The effect of bone metastases on survival in lung cancer

Year 2020, Volume: 4 Issue: 11, 965 - 969, 01.11.2020

Suphi Aydın , Aydın Balcı

https://doi.org/10.28982/josam.804514

Cited By: 1

Abstract

Aim: The most common sites of distant metastasis in lung cancers are bones. In our study, we aimed to investigate the incidence of bone metastasis in lung cancers, and the effects of single and multiple bone metastases on survival. We conducted such a study to contribute to the literature due to the small number of studies on this subject.
Methods: Lung cancer patients diagnosed with bone metastases in our hospital between January 2012-December 2018 were identified. A total of 103 (60.59%) patients with single bone metastasis, and 67 (39.41%) patients with multiple bone metastases were included in the study. Patients' demographic characteristics, symptoms, radiological findings, diagnostic methods, histological subtypes, survival, biochemistry values, tumor markers were analyzed retrospectively according to single and multiple bone metastases. A cohort study was conducted, and the results were presented as mean and standard deviation for continuous variables, and percentage for categorical variables.
Results: Among the 170 patients included in the study, 147 (86.5%) were male, and 23 (13.5%) were female. The overall mean age of the patients was 64.32 (9.965) years. The most common symptom was dyspnea, reported by 58 (34.1%) patients. Bronchoscopic biopsy was most used for diagnosis, in 116 (68.2%) patients. Among patients with adenocarcinoma, squamous cell carcinoma, and small cell lung carcinoma, the number of those with single and multiple bone metastases were 44 (55%) and 36 (45%), 37 (75.5%) and 12 (24.5%), and 22 (53.7%) and 19 (46.3%), respectively. Vertebrae were the most common site of metastasis in single bone metastases. The mean survival times of adenocarcinoma, squamous cell carcinoma, and small cell lung carcinoma patients with single and multiple bone metastases were 14.93 (11.8) and 13.03 (9.32), 15.55 (9.41) and 9.42 (5.744), and 10.55 (8.32) and 8.79 (4.171) months, respectively.
Conclusion: No significant differences were detected in terms of survival between adenocarcinoma and small cell lung cancer patients with single and multiple bone metastases. However, multiple bone metastases were observed to significantly decrease survival in squamous cell carcinoma.

Keywords

Lung cancer, Histological subtypes, Metastase, Survival

Akciğer kanserinde kemik metastazlarının sağkalıma etkisi

Abstract

Amaç: Akciğer kanserlerinde en sık uzak metastaz yerleri kemiklerdir. Çalışmamızda akciğer kanserlerinin kemik metastazı insidansını, tek ve multıpl kemik metastazlarının sağkalıma etkisini araştırmayı amaçladık. Bu konudaki çalışmaların az olması nedeniyle literatüre katkı sağlamak amacıyla böyle bir çalışma yaptık.
Yöntem: Ocak 2012-Aralık 2018 yılları arasında kemik metastazı yapmış akciğer kanseri hastaları tespit edildi. Tek kemik metastazı tespit edilen 103(%60.59), multipl kemik metastazı tespit edilen 67(%39,41) hasta çalışmaya alındı. Hastaların demografik özellikleri, semptomları, radyolojik bulguları, tanı yöntemleri, histolojik alt tipleri, tek ve multıpl kemik metastazlarına göre sağkalım, biyokimya değerleri, tümör markırları retrospektif incelendi. Kohort çalışması yapıldı, sürekli değişkenler için ortalama, standart sapmaya, kategorik değişkenler için yüzdeye göre analizi yapıldı.
Bulgular: Çalışmaya 147 (%86,5)’si erkek, 23 (%13,5)’ü kadın 170 hasta dahil edildi. Yaş ortalaması 64,32(9,965) idi. En sık semptom 58 (%34,1) hastada izlenen dispneydi. Tanıda 116 (%68,2) hasta ile en sık bronkoskopik biyopsi kullanılmıştı. 80 hastada adenokarsinoma (44 (%55) hastada tek kemikte, 36 (%45) hastada multıpl kemikte metastaz), 49 hastada skuamöz hücreli karsinoma (37 (%75,51) hastada tek kemikte, 12 (%24,49) hastada multıpl kemikte metastaz), 41 hastada küçük hücreli akciğer karsinomu (22 (%53,65) hastada tek kemikte, 19 (%46,35) hastada multıpl kemikte metastaz) izlendi. Tek kemik metastazlarında en sık metastaz yeri vertebralardı. Adenokarsinomada tek kemik metastazlarında sağkalım (ay) 14,93 (11,795), multıpl kemik metastazlarında sağkalım (ay) 13,03 (9,321), squamöz hücreli karsinomada tek kemik metastazlarında sağkalım (ay) 15,55 (9,414), multıpl kemik metastazlarında sağkalım (ay) 9,42 (5,744), küçük hücreli akciğer karsinomunda tek kemik metastazlarında sağkalım (ay) 10,55 (8,319), multıpl kemik metastazlarında sağkalım (ay) 8,79 (4,171) idi.
Sonuç: Adenokarsinom ve küçük hücreli akciğer kanserlerinde tek kemik metastazı ile multıpl kemik metastazı arasında sağkalım açısından fark izlenmezken, skuamöz hücreli karsinomada multıpl kemik metastazlarının sağkalımı anlamlı derecede azalttığı izlendi.

