| Background:Lung cancer has high morbidity and mortality worldwide, as well as in China. Of all lung cancers, NSCLC (non-small cell lung cancer) accounts for approximately 80%-85%. Surgical resection is still the standard treatment for patients with resectable NSCLC。Bone metastasis is the common site of blood metastasis and approximately 30-40% of patients will develop bone metastases. Patients with bone metastasis have shorter survival time than patients without bone metastasis. Systemic treatment is still the main care model, and at the same time, radiotherapy and surgery are effective for local control of bone metastasis. Bisphosphonates have been widely used for preventing development of SREs (skeletal-related events).However, there are no effective drugs for preventing bone metastasis in patients with NSCLC. Encouragingly, several studies have proven that bisphosphonates can reduce the incidence of bone metastasis in women with breast cancer. The consensus guidance for clinical practice from a European panel has also recommended that bisphosphonates should be used for prevention of bone metastases in patients with low levels of female sex hormones. Risk factors for bone metastases in resectable NSCLC (non-small cell lung cancer) patients are undefined. We assessed risk factors for bone metastasis in patients with completely resected NSCLC.Objectives:1. To find risk factors for bone metastasis in patients with completely resected NSCLC to support evidence for individual prophylactic treatment.2. We hope to find influencing factors for OS(overall survival) in patients with completely resected NSCLC, especially the relationship between bone metastasis and OS.Materials and Methods:A total of 374 NSCLC patients who had undergone a complete resection at our hospital from January 2008 to May 2012 were included in this retrospective study. The correlation between bone metastasis and clinical factors was evaluated. The Kaplan-Meier method and multivariate Cox regression analysis were used to evaluate risk factors for bone metastasis. A two-sided test that resulted in P<0.05 was considered to be statistically significant.Results:One hundred and forty-six patients (146/374,39.0%) had died by the time of the last follow-up. Forty-seven patients (47/374,12.6%) developed bone metastasis up until the last follow-up time. Most patients died of metastasis or recurrence, six patients died of other causes, including heart failure, myocardial infarction and lung infection. The median survival time for all patients was 46.0 months (ranging from 3 to 89 months). The OS ratios at 1 year,2 years and 3 years in patients without bone metastasis were 92.97%,83.49%, and 72.23%, respectively. In patients with bone metastasis, the OS ratios at 1 year,2 years and 3 years were 95.74%,72.34%, and 46.81%(p<0.0001)Bone metastasis (HR=1.785, p= 0.000), ECOG score<1 (HR=1.881, p= 0.000), smoking history (HR= 1.461,p= 0.033) and N-stage were prognostic factors related to survival. For patients without or with bone metastasis, the overall survival (OS) ratio at 3 years was 71.6% compared with 46.8%(p<0.0001), respectively.The patients with bone metastasis included 33 (19.4%) adenocarcinoma patients,4 (28.6%) adenosquamous carcinoma patients,2 (10.0%) mixed adenocarcinoma patients and only 6 (4.9%) squamous cell carcinoma patients (p=0.001). There were 17 (10.2%) patients with P-stage (pathologic stage) I disease,9 (9.5%) patients with P-stage II disease and 21 (18.8%) patients with P-stage III disease (p=0.007) among all the bone metastasis patients.Conclusions:Patients with bone metastasis had poor prognosis. Pathologic type and P-stage were risk factors for bone metastasis in completely resected NSCLC patients. Adenocarcinoma and P-stage Ⅲ disease were related to a high risk of bone metastasis. |
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