Prospective Study on the Incidence of Bone Metastasis (BM) and Skeletal-Related Events (SREs) in Patients (pts) with Stage IIIB and IV Lung Cancer—CSP-HOR 13

Abstract

Background:Bone metastasis (BM) is a frequent complication in patients with advanced lung cancer and it causes skeletal-related events (SREs). Our study aim is to prospectively investigate the incidence of BM, incidence and types of SRE, and predictive factors of BM and SREs.Methods:Newly diagnosed, advanced non–small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC) patients were enrolled into the study. Patients were followed up every 4 weeks to monitor the development of SREs. Treatment for lung cancer was performed at the discretion of the investigator.Results:Two hundred seventy-four patients were enrolled in this study between April 2007 and December 2009 from 12 institutions. Patients included 77 cases of SCLC and 197 of NSCLC (stage IIIB/IV = 73/124). Median follow-up time was 13.8 months. The incidence of BM at initial diagnosis was 48% in stage IV NSCLC and 40% in extensive stage (ED)-SCLC. Forty-five percent of patients who developed BM had SREs consisting of pathologic fracture (4.7%), radiation to bone (15.3%), spinal cord compression (1.1%), and hypercalcemia (2.2%). Multivariate analysis revealed that factors predicting BM are stage IV, performance status 1 or greater and higher bone alkaline phosphatase in NSCLC patients, higher lactate dehydrogenase, and lower parathyroid hormone–related peptide in SCLC patients. Factors predicting SREs were stage IV, age 64 or younger, and lower albumin in NSCLC patients. Multivariate analysis of SRE was not performed for SCLC because of the small number of events.Conclusion:Predictive factors should be taken into consideration in future randomized studies evaluating BM and SREs.

Prognostic Factors and Skeletal-Related Events in Patients with Small Cell Lung Cancer with Bone Metastases at the Time of Diagnosis

“…In our study, bone metastases were found in 26.2% of all patients with SCLC and 34.3% of the patients with SCLC-ED. These results are also consistent with other previous reports that bone metastases are present in around 20% of all SCLC and 40% of SCLC-ED patients [8,9,10]. …”

“…We reported a 34.4% rate of SREs in patients with SCLC with bone metastases. In agreement with the results of other studies, the incidence of SREs in our study in SCLC was lower than that reported for NSCLC [3,10]. Shorter survival might be the reason for a lower incidence of SREs in SCLC.…”

“…In NSCLC, the incidence of SREs is 43-62.6% in patients with bone metastases [10,20,21,22]. We reported a 34.4% rate of SREs in patients with SCLC with bone metastases.…”

“…Several predictive markers for SREs have been reported, mostly in studies of NSCLC [10,21]. In the study by Sun et al [21], patients with characteristics such as a history of smoking, nonadenocarcinoma, poor ECOG PS, and no history of epidermal growth factor receptor tyrosine kinase inhibitor treatment were more likely to have SREs.…”

“…The occurrence of SREs in patients with bone metastases and their prognostic effect have been investigated in several cancers that frequently present with bone metastases, such as NSCLC, prostate cancer, and breast cancer [3,4,10,19,20,21,22]. In NSCLC, the incidence of SREs is 43-62.6% in patients with bone metastases [10,20,21,22].…”