Predictors of skeletal-related events in non-small cell lung cancer patients with bone metastases.

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e18062 Background: Skeletal-related events (SREs) cause significant pain and morbidity to many non-small cell lung cancer (NSCLC) patients. We try to evaluate the predictive factor of SREs in NSCLC patients with bone metastases. Methods: We retrospectively examined the medical charts of 273 patients diagnosed with bone metastases secondary to NSCLC. The predictive factor of SREs was analyzed using the first-event analyses and a survival-adjusted multiple-event analysis. In addition, the impact of the kind of systemic treatment on SREs was evaluated by comparing the incidence rates of SREs during epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) therapy and cytotoxic chemotherapy. Results: Out of 273 patients with bone metastases, 171 (62.6%) had at least one SRE and 46 of these experienced multiple SREs. In the first-event analyses, a larger proportion of ever-smokers have experienced the SRE compared with never-smokers (odds ratio, 2.80: 95% CI, 1.32 to 6.00). In addition, ever-smokers (Hazard ratio [HR], 1.75: 95% CI, 1.05 to 2.92), patients without history of EGFR TKI therapy (HR, 2.12: 95% CI, 1.49 to 3.00) and patients with histology of nonadenocarcinoma (HR, 1.59: 95% CI, 1.14 to 2.22) had a shorter median time from bone metastasis to first SRE. In a survival-adjusted multiple-event analysis, clinical characteristics such as ever-smoking, nonadenocarcinoma, poor performance status (ECOG ≥ 2), and no history of EGFR TKI therapy were independent risk factor of development of SRE throughout the course of disease. The incidence rate of SREs was 4.4% per cycle of EGFR TKI therapy (39 SREs/891 cycles), which was significantly lower than 7.3% per cycle for cytotoxic chemotherapy (125 SREs/1719 cycles) (p = 0.004). Conclusions: Our data indicate that patients with characteristics such as ever-smoking, nonadenocarcinoma, poor performance status, and no history of treatment with EGFR TKI are more likely to have SRE, so more vigilant surveillance and prevention should be considered to these patients. No significant financial relationships to disclose.