Bone metastases in patients with small cell lung carcinoma: rate of development, early versus late onset, modality of treatment, and their impact on survival. A single-institution retrospective cohort study

Abstract

The aim of the present study was to further explore the impact of bone metastases (BMs) and their therapeutic management on the overall prognosis of patients with small cell lung carcinoma (SCLC). We performed a retrospective analysis of medical records of 363 patients with histologically or cytologically confirmed SCLC, diagnosed and treated in the Oncology Unit of Sotiria Athens General Hospital, between January 2003 and December 2012. Demographic and clinicopathological features, including BMs, their time point of development (early onset/at diagnosis versus late onset/at a subsequent time point), treatment modality for BMs (radiotherapy, bisphosphonates or both) and the presence of skeletal-related events (SREs), were correlated with overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, log-rank tests and Cox regression analysis. Overall, 130/363 patients (35.8 %) were diagnosed with either early-onset (97/363 cases, 26.7 %) or late-onset BMs (33/363 cases, 9.1 %). Patients with early-onset BMs had a reduced OS as compared to those with late-onset BMs [Hazard ratio (HR) 0.61; 95 % Confidence interval (CI) 0.41-0.91; p = 0.015) or those without BMs (HR 0.76; 95 % CI 0.6-0.96; p = 0.024). SREs and treatment modality of BMs had no impact on OS. Multiple Cox regression analysis showed that increased age, poor performance status (PS), presence of BMs and early onset BMs were independently associated with reduced OS. The results of our single-institution study suggest that the development of early-onset BMs may represent an independent predictor of a worse prognosis among patients with SCLC, in addition to well-established adverse prognostic factors such as poor PS.

The expression of S100B protein in serum of patients with brain metastases from small-cell lung cancer and its clinical significance

“…Each year, ~15% of newly diagnosed cases of lung cancer are SCLC. The incidence of SCLC increases with age, and ~45% of patients are over the age of 70 ( 1 , 2 ). Therefore, early diagnosis of SCLC metastasis is an area of intense research ( 5 – 8 ).…”

“…In many developed and developing countries, the occurrence and mortality from lung cancer rank in first place among all malignant tumors. In China, deaths caused by lung cancer account for 20% of total cancer deaths, and this represents the highest rates of occurrence and mortality in the world ( 1 ). Lung cancer can be divided into non-small cell lung cancer (SCLC) and SCLC according to the different pathological types.…”

“…Lung cancer can be divided into non-small cell lung cancer (SCLC) and SCLC according to the different pathological types. The occurrence of SCLC accounts for 13 to 20% of the total number of cases of lung cancer, and its occurrence is closely related to the intensity and duration of smoking ( 1 – 3 ). SCLC is characterized by rapid development and high invasion ability, and is often accompanied by secondary tumor syndrome and early metastasis.…”

Bone Metastasis: Current State of Play

“…Small-cell lung cancer is also associated with BM incidence, although data are limited. In one study, the diagnostic rate of BM was 26.7% in a retrospective cohort of 363 patients in Greece [44].…”

“…In a study on small-cell lung cancer, the prognosis of patients with an early onset of BM was worse than that of those with a late onset ( p = 0.015). However, the SRE rate was similar in both groups: 20.8% in those with an early onset and 20.6% in those with a late onset [44]. In a meta-analysis, the median survival time of patients with BM and subsequent SREs was 7 months [56].…”