1.39) | 0.613 | 0.97 (0.63–1.50) | 0.893 | 1.23 (0.64–2.38) | 0.537 | 1.10 (0.58–2.11) | 0.770 |
Surgery for other regional or distant sites | ||||||||
No | Ref | Ref | Ref | Ref | ||||
Yes | 1.48 (0.97–2.27) | 0.070 | 1.43 (0.96–2.13) | 0.080 | 1.36 (0.68–2.75) | 0.388 | 1.46 (0.74–2.87) | 0.277 |
Chemotherapy | ||||||||
No/unknown | Ref | Ref | Ref | Ref | ||||
Yes | 0.24 (0.07–0.75) | 0.014 | 0.37 (0.12–1.16) | 0.089 | 0.99 (0.24–4.13) | 0.993 | 1.65 (0.40–6.86) | 0.489 |
Radiation | ||||||||
No/unknown | Ref | Ref | Ref | Ref | ||||
Yes | 0.76 (0.52–1.11) | 0.155 | 0.80 (0.57–1.13) | 0.213 | 2.00 (1.05–3.81) | 0.035 | 1.72 (0.91–3.24) | 0.095 |