Tamiya Hironari, Nishino Kazumi, Kato Yuji, Nakahashi-Kato Reina, Kosuga-Tsujimoto Yurika, Kinoshita Shota, Suzuki Rie, Watanabe Makiyo, Wakamatsu Toru, Kakunaga Shigeki, Takenaka Satoshi
Department of Rehabilitation, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Curr Oncol. 2025 Jan 15;32(1):42. doi: 10.3390/curroncol32010042.
Bone metastasis is associated with a poor prognosis. Bone-modifying agents (BMA) are commonly used for the prevention or treatment of skeletal-related events (SRE) in patients with bone metastasis; however, whether or not treatment with BMA improves survival remains unclear. In this study, we investigated whether BMA was involved in post-bone metastasis survival.
A total of 539 cancer patients were retrospectively analyzed to identify significant independent factors in post-bone metastasis survival.
Among the overall population, patients with the following cancers had a median survival longer than 24 months: thyroid, 97.2 months; breast, 51.5 months; prostate, 47.2 months; and kidney, 38.8 months. In contrast, median post-bone metastasis survival was significantly shorter in gastrointestinal (GI) (6.5 months), head and neck (6.3 months), and urinary tract (3.4 months) cancers. In non-small cell lung cancer (NSCLC), the log-rank test demonstrated that the epidermal growth factor receptor (EGFR) mutation was a significant factor for post-bone metastasis survival: EGFR mutation (-) = 67, median post-bone metastasis survival 11.5 months (95% CI: 6.0-15.2); EGFR mutation (+) = 39, median post-bone metastasis survival 28.8 months (95% CI: 18.1-35.7) ( < 0.05). Intriguingly, treatment with BMA was a significant positive prognostic factor: BMA (-) = 203, median post-bone metastasis survival 7.8 months (95% CI: 5.8-12.5); BMA (+) = 336, median post-bone metastasis survival 21.9 months (95% CI: 16.1-26.4) ( < 0.001). Moreover, the Cox proportional hazards model showed that this was particularly evident in cancer types with poor prognosis such as GI cancer (hazard ratio [HR]: 0.62, 95% CI: 0.40-0.95; < 0.05) and NSCLC without the epidermal growth factor receptor (EGFR) mutation (HR: 0.56, 95% CI: 0.34-0.91; < 0.05).
Treatment with BMA is recommended not only for the prevention and/or treatment of SRE, but also may have a positive impact on post-bone metastasis survival, particularly in cancers with typically poor post-bone metastasis survival such as GI cancer and NSCLC without the EGFR mutation.
骨转移与预后不良相关。骨改良药物（BMA）常用于预防或治疗骨转移患者的骨相关事件（SRE）；然而，BMA治疗是否能改善生存率仍不清楚。在本研究中，我们调查了BMA是否与骨转移后的生存有关。
对539例癌症患者进行回顾性分析，以确定骨转移后生存的显著独立因素。
在总体人群中，以下癌症患者的中位生存期超过24个月：甲状腺癌，97.2个月；乳腺癌，51.5个月；前列腺癌，47.2个月；肾癌，38.8个月。相比之下，胃肠道（GI）癌（6.5个月）、头颈癌（6.3个月）和泌尿系统癌（3.4个月）骨转移后的中位生存期明显较短。在非小细胞肺癌（NSCLC）中，对数秩检验表明表皮生长因子受体（EGFR）突变是骨转移后生存的一个重要因素：EGFR突变（-）=67例，骨转移后中位生存期11.5个月（95%CI：6.0-15.2）；EGFR突变（+）=39例，骨转移后中位生存期28.8个月（95%CI：18.1-35.7）（P<0.05）。有趣的是，BMA治疗是一个显著的阳性预后因素：BMA（-）=203例，骨转移后中位生存期7.8个月（95%CI：5.8-12.5）；BMA（+）=336例，骨转移后中位生存期21.9个月（95%CI：16.1-26.4）（P<0.001）。此外，Cox比例风险模型显示，这在预后较差的癌症类型中尤为明显，如GI癌（风险比[HR]：0.62，95%CI：0.40-0.95；P<0.05）和无表皮生长因子受体（EGFR）突变的NSCLC（HR：0.56，95%CI：0.34-0.91；P<0.05）。
推荐使用BMA进行治疗，不仅用于预防和/或治疗SRE，而且可能对骨转移后的生存有积极影响，特别是在骨转移后生存通常较差的癌症中，如GI癌和无EGFR突变的NSCLC。
