Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study

Abstract

Background: Bones are one of the most common metastatic sites for solid malignancies. Bone metastases can significantly increase mortality and decrease the quality of life of cancer patients. In the United States, around 350,000 people die each year from bone metastases. This study aimed to analyze and update the incidence and prognosis of bone metastases with solid tumors at the time of cancer diagnosis and its incidence rate for each solid cancer.

Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to find patients diagnosed with solid cancers originating from outside the bones and joints between 2010 and 2016. Data were stratified by age, sex, and race. Patients with a tumor in situ or with an unknown bone metastases stage were excluded. We then selected most of the sites where cancer often occurred, leaving 2,207,796 patients for the final incidence analysis. For the survival analysis, patients were excluded if they were diagnosed at their autopsy or on their death certificate, or had unknown follow-ups. The incidence of bone metastases and overall survival was compared between patients with different primary tumor sites.

Results: We identified 2,470,634 patients, including 426,594 patients with metastatic disease and 113,317 patients with bone metastases, for incidence analysis. The incidence of bone metastases among the metastatic subset was 88.74% in prostate cancer, 53.71% in breast cancer, and 38.65% in renal cancer. In descending order of incidence, there were patients with other cancers in the genitourinary system (except for renal, bladder, prostate, and testicular cancer) (37.91%), adenocarcinoma of the lung (ADC) (36.86%), other gynecologic cancers (36.02%), small-cell lung cancer (SCLC) (34.56%), non-small cell lung cancer not otherwise specified and others [NSCLC (NOS/others)] (33.55%), and bladder (31.08%) cancers. The rate of bone metastases is 23.19% in SCLC, 22.50% in NSCLC (NOS/others), 20.28% in ADC, 8.44% in squamous cell carcinoma of the lung (SCC), and 4.11% in bronchioloalveolar carcinoma [NSCLC (BAC)]. As for the digestive system, the overall bone metastases rate was 7.99% in the esophagus, 4.47% in the gastric cancer, 4.42% in the hepatobiliary cancer, 3.80% in the pancreas, 3.26% in other digestive organs, 1.24% in the colorectum, and 1.00% in the anus. Overall, the incidence rate of bone metastases among the entire cohort in breast and prostate cancer was 3.73% and 5.69%, respectively.

Conclusions: The results of this study provide population-based estimates for the incidence rates of patients with bone metastases at initial diagnosis of their solid tumor. The findings can help clinicians to early detect bone metastases by bone screening to anticipate the occurrence of symptoms and favorably improve the prognosis.

Keywords: Bone metastases; Surveillance, Epidemiology, and End Results (SEER); incidence; prognosis.

Figure 1

Selection of study patients.

Figure 2

Incidence proportion of patients diagnosed with bone metastases within the entire cohort. SCLC, small-cell lung cancer; NSCLC, non-small cell lung cancer; BAC, bronchioloalveolar carcinoma; NOS, not otherwise specified; ADC, adenocarcinoma of the lung; SCC, squamous cell carcinoma of the lung; GI, gastrointestinal; GU, genitourinary; GYN, gynecologic.

Figure 3

Incidence proportion of patients diagnosed with bone metastases within subset with metastatic disease. SCLC, small-cell lung cancer; NSCLC, non-small cell lung cancer; BAC, bronchioloalveolar carcinoma; NOS, not otherwise specified; ADC, adenocarcinoma of the lung; SCC, squamous cell carcinoma of the lung; GI, gastrointestinal; GU, genitourinary; GYN, gynecologic.

Figure 4

Median survival of patients with identified bone metastases. SCLC, small-cell lung cancer; NSCLC, non-small cell lung cancer; BAC, bronchioloalveolar carcinoma; NOS, not otherwise specified; ADC, adenocarcinoma of the lung; SCC, squamous cell carcinoma of the lung; GI, gastrointestinal; GU, genitourinary; GYN, gynecologic.