Analysis Of The Clinical Characteristics Of Non-small Cell Lung Cancer Patients With Bone Metastases

PartⅠ:Analysis of non-small cell lung cancer patients with bone metastases accompanying soft-tissue massObjective:To analyze the clinical characteristics of non-small cell lung cancer with bone metastases accompanying soft-tissue mass.Methods:The clinical data of 388 patients with bone metastases of non-small cell lung cancer in Zhongshan Hospital, Fudan University and Shanghai Pulmonary Hospital, Tongji University from January 2009 to December 2010 were collected and retrospectively analyzed. Chi-square and Fisher’s exact are used to compare categorical variables among groups. Non-parametric Mann-Whitney test is used to compare continuous variables among groups.Results:The predilection sites of bone metastases of non-small-cell lung cancer were spine(37.2%),rib(23.3%),pelvis(21.3%).Soft-tissue masses are more likely to occur in non-adenocarcinoma patients than adenocarcinoma patients (52.9% vs.34.6%, P=0.003); low level serum albumin than normal (58.0% vs.33.8%, P=0.002); High level AKP than normal (52.4% vs.34.0%, P=0.011); with SRES than without (57.2% vs.24.8%, P<0.001)Conclusion:Soft-tissue mass is more likely to occur in non-adenocarcinoma patients with bone metastases(52.9%, P=0.003). Low serum albumin level (58.0%, P= 0.002), high AKP(52.4%, P=0.011) and SREs are more common in bone metastases patients with soft-tissue mass than those without.PartⅡ:Analysis of Risk Factors for Skeletal-Related Events in Non-Small Cell Lung Cancer Patients with Bone Metastases Objective:To identify the risk factors of skeletal-related events (SRES) in non-small cell lung cancer (NSCLC) patients with bone metastases.Methods:The clinical data of 314 NSCLC patients with bone metastases at Zhongshan Hospital, Fudan University between January 2009 and December 2010 were retrospectively analyzed. The proportion of patients experienced SREs was compared between groups with and without potential risk factors using Binary Logistic analysis and Multinomial Logistic analysis. Time to first SRE was compared between groups with and without potential risk factors using the Log-rank test, and Cox regression was used to further confirm the independent factors.Results:Out of 314 NSCLC patients with bone metastases,129 patients (41.1%) developed at least one SRE and 15 of those experienced multiple SRES. Bone metastases with soft-tissue mass(P≤0.001) and history of bisphosphonate therapy (P =0.009) are more likely to have SREs. Patients with Soft-tissue mass (P=0.004), serum albumin decrease (P=0.006) and history of target therapy (P=0.042) had a shorter median time from bone metastasis to first SRE.Conclusions:The presence of bone metastases with soft-tissue extension was significantly associated with the development of SREs in patients with advanced NSCLC. Bone metastasis with soft-tissue mass, serum albumin decrease and no history of target therapy were independent risk factors of shorter median time from bone metastasis to first SRE.PartⅢ:Analysis of Prognostic Factors of non-small cell lung carcinoma Patients with Bone Metastases Treated with Epidermal growth factor receptor-Tyrosine Kinase Inhibitor (EGFR-TKI)Objective:To analyse the clinical features and prognostic factors of non-small cell lung carcinoma patients with bone metastases treated with EGFR-TKI.Methods:The clinical data of 132 non-small cell lung carcinoma patients with bone metastases treated with EGFR-TKI, admitted in Zhongshan Hospital Fudan University and Shanghai Pulmonary Hospital Tongji University during January 2009 to December 2010, were retrospectively researched. Kaplan-Meier analysis was used to estimate the 1-year and 2-year survival rates of patients. Log-rank test was used to screen the survival influencing factors and Cox regression was further used to confirm the independent factors.Results:The median survival time of the 132 patients was 15.9 months; the 1-year and 2-year survival rates were 63.9%and 41.5% respectively. Univariate analysis showed that female, nonsmoker, normal serum albumin were associated with the good prognosis of patients (P<0.05), while multivariate analysis only revealed that low serum albumin level was the independent prognostic factor.Conclusions:The treatment with EGFR-TKI tended to prolong the median survival of non-small cell lung carcinoma patients with bone metastases who are female and nonsmokers. Low serum albumin level was an unfavorable prognostic factor.