Abstract
In the pre-tyrosine kinase inhibitors (TKIs) era, non-small cell lung cancer (NSCLC) patients with de novo bone metastases had a worse prognosis than those without. However, whether epidermal growth factor receptor (EGFR)-TKIs affect the outcomes of EGFR mutant NSCLC patients with de novo bone metastases has not been well studied thus far. We retrospectively studied the effect of EGFR mutation status and first-line EGFR-TKIs on patient outcomes and created a survival scoring system for NSCLC patients with de novo bone metastases. This retrospective study evaluated 1510 NSCLC patients diagnosed between November 2010 and March 2014. Among these patients, 234 patients had de novo bone metastases. We found that 121 of these 234 patients (51.7%) had positive EGFR mutation tests, and a positive EGFR mutation test significantly affected overall survival (OS) (EGFR mutant: 15.2 months, EGFR wild type: 6.5 months; p < 0.001). Other prognostic factors significant in the multivariable analysis for NSCLC with de novo bone metastases included Eastern Cooperative Oncology Group performance status (PS) (OS; PS 0–2: 11.2 months, PS 3–4: 4.9 months; p = 0.002), presence of extraosseous metastases (OS; with extraosseous metastases: 8.8 months, without extraosseous metastases: 14.0 months; p = 0.008), blood lymphocyte-to-monocyte ratio (LMR) (OS; LMR > 3.1: 17.1months, LMR ≤ 3.1: 6.9months; p < 0.001). A positive EGFR mutation status reversed the poor outcomes of NSCLC patients with de novo bone metastases. A simple and useful survival scoring system including the above clinical parameters was thus created for NSCLC patients with de novo bone metastases.
Highlights
Lung cancer is the leading cause of cancer death worldwide and in Taiwan.[1, 2] Today, a further understanding of the molecular mechanisms underlying non-small cell lung cancer (NSCLC) has resulted in the development of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs)
Previous studies showed that EGFR-TKIs improved quality of life, progression-free survival (PFS), and even overall survival (OS) in advanced NSCLC patients harboring EGFR mutations.[3,4,5]
The aim of this study was to determine if patients positive for EGFR mutations who were taking first-line EGFR-TKIs experienced a reversal of the poor outcomes of NSCLC patients with de novo bone metastases
Summary
Lung cancer is the leading cause of cancer death worldwide and in Taiwan.[1, 2] Today, a further understanding of the molecular mechanisms underlying non-small cell lung cancer (NSCLC) has resulted in the development of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs). As the most common cause of cancer-related pain, bone metastases significantly reduce quality of life.[6] Bone metastases occur in 24.0–39.8% of NSCLC patients, most commonly involving the weight bearing skeleton and proximal long bones.[7, 8] Bone metastases lead to skeletal-related events (SREs), which can negatively affect quality of life and survival duration.[9] The median survival duration for patients with bone metastases is often less than 1 year.[10,11,12]
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