Association of primary tumor surgery with survival outcomes in patients with bone metastases across multiple cancer types.

BACKGROUND: Synchronous bone metastases (BM) have a notable impact on the survival rates of patients across various cancer types. While primary tumor surgery (PTS) has shown potential benefits, its impact across different cancers and patient subgroups needs further clarification. This study aimed to investigate the survival benefits of PTS across various cancer types. METHODS: This retrospective cohort study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database, covering 53,015 patients diagnosed with BM from 2010 to 2019. Propensity score matching (PSM) was performed to reduce baseline imbalance. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis and Cox proportional hazards regression. RESULTS: PTS substantially improved overall and cancer-specific survival in patients with lung, kidney, breast and bladder cancers. All surgical modalities benefited breast and renal cancer survival. In prostate cancer, PTS produced no overall survival gain; survival varied by surgery type, being better after prostatectomy and worse with local resection. For liver cancer, PTS improved cancer-specific but not overall survival, and the small matched cohort necessitates circumspect interpretation. CONCLUSION: The findings indicate that PTS can significantly enhance survival in selected patients with BM, particularly in lung, kidney, breast, and bladder cancers. Tailoring surgical approaches based on individual cancer type and patient characteristics is crucial to optimizing treatment outcomes. Further studies are required to validate these results and expand the understanding of PTS in cancer management.