{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:21:32Z","timestamp":1763464892501,"version":"3.45.0"},"reference-count":31,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2025,11,15]],"date-time":"2025-11-15T00:00:00Z","timestamp":1763164800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Metastatic bone disease (MBD) poses an increasing challenge in orthopaedic oncology due to prolonged survival. While clinical prognostic factors are well established, the role of socio-economic determinants remains unclear, particularly within universal healthcare systems. Methods: We retrospectively analysed 243 patients who underwent surgery for MBD (excluding spine) between 2005 and 2024 at a German sarcoma centre. Socio-economic indicators were derived from national databases and linked to patients\u2019 residential districts. Survival was analysed using Kaplan\u2013Meier estimates and Cox regression, adjusting for clinical confounders. Results: Median postoperative survival was 22 months. Several socio-economic indicators\u2014income, education, and employment\u2014were associated with survival in univariate analysis. In multivariate models, only residential area size remained independently significant (p = 0.047). Patients from villages (&lt;2000 inhabitants) and large cities (&gt;100,000) had poorer survival than those from small or medium-sized towns. This effect persisted after adjustment for tumour type, pathological fractures, and year of surgery. Conclusions: Within a universal healthcare system, residential area size was associated with survival after surgery for MBD, suggesting that regional disparities may persist despite equal formal access to care. Further studies integrating individual-level socioeconomic data are needed to identify mechanisms and guide interventions to reduce geographic inequalities.<\/jats:p>","DOI":"10.3390\/cancers17223664","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T11:05:31Z","timestamp":1763463931000},"page":"3664","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Geographic Disparities in Survival After Surgery for Metastatic Bone Disease: A Retrospective Analysis from a German Sarcoma Centre"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4828-1812","authenticated-orcid":false,"given":"Wolfram","family":"Weschenfelder","sequence":"first","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery and Orthopaedics, University Hospital Jena, 07747 Jena, Germany"},{"name":"Comprehensive Cancer Centre Central Germany, Campus Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula Maria","family":"Nickl","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery and Orthopaedics, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-391X","authenticated-orcid":false,"given":"Friederike","family":"Weschenfelder","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Spiegel","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery and Orthopaedics, University Hospital Jena, 07747 Jena, Germany"},{"name":"Comprehensive Cancer Centre Central Germany, Campus Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin Gabriela","family":"Schrenk","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Centre Central Germany, Campus Jena, 07747 Jena, Germany"},{"name":"Department of Haematology and Internal Oncology, Clinic of Internal Medicine II, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2147-489X","authenticated-orcid":false,"given":"Thomas","family":"Ernst","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Centre Central Germany, Campus Jena, 07747 Jena, Germany"},{"name":"Department of Haematology and Internal Oncology, Clinic of Internal Medicine II, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Trauma, Hand and Reconstructive Surgery and Orthopaedics, University Hospital Jena, 07747 Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.suronc.2012.04.001","article-title":"Skeletal metastases-the role of the orthopaedic and spinal surgeon","volume":"21","author":"Eastley","year":"2012","journal-title":"Surg. 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