Keywords

Akciğer kanseri, Histolojik alt tip, Metastaz, Sağkalım

References

• 1. Niu Y, Lin Y, Pang H, Shen W, Liu L, Zhang H. Risk factors for bone metastasis in patients with primary lung cancer A systematic review. Medicine. 2019;98:3. doi: 10.1097/MD.0000000000014084
• 2. Ibrahim T, Mercatali L, Amadori D. Bone and cancer: the osteoncology. Clin Cases Miner Bone Metab. 2013;10:121–3.
• 3. Brodowicz T, O'Byrne K, Manegold C. Bone matters in lung cancer. Ann Oncol. 2012;23:2215-22.
• 4. Coleman RE. Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treat Rev. 2001;27:165–76.
• 5. Zhang L, Gong Z. Clinical Characteristics and Prognostic Factors in Bone Metastases from Lung Cancer. Med Sci Monit, 2017;23:4087-94. doi: 10.12659/MSM.902971
• 6. Svensson E, Christiansen CF, Ulrichsen SP, Rørth MR, Sørensen HT. Survival after bone metastasis by primary cancer type: a Danish population-based cohort study. BMJ Open. 2017;7:e016022. doi:10.1136/bmjopen-2017-016022
• 7. Husaini H, Wheatley-Price P, Clemons M, Shephered FA. Prevention and management of bone metastases in lung cancer: a review. J Thorac Oncol. 2009;4:251–9.
• 8. Santoni M, Conti A, Procopio G, Porta C, Ibrahim T, Barni S, et al. Bone metastases in patients with metastatic renal cell carcinoma: are they always associated with poor prognosis? J Exp Clin Cancer Res. 2015;34:10.
• 9. Santini D, Barni S, Intagliata S, Falcona A, Ferrau F, Galetta D, et al. Natural history of non-small-cell lung cancer with bone metastases. Sci Rep. 2015;5:18670.
• 10. Cetin K, Christiansen CF, Sværke C, Jacobsen JB, Sørensen HT. Survival in patients with breast cancer with bone metastasis: a Danish population-based cohort study on the prognostic impact of initial stage of disease at breast cancer diagnosis and length of the bone metastasis-free interval. BMJ Open. 2015;5:e007702.
• 11. Goksel T, Akkoclu A. Patern of lung cancer in Turkey, 1994-1998. Respiration. 2002;69:207-10.
• 12. De Kock I, Mirhosseini M, Lau F, Thai V, Downing M, Quan H, et al. Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS) and the interchangeability of PPS and KPS in prognostic tools. J Palliat Care. 2013;29:163–9.
• 13. Beckles MA, Spiro SG, Colice GL, Rudd RM. Initial Evaluation of the patient with lung cancer. Symptoms, signs, laboratory tests, and paraneoplastic syndromes. Chest. 2003;123:97-104.
• 14. Bircan AH, Öztürk Ö, Şahin Ü, Özaydın N, Akkaya A. Akciğer kanseri tanısı alan olgularımızın Retrospektif değerlendirilmesi. SDÜ Tıp Fak Derg. 2005;2(3):1-6.
• 15. Balcı P, Altay C. Akciğer Kanserinde Radyolojik Bulgular. turkradyolojiseminerleri.org doi: 10.5152/trs.2014.025
• 16. Kadota K, Sima CS, Arcila ME, Hedvat C. KRAS Mutation Is a Significant Prognostic Factor in Early-stage Lung Adenocarcinoma. Am J Surg Pathol. 2016;40:1579–90.
• 17. Wang Z, Ning L, Li H, Yang YM. Clinical observation of percutaneous osteoplasty in the treatment of 92 lung cancer patients with extraspinal bone metastases. Tumor. 2014;34(5):443–9.
• 18. Lee DS, Kim SJ, Kang JH, Hong SH, Jeon EK, Kim YK, et al. Serum carcinoembryonic antigen levels and the risk of whole-body metastatic potential in advanced non-small cell lung cancer. J Cancer. 2014;5:663–9.