Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan.
Support Care Cancer. 2021 Jul;29(7):4081-4088. doi: 10.1007/s00520-020-05880-5. Epub 2021 Jan 6.
The risk factors for skeletal-related events (SREs) among non-small cell lung cancer (NSCLC) patients during treatment with bone-modifying agents (BMAs) are not yet well-understood.
The medical records of 238 consecutive NSCLC patients treated with BMAs, including zoledronic acid and denosumab, at the Chiba University Hospital from 2012 to 2016 were reviewed in the present study. SREs were defined as either pathologic fractures, spinal cord compression, the need for bone irradiation or surgery, or hypercalcemia. The risk factors for earlier occurrence of the first SRE from the time of the first bone metastasis diagnosis after the initiation of BMA treatment were identified.
Of the 238 included patients, 92% (n = 220) had a performance status (PS) of 0-2 at diagnosis of bone metastasis. Forty-eight (20%) patients developed at least one SRE. The most common first SRE was the need for bone irradiation surgery (n = 27, 56%). Significant risk factors included poor PS (hazard ratio [HR]: 4.36; p = .024), male sex (HR: 2.17; p = .022), and the use of zoledronic acid (HR: 1.91; p = .032). The overall survival (OS) from the first bone metastasis diagnosis was 394 days (95% confidence interval [CI]: 331-465). The OS of patients with PS 3 and 4 at the diagnosis of bone metastasis (median: 36 days; 95% CI: 13-50) was significantly (p < 0.0001) shorter than that of patients with PS 0-2 (median: 411 days; 95% CI: 354-558) (HR: 4.53; 95% CI: 2.62-7.35).
Careful observation is needed for patients with the identified risk factors, which include poor PS and male sex, despite the BMA treatment.
在使用骨修饰剂（BMA）治疗期间，非小细胞肺癌（NSCLC）患者发生骨骼相关事件（SREs）的风险因素尚不清楚。
本研究回顾性分析了 2012 年至 2016 年在千叶大学医院接受 BMA（包括唑来膦酸和地舒单抗）治疗的 238 例连续 NSCLC 患者的病历。SREs 定义为病理性骨折、脊髓压迫、需要骨照射或手术或高钙血症。确定了从开始使用 BMA 治疗到首次骨转移诊断后首次 SRE 发生时间的风险因素。
在 238 例纳入的患者中，92%（n=220）在诊断骨转移时的表现状态（PS）为 0-2。48 例（20%）患者发生至少一次 SRE。最常见的首次 SRE 是需要骨照射手术（n=27，56%）。显著的风险因素包括较差的 PS（危险比[HR]：4.36；p=0.024）、男性（HR：2.17；p=0.022）和使用唑来膦酸（HR：1.91；p=0.032）。从首次骨转移诊断开始的总生存期（OS）为 394 天（95%置信区间[CI]：331-465）。骨转移诊断时 PS 为 3 和 4 的患者的 OS（中位：36 天；95%CI：13-50）明显短于 PS 为 0-2 的患者（中位：411 天；95%CI：354-558）（HR：4.53；95%CI：2.62-7.35）。
尽管使用了 BMA 治疗，但仍需对具有上述风险因素（包括较差的 PS 和男性）的患者进行密切观察。
