Deberne Mélanie, Ropert Stanislas, Billemont Bertrand, Daniel Catherine, Chapron Jeanne, Goldwasser François
Radiation Oncology Department, Institut Curie, 26 rue d'Ulm, Paris 75005, France.
BMC Cancer. 2014 Jun 10;14:416. doi: 10.1186/1471-2407-14-416.
In non-small cell lung cancer patients (NSCLC), median survival from the time patients develop bone metastasis is classically described being inferior to 6 months. We investigated the subcategory of patients having an inaugural skeletal-related-event revealing NSCLC. The purpose of this study was to assess the impact of bone involvement on overall survival and to determine biological and tumoral prognosis factors on OS and PFS. An analysis of the subgroup of solitary bone metastasis patients was also performed.
In a population of 1208 lung cancer patients, 55 consecutive NSCLC patients revealed by inaugural bone metastasis and treated between 2003 and 2010, were retrospectively analysed. Survival was measured with a Kaplan-Meyer curve. Univariate and multivariate analysis were performed using the Stepwise Cox proportional hazard regression model. A p value of less than 0,05 was considered statistically significant.
Estimated incidence of revealing bone metastasis is 4,5% among newly diagnosed lung cancer patients. Median duration of skeletal symptoms before diagnosis was 3 months and revealing bone site was located on axial skeleton in 70% of the cases. Histology was adenocarcinoma (78%), with small primary tumors Tx-T1-2 accounting for 71% of patients. Rate of second SRE is 37%.Median overall survival was 8.15 months, IQR [5-16 months], mean survival 13.4 months, and PFS was 3.5 months. In multivariate analysis, variables significantly associated with shortened survival were advanced T stage (HR=2.8; p=0.004), weight loss>10% (HR=3.1; p=0.02), inaugural spinal epidural metastasis (HR 2.5; p=0.0036), elevated C-reactive protein (HR=4.3; p=0.002) and TTF-1 status (HR=2.42; p=0.004). Inaugural spinal epidural metastasis is a very strong adverse pronostic factor in these cases, with a 3 months median survival. Single bone metastasis patients showed prolonged survival of 14.2 months versus 7.6 months, only in univariate analysis (HR=0.42; p=0.0059).
Prognosis of lung cancer patients with inaugural SRE remains pejorative. Accurately estimating the survival of this population is helpful for bone surgical decision-making at diagnosis. The trend for a higher proportion of adenocarcinoma in NSCLC patients should result with an increasing number of patients with inaugural SRE at diagnosis.
在非小细胞肺癌（NSCLC）患者中，从发生骨转移起的中位生存期传统上被描述为低于6个月。我们研究了因首次发生骨相关事件而确诊为NSCLC的患者亚组。本研究的目的是评估骨转移对总生存期的影响，并确定影响总生存期（OS）和无进展生存期（PFS）的生物学及肿瘤预后因素。还对孤立性骨转移患者亚组进行了分析。
在1208例肺癌患者群体中，对2003年至2010年间接受治疗的55例因首次骨转移而确诊的NSCLC患者进行回顾性分析。采用Kaplan - Meyer曲线测量生存期。使用逐步Cox比例风险回归模型进行单因素和多因素分析。p值小于0.05被认为具有统计学意义。
在新诊断的肺癌患者中，因骨转移确诊的估计发生率为4.5%。诊断前骨骼症状的中位持续时间为3个月，70%的病例中首次发生骨转移的部位位于中轴骨骼。组织学类型为腺癌（78%），小的原发性肿瘤Tx - T1 - 2占患者的71%。第二次骨相关事件的发生率为37%。中位总生存期为8.15个月，四分位间距[5 - 16个月]，平均生存期为13.4个月，PFS为3.5个月。在多因素分析中，与生存期缩短显著相关的变量为晚期T分期（HR = 2.8；p = 0.004）、体重减轻>10%（HR = 3.1；p = 0.02）、首次发生脊柱硬膜外转移（HR = 2.5；p = 0.0036）、C反应蛋白升高（HR = 4.3；p = 0.002）和TTF - 1状态（HR = 2.42；p = 0.004）。在这些病例中，首次发生脊柱硬膜外转移是一个非常强的不良预后因素，中位生存期为3个月。仅在单因素分析中，孤立性骨转移患者的生存期延长至14.2个月，而其他患者为7.6个月（HR = 0.42；p = 0.0059）。
因首次发生骨相关事件而确诊的肺癌患者预后仍然较差。准确估计该群体的生存期有助于诊断时的骨外科决策。NSCLC患者中腺癌比例增加的趋势将导致诊断时因首次发生骨相关事件而确诊的患者数量增加。
