Aiba Hisaki, Kimura Tomoki, Yamagami Takaya, Watanabe Nobuyuki, Sakurai Hironari, Kimura Hiroaki, Shimozaki Shingo, Yamada Satoshi, Otsuka Takanobu
Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1, Azakawasumi, Mizuho-cho, Mizuho-ku, Nagoya City, Aichi pref, 467-8601, Japan.
Department of Orthopaedic Surgery, Tosei General Hospital, 160, Nishioiwake-cho, Seto City, Aichi pref, 489-8642, Japan.
Support Care Cancer. 2016 Aug;24(8):3361-7. doi: 10.1007/s00520-016-3167-5. Epub 2016 Mar 15.
Advanced lung cancer frequently causes bone metastasis which can be associated with skeletal-related events (SREs) that may cause significant deterioration of the patient's quality of life (QoL). The Spinal Instability Neoplastic Score (SINS) can be used to assist in standardizing evaluations of neoplastic spinal instability between spinal and non-spine surgeons. This research investigated the association between SREs and SINS for patients with non-small cell lung cancer (NSCLC).
Between 2009 and 2013, 47 patients with NSCLC who were diagnosed with bone metastasis were classified using SINS into either a stable group (SINS, 0-6 points) or unstable group (SINS, 7-18 points). The primary endpoint was time from diagnosis of metastasis to SREs. Secondary endpoints included tumor type and epidermal growth factor receptor (EGFR) mutational status. SREs were defined as spinal compression, pathologic fracture, spinal surgery, and hypercalcemia.
Patients included 37 cases of adenocarcinoma and 10 cases of squamous cell carcinoma. Mean follow-up time was 10.2 ± 13.7 months. SRE incidence was 15.0 % (3/20) in the stable group versus 44.4 % (12/27) in the unstable group (p = 0.048). A Cox regression model revealed that an EGFR-positive mutational status (hazard ratio [HR] = 0.15, 95 % CI, 0.030.71; p = 0.017) or good spinal stability (HR = 0.49; 0.08-0.99; p = 0.049) were favorable prognostic factors.
The incidence of SREs was significantly lower in NSCLC patients with better spinal stability as determined by SINS, which was a good prediction tool for SREs from bone metastasis. The lower incidence of SREs in EGFR-positive patients suggests tumor biology should be considered when predicting SREs.
晚期肺癌常导致骨转移，这可能与骨相关事件（SREs）相关，而骨相关事件可能导致患者生活质量（QoL）显著下降。脊柱不稳定肿瘤评分（SINS）可用于协助脊柱外科医生和非脊柱外科医生对肿瘤性脊柱不稳定的评估进行标准化。本研究调查了非小细胞肺癌（NSCLC）患者中SREs与SINS之间的关联。
2009年至2013年期间，47例诊断为骨转移的NSCLC患者根据SINS分为稳定组（SINS，0 - 6分）或不稳定组（SINS，7 - 18分）。主要终点是从转移诊断到发生SREs的时间。次要终点包括肿瘤类型和表皮生长因子受体（EGFR）突变状态。SREs定义为脊柱压迫、病理性骨折、脊柱手术和高钙血症。
患者包括37例腺癌和10例鳞状细胞癌。平均随访时间为10.2±13.7个月。稳定组SREs发生率为15.0%（3/20），不稳定组为44.4%（12/27）（p = 0.048）。Cox回归模型显示，EGFR阳性突变状态（风险比[HR]=0.15，95%CI，0.03 - 0.71；p = 0.017）或良好的脊柱稳定性（HR = 0.49；0.08 - 0.99；p = 0.049）是有利的预后因素。
根据SINS确定脊柱稳定性较好的NSCLC患者中SREs的发生率显著较低，SINS是骨转移SREs的良好预测工具。EGFR阳性患者中SREs发生率较低表明在预测SREs时应考虑肿瘤生物学特性。
