Université Paris Cité, Rheumatology Department, Hôpital Bichat Claude-Bernard, Paris, France.
Pulmonology Department, Hôpital Forcilles - Fondation Cognacq-Jay, 77150 Férolles-Attily, France.
Eur J Cancer. 2024 Mar;200:113604. doi: 10.1016/j.ejca.2024.113604. Epub 2024 Feb 5.
Immunotherapy and targeted therapy have extended life expectancy in non-small cell lung cancer (NSCLC) patients, shifting it into a chronic condition with comorbidities, including osteoporosis. This study aims to evaluate the prevalence and incidence of osteoporotic vertebral fracture (OPVF) during NSCLC follow-up, identify risk factors of OPVF, and determine the impact on overall survival (OS).
We performed a longitudinal single-center retrospective cohort study involving patients with histologically proven NSCLC of any stage. Chest-abdomen-pelvis computed tomography (CAP CT) at diagnosis and during follow-up were double-blind reviewed to determine OPVF site, count, type, time to incident OPVF, and trabecular volumetric bone density (TVBD). An institutional expert committee adjudicated discrepancies. Binary logistic regression was used to predict the occurrence of incident OPVF. OS was calculated using the Kaplan-Meier method.
We included 289 patients with a median follow-up of 29.7 months. OPVF prevalence was 10.7% at inclusion and 23.2% at the end of follow-up. Cumulative incidence was 12.5%, with an incidence rate of 4 per 100 patient-years. Median time to incident OPVF was 13 months (IQR: 6.7-21.2). Seven of the 36 patients with incident OPVF received denosumab or bisphosphonates. In multivariable analysis, independent risk factors for incident OPVF were BMI < 19 kg/m (OR: 5.62, 95%CI 1.84-17.20, p = 0.002), lower TVBD (OR: 0.982 per HU, 95%CI 0.97-0.99, p = 0.001) and corticosteroid use (OR: 4.77, 95%CI: 1.76-12.89, p = 0.001). OPVF was not significantly associated with OS.
Osteoporosis should be screened for in NSCLC patients. Thoracic oncologists must broaden the use of steroid-induced osteoporosis recommendations.
免疫疗法和靶向治疗延长了非小细胞肺癌（NSCLC）患者的预期寿命，使 NSCLC 成为一种伴有合并症的慢性病，包括骨质疏松症。本研究旨在评估 NSCLC 随访期间骨质疏松性椎体骨折（OPVF）的患病率和发生率，确定 OPVF 的危险因素，并确定其对总生存期（OS）的影响。
我们进行了一项纵向单中心回顾性队列研究，纳入了经组织学证实的任何分期 NSCLC 患者。在诊断时和随访期间进行胸部-腹部-骨盆计算机断层扫描（CAP CT）双盲复查，以确定 OPVF 部位、数量、类型、新发 OPVF 时间和小梁体积骨密度（TVBD）。机构专家委员会对差异进行了裁决。二元逻辑回归用于预测新发 OPVF 的发生。使用 Kaplan-Meier 方法计算 OS。
我们纳入了 289 例患者，中位随访时间为 29.7 个月。入组时 OPVF 的患病率为 10.7%，随访结束时为 23.2%。累积发病率为 12.5%，发病率为每 100 患者年 4 例。新发 OPVF 的中位时间为 13 个月（IQR：6.7-21.2）。36 例新发 OPVF 患者中有 7 例接受了地舒单抗或双磷酸盐治疗。多变量分析显示，新发 OPVF 的独立危险因素是 BMI<19kg/m2（OR：5.62，95%CI 1.84-17.20，p=0.002）、较低的 TVBD（OR：每 HU 0.982，95%CI 0.97-0.99，p=0.001）和皮质类固醇的使用（OR：4.77，95%CI：1.76-12.89，p=0.001）。OPVF 与 OS 无显著相关性。
应在 NSCLC 患者中筛查骨质疏松症。胸科肿瘤学家必须扩大皮质类固醇性骨质疏松症建议的使用。
