The Charactors And Prognostic Factors Of Bone Metastasis In Lung Cancer And The Significance Of Serum Markers In Diagnosis

Objective The percentage of bone metastasis(BM)in Lung cancer patients ranges from 20% to40%.If BM occurred in NSCLC,the 3-year OS rate decreased from 71.6% to46.8%.Bone pain,pathological fractures,malignant hypercalcemia and other bone related events(SREs)significantly reduced the quality of life of patients .Therefore,our research objectives : 1.To evaluate the prognostic factors of lung cancer BM and to intervene early to improve the survival period and quality of life of patients;2.To explore the value of serum RANKL,TRACP5 b,NTX and BLP in the diagnosis and follow-up of lung cancer BM to seek a new and more convenient auxiliary method for BM diagnosis and follow-up besides the traditional method for the diagnosis of lung cancer BM,so as to reduce the economic burden of patients and radiation exposure.Methods1.160-lung cancer patients with BM as the research object,through the follow-up observation,a complete record of medical records,on gender,age,pathological type,properties of BM,place,quantity,treatment time of double zoledronic and bone related events on time without progression(PFS)and overall survival(OS).Clinical characteristics of BM subgroups were compared by T-test,m OS and survival rate were calculated and plotted by KM,survival differences of different factors were tested by log-rank,and prognostic risk factors of BMwere analyzed by COXsurvival correlation model.P<0.05 was considered as significant difference.2.There were 100 patients with stage IV lung cancer and initially treated,50 with and50 without BM.All of them were confirmed as primary bronchial lung cancer by pathology or cytology.All the enrolled patients received blood 2ml in the morning of the next day.RANKL,TRACP-5b,NTX and BAP were detected by elisa.At the same time,continuous blood samples were collected from 50 patients in combination with dynamic imaging followup,and the follow-up value of serum RANKL,tracp-5b,NTX and BAP were detected and analized.Results Osteolytic,osteogenic,and mixed BM were 58.75%,25.63%,and 15%respectively,which is significantly different from previous reports that osteolytic BM is more than 80%.The m OS of patients with BM was 425 days,significantly longer than the historical literature about half a year.The m OS of SCLC with BM is 323 days,COX multiple factor correlation analysis found that if the times of zoledronic such as 6 or more,the BM number,SREs and zoledronic application are significant related with m OS.The m OS of EGFRNSCLC with BM was 400 days,Among the 36 cases of EGFR+ NSCLC with BM which were effectively treated by TKIs,the m OS was 826 days.COX multiple factor correlation analysis of EGFR-NSCLC with BM found that if zoledronic used for six or nine times,gender,BM number,the application of zoledronic times all were associated with mOS dramatically P<0.05.5.The combined diagnostic sensitivity,specificity and accuracy of serum RANKL,TRACP-5b,NTX and BLP were 76%,78.5% and 73.8%.Therefore,we believe that the combined detection is of certain value in the diagnosis of BM.In the evaluation of the efficacy of bone metastasis,TRACP-5b has the same trend as bone scan,which can be further observed after expanding the sample size.Conclusion:The results of osteogenic type and mixed type were higher than those of previous studies.Factors influencing the prognosis of lung cancer with BM for the application of zoledronic time and the number of applications,so for lung cancer patients with BM rule applied double zoledronic can not only prolong the lifetime can also reduce bone related events,improve the quality of life,but in TKI treatment effective EGFR + non-small cell lung cancer patients with BM of this effect is not obvious,the prognostic factors for further research.The sensitivity,specificity and accuracy of serum RANKL,TRACP5 b,NTX and BAP combined diagnostic were 78.5%,76%and77.8%.We believe that the combined detection has a certain value in the diagnosis of BM.In the evaluation of the efficacy of BM,TRACP5 b has the same trend as bone scan,which can be further observed after expanding the sample size.