Hematology-Oncology Division, University of Pennsylvania, 3400 Civic Center Blvd., 2 Perelman Center for Advanced Medicine, Philadelphia, PA 19104, USA.
Lung Cancer. 2010 Jan;67(1):4-11. doi: 10.1016/j.lungcan.2009.08.020.
The skeleton is one of the most frequent sites for metastases from non-small cell lung cancer (NSCLC), and skeletal-related events (SREs) can decrease quality of life (QOL). However, limited guidance exists regarding the diagnosis and treatment of bone metastases in patients with NSCLC.
Data on the burden of skeletal morbidity and the diagnosis and treatment of bone metastases in patients with NSCLC were obtained from reviewing the published literature (PubMed) and presentations and abstracts from recent oncology congresses.
Bone metastases are common but underdiagnosed in patients with NSCLC. Most NSCLC patients with bone metastases develop > or =1 SRE during their lifetimes. As survival improves with new treatment modalities, the prevalence of SREs is likely to increase. Direct costs of SREs and their subsequent supportive care are approximately $28,000 per patient. Although bone metastases often are not diagnosed until after the onset of symptoms, early treatment can delay the onset of potentially debilitating SREs. In patients with NSCLC and other solid tumors (n=773), zoledronic acid (ZOL; 4 mg via 15-min infusion every 3 weeks) delayed the median time to first on-study SRE by >80 days compared with placebo (p=0.009). Moreover, ZOL significantly reduced the ongoing risk of SREs by 32% versus placebo (p=0.016).
Skeletal morbidity is an important concern in patients with NSCLC. The incidence of SREs is expected to increase as survival improves in this setting. Prevention of SREs with therapies such as ZOL may preserve patients' QOL and possibly reduce healthcare costs.
骨骼是非小细胞肺癌（NSCLC）转移的最常见部位之一，骨骼相关事件（SREs）可降低生活质量（QOL）。然而，对于 NSCLC 患者的骨转移诊断和治疗，目前的指导意见有限。
通过查阅已发表的文献（PubMed）和最近肿瘤会议的报告和摘要，获取有关骨骼发病率负担以及 NSCLC 患者骨转移诊断和治疗的数据。
骨骼转移在 NSCLC 患者中很常见，但常常被漏诊。大多数患有骨转移的 NSCLC 患者在其一生中会发生≥1 次 SRE。随着新的治疗方法改善了生存率，SRE 的发生率可能会增加。SRE 及其后续支持性治疗的直接费用约为每位患者 28,000 美元。尽管骨骼转移通常在出现症状后才被诊断出来，但早期治疗可以延迟可能导致致残的 SRE 的发生。在 NSCLC 和其他实体瘤患者（n=773）中，唑来膦酸（ZOL；每 3 周静脉输注 15 分钟，4 mg）与安慰剂相比，首次研究 SRE 的中位时间延迟了>80 天（p=0.009）。此外，与安慰剂相比，ZOL 显著降低了 32%的 SRE 持续风险（p=0.016）。
骨骼发病率是 NSCLC 患者的一个重要关注点。在这种情况下，随着生存率的提高，SRE 的发生率预计会增加。使用 ZOL 等疗法预防 SRE 可能会保持患者的生活质量，并可能降低医疗保健成本。
