Risk Factors For Bone Metastasis In Patients With Lung Cancer

Objective The clinical characteristics of bone metastasis in primary lung cancer were analyzed to provide evidence for the diagnosis and treatment of the disease.Methods The patients of lung cancer,diagnosed by pathology,had been collected that including gender,age,smoking status,pathological type,diameter size of the primary lesion,EGFR gene expression,whether the first diagnosis of bone metastases,bone metastases lesions number and the site,with or without skeletal related event(SRE)and the method of treatment from March 2012 to June 2018 in the first affiliated hospital of Fujian medical university.SPSS 24.0 statistical software was used to analysis the correlation of the above factors and bone metastasis of lung cancer.The related risk factors were determined with binary logistic regression.ROC curve was drawn by SPSS or Med Calc software to determine the value of risk factors in predicting bone metastasis of lung cancer.Results 1.Among 445 lung cancer patients,the median age was 61 years old(22-90),among which 255 were males(57.3%)and 190 were females(42.7%),with a male to female ratio of 1.34:1.EGFR gene was detected in 226 cases of mutant(50.8%)and 219 cases of wild type(49.2%).There were 144 cases(32.4%)with bone metastasis,301 cases(67.6%)without bone metastasis,124 cases(27.9%)with bone metastasis at the initial diagnosis,390 cases(73%)with adenocarcinoma,41 cases(16%)with small cell lung cancer and 10 cases(6%)with other types.2.Among 144 cases of bone metastasis of lung cancer,36 cases(18.1%)were single lesion,87 cases(60.4%)were multiple lesion,and 21 cases(14.5%)were unknown.According to the order of bone partition,66 cases(45.83%)in chest,63 cases(43.75%)in spine,54 cases(37.5%)in pelvis,26 cases(18.06%)in limbs,and 12 cases(8.33%)in skull.Gender,smoking history,pathological type,EGFR gene expression,number of metastasis,SRE and metastatic sites were compared,there were not statistically significant differences(P>0.05).3.In the subgroup analysis of EGFR gene expression,there was no statistically significant difference between EGFR gene expression and age,U=23273.5,Z=-1.087,P=0.277,which was statistically significant compared with smoking history,pathological type,lung cancer bone metastasis,and bone metastasis at first diagnosis(P<0.05).The research showed that the adenocarcinoma group was more prone to EGFR gene mutation than the squamous cell carcinoma group(P<0.05),there was no difference in small cell carcinoma and other types(P>0.05).4.In the single factor analysis,the measurement data of the Mann-Whitney rank and test results showed that the bone metastasis and non-bone metastases group in LDH,ALP,CEA and AFP,NSE,CA125,maximum lesions,Cyfra21-1 diameter,statistically significant difference(P<0.05),but in the age,hemoglobin no.Youden index was calculated through ROC curve analysis to determine its diagnostic boundary.The chi-square test results of counting data showed that there were statistically significant differences between the lung cancer bone metastasis group and the non-bone metastasis group in EGFR expression,pathological type,whether radiotherapy was performed,and whether chemotherapy was performed(P<0.05),while in gender,smoking history,and whether radiotherapy was performed(P>0.05).5.In the multivariate analysis,the identified risk factors were performed with binary Logistic regression analysis.While the results showed that ALP and radical surgery were risk factors for bone metastasis of lung cancer.6.ROC curve analysis alone or in combination with each independent risk factor to predict the occurrence of bone metastasis in lung cancer.It revealed when a single independent risk factor predicted the occurrence of bone metastasis in lung cancer,the area under the ROC curve(AUC)of ALP was 0.728.Two independent risk factors predicted an AUC of 0.749 when bone metastasis occurred in lung cancer.Conclusion 1.It was revealed that the most common sites of bone metastases of lung cancer were axial bones as chest,spine and pelvis in this study.2.Lung cancer patients with female,not smoking and adenocarcinoma were more likely to have EGFR gene mutation,and lung cancer patients with EGFR gene mutation are more susceptible to have bone metastasis,most of which are bone metastasis at the first diagnosis.3.ALP and whether radiotherapy was performed or not were independent risk factors for bone metastasis of lung cancer.When two independent risk factors were combined to predict bone metastasis in lung cancer,the AUC was 0.749,which had high diagnostic value.