Amgen, Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
Wade Outcomes Research and Consulting, 358 South 700 East, Suite B432, Salt Lake City, UT, 84102, USA.
BMC Cancer. 2018 Jan 6;18(1):44. doi: 10.1186/s12885-017-3922-0.
Bone metastases commonly occur in conjunction with solid tumors, and are associated with serious bone complications. Population-based estimates of bone metastasis incidence are limited, often based on autopsy data, and may not reflect current treatment patterns.
Electronic medical records (OSCER, Oncology Services Comprehensive Electronic Records, 569,000 patients, 52 US cancer centers) were used to identify patients ≥18 years with a solid tumor diagnosis recorded between 1/1/2004 and 12/31/2013, excluding patients with hematologic tumors or multiple primaries. Each patient's index date was set to the date of his or her first solid tumor diagnosis in the selection period. Kaplan-Meier analyses were used to quantify the cumulative incidence of bone metastasis with follow-up for each patient from the index date to the earliest of the following events: last clinic visit in the OSCER database, occurrence of a new primary tumor or bone metastasis, end of study (12/31/2014). Incidence estimates and associated 95% confidence intervals (CI) are provided for up to 10 years of follow-up for all tumor types combined and stratified by tumor type and stage at diagnosis.
Among 382,733 study patients (mean age 64 years; mean follow-up 940 days), breast (36%), lung (16), and colorectal (12%) tumors were most common. Mean time to bone metastasis was 400 days (1.1 years). Cumulative incidence of bone metastasis was 2.9% (2.9-3.0) at 30 days, 4.8% (4.7-4.8) at one year, 5.6% (5.5-5.6) at two years, 6.9% (6.8-7.0) at five years, and 8.4% (8.3-8.5) at ten years. Incidence varied substantially by tumor type with prostate cancer patients at highest risk (18% - 29%) followed by lung, renal or breast cancer. Cumulative incidence of bone metastasis increased by stage at diagnosis, with markedly higher incidence among patients diagnosed at Stage IV of whom11% had bone metastases diagnosed within 30 days.
These estimates of bone metastasis incidence represent the experience of a population with longer follow-up than previously published, and represent experience in the recent treatment landscape. Underestimation is possible given reliance on coded diagnoses but the clinical detail available in electronic medical records contributes to the accuracy of these estimates.
骨转移通常与实体瘤同时发生，并伴有严重的骨骼并发症。基于人群的骨转移发病率估计有限，通常基于尸检数据，并且可能无法反映当前的治疗模式。
电子病历（OSCER，肿瘤服务综合电子记录，569000 名患者，52 家美国癌症中心）用于确定在 2004 年 1 月 1 日至 2013 年 12 月 31 日期间记录有实体瘤诊断的≥18 岁患者，不包括血液系统肿瘤或多原发肿瘤患者。每位患者的索引日期设置为他/她在选择期内首次诊断实体瘤的日期。Kaplan-Meier 分析用于量化从索引日期到以下最早事件的每位患者的骨转移累积发生率：OSCER 数据库中最近一次就诊、新发原发性肿瘤或骨转移、研究结束（2014 年 12 月 31 日）。为所有肿瘤类型提供了长达 10 年的随访发病率估计值和相关的 95%置信区间（CI），并按肿瘤类型和诊断时的阶段进行分层。
在 382733 名研究患者中（平均年龄 64 岁；平均随访 940 天），乳腺癌（36%）、肺癌（16%）和结直肠癌（12%）最为常见。骨转移的平均时间为 400 天（1.1 年）。30 天时骨转移的累积发生率为 2.9%（2.9-3.0），1 年时为 4.8%（4.7-4.8），2 年时为 5.6%（5.5-5.6），5 年时为 6.9%（6.8-7.0），10 年时为 8.4%（8.3-8.5）。发病率因肿瘤类型而异，前列腺癌患者的风险最高（18%-29%），其次是肺癌、肾癌或乳腺癌。骨转移的累积发生率随诊断时的分期而增加，IV 期诊断的患者发生率明显更高，其中 11%的患者在 30 天内诊断出骨转移。
这些骨转移发病率的估计值代表了人群的随访时间长于以往的研究，并且代表了最近治疗环境下的经验。由于依赖编码诊断，因此可能存在低估，但电子病历中提供的临床详细信息有助于提高这些估计值的准确性。
