The Clinical Feature Of Bone Metastases In Lung Cancer Patients With Different Pathological Types

Objective With the development of comprehensive treatment,the survival of patients with advanced lung cancer has been prolonged and the incidence of skeletal metastases increased.Bone metastasis of lung cancer reduce the quality of life and the survival of the patients.At present,the diagnosis and treatment of bone metastases of lung cancer has become an important problem in the clinic.This study will illustrates the clinical characteristics of patients with bone metastases and explore the factors that affect the quality of life and the survival.The relationship between bone metastases,skeletal related events and survival time and different pathological subtypes of lung cancer were evaluated.Method The data of 861 patients with lung cancer from May 2010 to April 2012 at Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively.Data of patients were collected,including general data(including gender,age,smoking history),the pathological type of lung cancer,imaging data(X-ray,ultrasound,CT,MRI,bone scan and PET-CT that reflect bone metastases and visceral metastases),detection of EGFR mutation,treatment scheme(chemotherapy,targeted drugs,bisphosphonate treatment)and skeletal related events(radiotherapy for bone metastases,pathological fracture,spinal cord compression,surgery for bone metastases,hypercalcemia)and survival time.The inclusion criteria for patients with lung cancer: 1.Lung tissue was diagnosed as lung cancer by pathological diagnosis,and classification of pathological subtypes of lung cancer was clear;2.Bone metastases was diagnosed as lung cancer by biopsy,pathological subtypes was clear.Imaging examination,such as X-ray,CT,MR,ECT,PET-CT,suggestive of bone metastases;3.Complete follow-up data.Exclusion criterial: 1.Double or multiple cancer;2.Without pathological examination.Results 861 cases of lung cancer patients were enrolled in the study,including 293 cases of lung cancer patients with bone metastases.Adenocarcinoma is the most common type of bone metastases in different pathological subtypes(n=173,59.04%),followed by squamous cell carcinoma(n=56,19.11%),other types(n=35,11.95%)and small cell lung cancer(n=29,9.90%).The most common location of the bone metastases is the spine(n=175,59.73%),followed by the ribs(n=144,49.15%).The highest incidence of bone metastases in different pathological types of lung cancer was adenocarcinoma(39.14%),followed by other types(n=35,29.91%),squamous cell carcinoma(n=56,29.47%),SCLC(n=29,25.89%).The incidence of bone metastases in adenocarcinoma was higher than non-adenocarcinoma(39.14% vs28.64%;P = 0.001),OR and 95%CI were used to evaluate the relationship between pathological types and bone metastasis.Adenocarcinoma 1.60(95%CI:1.21-2.13),squamous cell carcinoma 0.77(95%CI:0.54-1.09),small cell lung cancer0.64(95%CI:0.41-1.01),and other types 0.80(95%CI:0.53-1.23).171 cases(58.36%)had skeletal related events in lung cancer patients with bone metastases.Various types of skeletal related events of patients with bone metastases in ratio,the most common was radiotherapy for bone metastases in 51.88%(n=152),followed by pathological fracture(n=44,15.02%),spinal cord compression(n=19,6.48%),surgery for bone metastases(n=14,4.78%),hypercalcemia(n=5,1.71%).Different pathological types of skeletal related events rate had no significant difference.The factors of sex,age and smoking history were analyzed,and it was found that women was risk factor for bone metastases of lung cancer(OR=1.938,95%CI:1.433-2.621,P < 0.001).The median survival time of the patients with bone metastases was 11.5 months(1.5-50 months).The median survival time of lung cancer patients with different pathological subtypes were different,12.0 months for adenocarcinoma,11.4 months for squamous cell carcinoma,11.5 months for other types,and 7.8 months for small cell lung cancer.Multivariate Cox survival analysis showed that visceral or brain metastases(P=0.001),ALP(P = 0.005)and EGFR-TKIs treatment(P=0.006)were independent prognostic factors for patients with lung cancer with bone metastases.Conclusion This study showed that female and lung adenocarcinoma are high risk factor of bone metastases.This study supported early screening and monitoring of bone metastasis in female patients with adenocarcinoma.In this study,without visceral or brain metastasis,low level of ALP and EGFR-TKIs treatment were independent prognostic factors for patients of lung cancer with bone metastases.