Fan Zhiyi, Huang Zhangheng, Tong Yuexin, Zhu Zhe, Huang Xiaohui, Sun He
Department of Spine Surgery, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.
Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China.
J Oncol. 2021 Jul 28;2021:9949714. doi: 10.1155/2021/9949714. eCollection 2021.
Small cell lung cancer (SCLC) is often associated with metastases at the time of diagnosis, and the bone is one of the most common sites. The primary aim of this study was to investigate the site of synchronous distant metastasis to other organs in SCLC patients with bone metastasis (BM) and develop a robust predictive prognostic model.
We retrospectively analyzed the data from patients diagnosed with SCLC with BM in the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox analyses were used to identify independent prognostic factors. A prognostic nomogram was constructed and evaluated by calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). Then, according to the sites of metastasis and treatment modality, all patients were stratified into several subgroups. The relationship among sites of metastasis, treatment modality, and overall survival was then analyzed.
A total of 6253 patients were included. Independent prognostic factors for SCLC with BM were age, sex, primary site, radiotherapy, chemotherapy, brain metastasis, liver metastasis, and marital status. Calibration, ROC curves, and DCA indicated the excellent performance of the prognostic nomogram. The liver is the most common organ for extraskeletal metastases, followed by the lung. Patients with only BM had the longest mean survival time (9.30 ± 0.31 months). In the subgroup analysis, chemotherapy was an independent prognostic factor for all subgroups. In contrast, radiotherapy showed a positive effect on the prognosis of patients in all subgroups except those with bone and brain metastases and those with bone, lung, and brain metastases.
The prognostic nomogram is expected to be an accurate and personalized tool for predicting the prognosis of SCLC patients with BM. Additionally, the determination of the sites of synchronous extraskeletal metastases and the associated prognosis helps in treatment selection.
小细胞肺癌（SCLC）在诊断时常常伴有转移，骨骼是最常见的转移部位之一。本研究的主要目的是调查骨转移（BM）的SCLC患者发生同步远处转移至其他器官的部位，并建立一个强大的预测预后模型。
我们回顾性分析了监测、流行病学和最终结果数据库中诊断为伴有BM的SCLC患者的数据。采用单因素和多因素Cox分析来确定独立的预后因素。构建了一个预后列线图，并通过校准曲线、受试者工作特征（ROC）曲线和决策曲线分析（DCA）进行评估。然后，根据转移部位和治疗方式，将所有患者分层为几个亚组。接着分析转移部位、治疗方式和总生存之间的关系。
共纳入6253例患者。伴有BM的SCLC的独立预后因素为年龄、性别、原发部位、放疗、化疗、脑转移、肝转移和婚姻状况。校准、ROC曲线和DCA表明预后列线图具有良好的性能。肝脏是骨外转移最常见的器官，其次是肺。仅发生BM的患者平均生存时间最长（9.30±0.31个月）。在亚组分析中，化疗是所有亚组的独立预后因素。相比之下，放疗对除骨和脑转移患者以及骨、肺和脑转移患者之外的所有亚组患者的预后均显示出积极影响。
预后列线图有望成为预测伴有BM的SCLC患者预后的准确且个性化的工具。此外，确定同步骨外转移的部位及其相关预后有助于治疗选择。
