Impact of the homogeneous and heterogeneous risk factors on the incidence and survival outcome of bone metastasis in NSCLC patients

Abstract

Purpose: Bone metastases (BM) is reported as the most frequent distant metastasis in non-small cell lung cancer (NSCLC), but the risk factors for the incidence and prognosis of BM patients in NSCLC have not been extensively elucidated. This study aimed to find risk factors to predict BM patients' morbidity and survival outcome in NSCLC.

Methods: 63,505 patients of NSCLC in the Surveillance, Epidemiology and End Results database diagnosed from 2010 to 2015 were used to analyze risk factors for developing BM by conducting multivariable logistic regression. Of these patients, 6152 and 5664 BM patients diagnosed between 2010 and 2014 were selected to investigate predictive factors for BM overall survival (OS) and cancer-specific survival (CSS) using the multivariable Cox proportional hazards regression.

Results: There were overall 7486 (11.79%) BM patients in NSCLC. The homogeneous risk factors for BM patients' morbidity and survival outcome included male, higher T stage, lymph node involvement, poor differentiation grade, brain metastases, and liver metastases. Married status, adenocarcinoma type and lung metastases were positively correlated with BM incidence, while older age, white race, unmarried status, and SCC and other NSCLC types could predict poor OS and CSS of BM in NSCLC.

Conclusions: The homogeneous and heterogeneous risk factors for morbidity and survival outcome of BM patients could help physicians in more precise and individualized screening and therapies for BM patients in NSCLC.

Keywords: Bone metastasis; Morbidity; Non-small cell lung cancer; Prognosis; Risk factors.

Fig. 1

Flowchart of the study analyzing the risk factors for the incidence and survival outcome of BM patients in NSCLC, along with recording of the number of patients and the reasons for exclusion from our investigation. OS overall survival; CSS cancer-specific survival

Fig. 2

Kaplan–Meier survival curve analysis of risk factors’ impact on the OS of BM patients in NSCLC, which were stratified according to age (a), race (b), marital status (c), sex (d), tumor histology (e), laterality (f), T stage (g), N stage (h), grade (i), brain metastases (j), liver metastases (k), and lung metastases (l). OS overall survival, BM bone metastases, NSCLC non-small cell lung cancer, ADC adenocarcinoma, SCC squamous cell carcinoma, Brain Met brain metastases, Liver Met liver metastases, Lung Met lung metastases, y years

Fig. 3

Kaplan–Meier survival curve analysis of risk factors’ impact on the CSS of BM patients in NSCLC, which were stratified according to age (a), race (b), marital status (c), sex (d), tumor histology (e), laterality (f), T stage (g), N stage (h), grade (i), brain metastases (j), liver metastases (k), and lung metastases (l). CSS cancer-specific survival, BM bone metastases, NSCLC non-small cell lung cancer, ADC adenocarcinoma, SCC squamous cell carcinoma, Brain Met brain metastases, Liver Met liver metastases, Lung Met lung metastases, y years

Fig. 4

The homogeneous and heterogeneous risk factors for the incidence and survival outcome of BM patients in NSCLC. The left circle was the risk factors for the incidence of BM patients. The right circle was the risk factors for the prognosis factors of BM patients’ OS and CSS. The intersection of two circles meant the homogeneous risk factors including male, higher T stage, lymph node involvement, poor differentiation grade, brain metastases, and liver metastases. OS overall survival, CSS cancer-specific survival, BM bone metastases, SCC squamous cell carcinoma, NSCLC non-small cell lung cancer