European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway; Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway; Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
J Pain Symptom Manage. 2021 Oct;62(4):681-690. doi: 10.1016/j.jpainsymman.2021.03.022. Epub 2021 Mar 29.
Radiotherapy (RT) reduces pain in about 60% of patients with painful bone metastases, leaving many patients without clinical benefit. This study assesses predictors for RT effectiveness in patients with painful bone metastases.
We included adult patients receiving RT for painful bone metastases in a multicenter, multinational longitudinal observational study. Pain response within 8 weeks was defined as ≥2-point decrease on a 0-10 pain score scale, without increase in analgesics; or a decrease in analgesics of ≥25% without increase in pain score. Potential predictors were related to patient demographics, RT administration, pain characteristics, tumor characteristics, depression and inflammation (C-reactive protein [CRP]). Multivariate logistic regression analysis with multiple imputation of missing data were applied to identify predictors of RT response.
Of 513 eligible patients, 460 patients (90 %) were included in the regression model. 224 patients (44%, 95% confidence interval (CI) 39%-48%) responded to RT. Better Karnofsky performance status (Odds ratio (OR) 1.39, CI 1.15-1.68), breast cancer (OR 2.54, CI 1.12-5.73), prostate cancer (OR 2.83, CI 1.27-6.33) and soft tissue expansion (OR 2.00, CI 1.23-3.25) predicted RT response. Corticosteroids were a negative predictor (OR 0.57, CI 0.37-0.88). Single and multiple fraction RT had similar response. The discriminative ability of the model was moderate; C-statistic 0.69.
This study supports previous findings that better performance status and type of cancer diagnosis predicts analgesic RT response, and new data showing that soft tissue expansion predicts RT response and that corticosteroids is a negative predictor for RT response in patients with painful bone metastases.
放射治疗（RT）可使约 60%的骨转移痛患者缓解疼痛，但仍有许多患者未从中获益。本研究旨在评估影响骨转移痛患者放射治疗效果的预测因素。
我们纳入了在一项多中心、多国纵向观察性研究中接受放射治疗的骨转移痛成年患者。8 周内疼痛缓解定义为疼痛评分 0-10 量表上下降≥2 分，且未增加镇痛药；或镇痛药减少≥25%，而疼痛评分无增加。潜在预测因素与患者人口统计学、RT 管理、疼痛特征、肿瘤特征、抑郁和炎症（C 反应蛋白[CRP]）相关。采用多元逻辑回归分析和缺失数据的多重插补来识别 RT 反应的预测因素。
在 513 名符合条件的患者中，有 460 名患者（90%）纳入回归模型。224 名患者（44%，95%置信区间[CI] 39%-48%）对 RT 有反应。更好的 Karnofsky 表现状态（优势比[OR] 1.39，CI 1.15-1.68）、乳腺癌（OR 2.54，CI 1.12-5.73）、前列腺癌（OR 2.83，CI 1.27-6.33）和软组织扩张（OR 2.00，CI 1.23-3.25）预测 RT 反应。皮质类固醇是负预测因素（OR 0.57，CI 0.37-0.88）。单次和多次分割 RT 有相似的反应。该模型的区分能力为中度；C 统计量为 0.69。
本研究支持先前的研究结果，即更好的表现状态和癌症诊断类型可预测镇痛 RT 反应，新数据显示软组织扩张可预测 RT 反应，皮质类固醇是骨转移痛患者 RT 反应的负预测因素。
