Clinicopathological Features,gene Characteristics And Prognosis Of Patients With Bone Metastasis Of Non-small Cell Lung Cancer

Objective: To investigate the clinicopathological characteristics and gene mutation characteristics of patients with bone metastasis of non-small cell lung cancer(NSCLC),and to analyze the prognostic factors.Methods:The clinical data of 345 patients with NSCLC bone metastases who visited the Cancer Hospital of Xinjiang Medical University between January 2015 and December 2020 were retrospectively analyzed.Kaplan-Meier survival analysis was mainly used to obtain overall survival(OS),median survival,1-year and 3-year survival rates,and plotted survival curves.In addition,Log-rank was used to screen out the factors affecting prognosis by univariate analysis,and a Cox proportional hazards regression model was established to further analyze the multivariate factors to determine the factors affecting the prognosis of NSCLC bone metastases.Results: 1)In this study,the male to female ratio of 345 patients with NSCLC bone metastases was1.52:l;130 patients aged ≥60;145 patients with a history of smoking;and 214 patients with an Eastern cooperative oncology group(ECOG)score of ≥2.There were 147 patients in stage 3-4 in stage T,and 236 patients(68.4%)in stage 2-3 in stage N.Adenocarcinoma was the most common with 289 cases;The most common sites of bone metastases were the spine(257 cases),thoracic bones(237 cases),pelvis(182 cases),limb bones(88 cases)and skull(46 cases).The most common metastasis site in adenocarcinoma patients was the spine(225 cases),and the most common metastasis site in patients with squamous cell carcinoma was the chest bone(29 cases).129(37.4%)patients experienced bone-related events(SREs);There were 209 driver gene positive patients,accounting for about 60.6%,of which Epidermal Growth Factor Receptor(EGFR)positive mutation was the most common(186/345,53.9%).2)The overall median survival of 345 patients in this study was 20 months,and the average survival time was 27.7 months.The 1-and 3-year survival rates were 71.3% and 29.9%,respectively.Univariate analysis affecting the prognosis of NSCLC bone metastasis showed that sex,pathological type,ECOG score,T stage,N stage,gene mutation,and serum markers Alkaline Phosphatase Phosphatase(ALP),Lactate dehydrogenase(LDH)and Cytokeratin fragment 19(CYFRA21-1)levels at bone metastasis were closely related to the prognosis of NSCLC bone metastasis(P<0.05).3)The results of multivariate regression analysis showed that ECOG score,N stage,gene mutation,and serometric ALP and CYFRA21-1 levels at bone metastasis were statistically significant in patients with NSCLC bone metastasis(P<0.05),which were independent prognostic factors in patients with NSCLC bone metastasis.Meanwhile,in patients with NSCLC bone metastases,patients with driver-gene-positive targeted therapy had significantly longer survival than those with driver-gene-negative therapy(27 months vs14 months,P < 0.05).Conclusion:1)In this study,the proportion of adenocarcinoma was the highest in the pathological type of bone metastasis of NSCLC.The main site of bone metastasis was spine.Multiple bone metastases were common.SRES occurred in 129patients(37.4%).The driver gene was positive in 209 patients(approximately 60.6%),with EGFR-positive mutations being the most common(186/345,53.9%).2)Univariate analysis showed that gender,pathological type,ECOG score,T stage,N stage,gene mutation,and serum markers ALP,LDH and CYFRA21-1 levels at bone metastasis were the prognostic factors of NSCLC bone metastasis.Among them,ECOG score,N stage,gene mutation,and serological markers ALP and CYFRA21-1 levels at bone metastasis can be used as independent prognostic factors in patients with NSCLC bone metastasis.3)The survival time of patients with driver gene mutation with targeted therapy is significantly prolonged,and targeted therapy should be preferred for patients with driver gene mutation.