Clinical Features And Prognostic Factors In Patients With Bone Metastases From Thoracic Or Abdominal Cancers

Purpose To identify clinical features and independent.predictors for patients with bone metastases from thoracic or abdominal cancers(hepatocellular carcinoma(HCC), prostate cancer,non-small-cell lung cancer(NSCLC),kidney cancer,stomach cancer,breast cancer,rectum cancer).Materials and Methods We retrospectively analysed 205 patients with bone metastases from HCC received external beam radiation therapy(EBRT) from 1997 to 2007 in department of radiation oncology,Fudan University Zhong Shan Hospital. Demographic variables,laboratory values,tumor characteristics(intrahepatic primary tumors and metastatic lesions) before EBRT and the treatments were recorded.Total radiation dose ranged from 32 to 60Gy(median:50Gy) and was focused on the involved bone.Statistical analysis was done using statistical package for social sciences,version 15.The Kaplan-Meier model was used to estimate the survival and control rates.The Cox proportion hazard model was used for multivariate analysis, occording to gender,KPS,liver function(Child-Pugh classification),HBsAg,tumor size and number,controll statuses of the intrahepatic lesions,level of AFP r-GT,ALT, AST,ALP,hemaglobulin,WBC,platelets,total bilirubin,albumin,A/G ratio,number of bone lesions,soft tissue expansion,liver transplantation history.The cohorts involved the patients with bone metastases from prostate cancer (n=115),NSCLC(n=148),kidney caner(n=45),stomach cancer(n=38),breast cancer (n=46),and rectum cancer(n=32).The patients were followed up to Dec 31,2007.Results One-,2-,3-year survival rates and median survival were 32.4%,13.2%, 8.5%and 7.4 months for patients with bone metastases from HCC,respectively.Of 205 patients with HCC,80(39%) was with expansile soft tissue masses,and Osteolytic lesions in most cases was found.Radiation dose was 32 to 66Gy.The relationship between dose and pain relief was not found,but the retreatment rate was higher in patients with expansile soft tissue.On univariate analyses,shorter survival was associated with poored performance status,lower albumin levels,higher alkaline phosphatase,r-glutamyltransferase and a-fetoprotein levels;tumor size＞5 cm, ucontrolled intrahepatic tumors;multifocal bone lesions,involvement of spinal vertebrae,extraosseous metastases,shorter disease-free interval after an initial diagnoses of HCC.On multivariate analysis,pretreatment unfavorable predictors were associated lower performance status;higher platelet count;higher aspartate aminotransferase,r-glutamyltransferase,and a-fetoprotein levels;uncontrolled intrahepatic tumor;and treatments received in the previous 5 years.One-,2-,3-year survival rates and median survival were 89.1%,76.9%,60.9% and 48.5 months for patients with bone metastases from prostate cancer,respectively. On univariate analysis,age,Gleason score,stage,number of bone lesions,ALP level, non-local-regional lymph node metastases,other organ metastases were prognostic factors.On multivariate analysis using cox regression,number of bone lesions,ALP level,Gleason score,age,non-local-regional lymph node metastases were prognostic factors.One-,2-,3-year survival rates and median survival were 52.2%,26.5%,3.7% and 13.0 months for patients with bone metastases from NSCLC,respectively.On univariate analysis,number of bone lesions,ALP level,other organ metastases were prognostic factors.On multivariate analysis using Cox regression method,stage,ALP level,other organ metastases,number of bone lesions were prognostic factors.One-,2-,3-year survival rates and median survival were 54.0%,26.0%,17.3% and 14.0 months for patients with bone metastases from kidney cancer,respectively. On univariate analysis,ALP level,other organ metastases were prognostic factor.On multivariate analysis using Cox regression,ALP level,other organ metastases,lymph node metastases were prognostic factors.One-,2-,3-year survival rates and median survival for patients with bone metastases from stomach cancer were 47.1%,29.6%,24.7%and 5.5 months, respectively.On univariate analysis,CEA level,ALP level were prognostic factors. On multivariate analysis using Cox regression,ALP level,lymph node metastases were prognostic factors.One-,2-,3-year survival rates and median survival for patients with bone metastases from breast cancer were 87.2%,68.3%,62.6%and 43.0 months, respectively.On univariate analysis,other organ metastases,ALP level were prognostic factors.On multivariate analysis using Cox regression,size of primary tumors,ALP level,chemotherapy to primary tumors,lymph node metastases,with or without soft tissue expansion,other organ metastases were all entered with Backward:LR method and not significant prognostic factor was found.One-,2-,3-year survival rates and median survival for patients with bone metastases from rectum cancer were 49.4%,27.5%,27.5%and 12 months, respectively.On univariate analysis,ALT level when bone metastases occurred,other organ metastases were prognostic factors.On multivariate analysis using Cox regression,ALT level when bone metastases occurred,primary tumor size were prognostic factors.Conclusion Patients with bone metastases from HCC received EBRT had significant pain relief,but long term survival is still poor.Controlled intrahepatic tumor,Karnofsky score,ALT and AST level and liver function,platelet count are independent predictors.This study provides detailed information about clinical features,survival outcomes and prognostic factors for HCC with bone metastases in a relatively large cohort of patients treated with EBRT,these prognostic facrtors will help in determining which dose and fraction are appropriate.Patents with bone metastases from prostate cancer received EBRT had significant pain relief,long term survival is high than bone metastasis from other caner,ALP level and gleason score,age,absence of regional lymph node metastases are independent predictors.For patients with bone metastases from prostate cancer,the bone lesions should be treated aggressively to improve patients' qualities of life.Bone metastases from NSCLC often occompanied by other distant metastases beyond bone.EBRT can relive pain significantly.Stage,ALP level,other organ metastases,number of bone metastases were independent predictors.The survival rate was lower in patients with bone metastases from kidney cancer than those without bone metastases.Patients' pain had been relief after EBRT.Long term follow up was poor.ALT level,other organ metastases,lymph node metastases when bone metastases occurred are independent prognostic factors.The survival rate was the lowest in patients with bone metastases from stomach cancer comparison to those without bone metastases.ALT level,lymph node metastases when bone metastases occurred were prognostic factors.The survival rate was lower in patients with bone metastases from breast cancer than those without bone metastases.Patients had apparent pain relief after EBRT,long term survival is high.For patients with bone metastases from breast cancer,the bone lesions should be treated aggressively to improve patients' qualities of life.Patients with bone metastases from rectum cancer were mainly aged persons,the survival rate was low when metastases to bone.ALT level when bone metastases occurred,primary tumor size were prognostic factors.