Table 1.
Characteristics of patients with solitary pathological proximal femoral (impending) fracture
| Variable | Malignant history [n = 24] | No malignant history [n = 61] | |
|---|---|---|---|
| Median age at diagnosis, years (IQR) | 64 (55–76) | 66 (61–75) | |
| Sex | Female | 15 (62) | 35 (57) |
| Side lesion | Left | 15 (62) | 32 (52) |
| Fracture | Actual | 15 (62) | 44 (72) |
| Impending | 9 (38) | 17 (28) | |
| Impending fracture fractured | 2 (22) | 7 (41) | |
| Median time to fracture, days (IQR) | 16 (10–21) | 0.5 (0–19) | |
| Fracture type | Neck of femur | 5 (21) | 17 (28) |
| Pertrochanteric | 5 (21) | 13 (21) | |
| Subtrochanteric/diaphyseal | 12 (50) | 16 (26) | |
| Greater trochanter | 1 (4) | 3 (5) | |
| Lesser trochanter | 0 (0) | 4 (7) | |
| Unknown | 1 (4) | 8 (13) | |
| Malignant history | Sarcoma | 3 (12.5) | |
| Carcinoma | 21 (87.5)a | ||
| Biopsy | 23 (96) | 58 (95) | |
| Median time to biopsy, days (IQR) | 17 (10–29) | 14 (9–21) | |
| Biopsy histology | Sarcoma | 7 (29) | 20 (35) |
| Hematologic | 1 (4) | 13 (22) | |
| Carcinoma | 11 (46) | 5 (9) | |
| Carcinoma unknown | 3 (13) | 17 (29) | |
| Inconclusive | 1 (4) | 3 (5) | |
| Diagnostic rate of biopsy | 19 (83) | 38 (66) | |
| CT-TAP available | 14 (58) | 53 (91) | |
| CT-TAP | Inconclusive | 11 (79) | 36 (68) |
| CUPb | 2 (8) | 15 (25) | |
| Median time to treatment, days (IQR) | 42 (27–56) | 29 (21–41) | |
| Procedure | Intramedullary nailing | 2 (8) | 1 (2) |
| Endoprosthesis | 17 (71) | 49 (80) | |
| Plate | 1 (4) | – | |
| Disarticulation hip | 1 (4) | 5 (8) | |
| Hindquarter amputation | – | 3 (5) | |
| Non-surgical | 1 (4) | 2 (3) | |
| Unknown | 2 (8) | 1 (2) | |
| Final diagnosis | Sarcoma | 7 (29) | 24 (39) |
| Hematological | 1 (4) | 13 (21) | |
| Carcinoma | 15 (63) | 17 (28) | |
| CUP | 1 (4) | 7 (12) | |
| Discrepancy | History and final diagnosis | 5 (21)c | NA |
| Biopsy and final diagnosis | – | 4 (7)d | |
| Follow-up | NED | – | 11 (18) |
| AWD | 1 (4) | 6 (10) | |
| DOD/DOOD | 21/2 (96) | 41/3 (72) | |
| Survival from diagnosis, % (95% CI) | 1 year | 44 (23–62) | 61 (47–73) |
| 2 years | 26 (11–45) | 49 (35–62) | |
| 5 years | 16 (4–34) | 18 (7–32) | |
Data are expressed as n (%) unless otherwise specified
IQR interquartile range, CT-TAP computerized tomography scan of the thorax, abdomen and pelvis, CUP biopsy unknown and CT-TAP inconclusive, NA not applicable, NED no evidence of disease, AWD alive with disease, DOD death of disease, DOOD death of other disease, CI confidential interval
aHistory of carcinoma; breast (n = 8), bowel (n = 3), prostate (n = 2), head and neck (n = 2), bladder (n = 1), lung (n = 1), renal (n = 1), melanoma (n = 1), esophagus (n = 1), skin other (n = 1)
bCUP patients (n = 2) with a history of cancer resulted in carcinomas (one carcinoma of unknown origin) and CUP patients without a history of cancer resulted in 2 sarcomas, 1 hematologic malignancy and 12 carcinomas (7 carcinomas of unknown origin).
cDiscrepancy between carcinoma history and final diagnosis (sarcoma [n = 4], hematologic malignancy [n = 1]).
dDiscrepancy between biopsy and final diagnosis; inconclusive biopsies (n = 3) became a hematologic malignancy (n = 1) and two sarcomas at final diagnosis, one possible hematologic malignancy became a sarcoma at final diagnosis.