Estimating survival and clinical outcome in advanced non-small cell lung cancer with bone-only metastasis using molecular markers

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Studies about prognostic factors of NSCLC patients with BOM are lacking.

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Five significant independent prognostic factors for them were found.

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We developed a GPA model to estimate life expectancy and to guide interventions.

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The more distal metastases to the spine, the worse the prognosis.

Objectives

This retrospective study investigated prognostic factors in advanced non-small cell lung cancer (NSCLC) with bone-only metastasis, and developed a graded prognostic assessment (GPA) model to estimate patient survival.

Methods

The primary endpoint was overall survival. We investigated the patients with advanced NSCLC with bone-only metastasis at the initial diagnosis and diagnosed between 2013 and 2019 in our hospital. A log-rank test and Cox proportional hazards model were used to examine factors. A GPA model was developed in the training set based on the factors that were determined significant according to their hazard ratios and verified by the validation set.

Results

We finally included 220 patients for analysis. These patients were divided into two groups, 147 cases for the training cohort and 73 for the validation cohort. The following were significant independent prognostic factors, and were included in the GPA model: smoking; EGFR (epidermal growth factor receptor) sensitive/ALK (anaplastic lymphoma kinase) mutations; loss of weight; hypoalbuminemia; and primary site treated by surgery or radiotherapy. GPA score of nil was assigned to smoking, without sensitive mutations, loss of weight, hypoalbuminemia, and without local treatment of primary site; the corresponding superior alternatives were scored 1.5, 2.0, 1.5, 1.5, and 1.5, respectively. The median survival times of patients with GPA scores of nil to 3.0, 3.5 to 6.0, and 6.5 to 8.0 were 14.2, 29.5, and 56.6 months in the training set (P < 0.001) and 15.2, 31.2, and 54.0 months in the validation set (P < 0.001).

Conclusion

The survival time of patients with NSCLC with bone-only metastasis was dramatically influenced by the presence of the determined prognostic factors. The GPA model developed in this study may be a useful clinical tool to estimate the life expectancy of these patients, and guide treatment.

Application of "omics" sciences to the prediction of bone metastases from breast cancer: State of the art

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Breast cancer (BC) is the first cause of cancer-related death in women.

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Most patients with advanced BC develop bone metastases (BM).

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Omics technologies have been applied to identify putative BM “predicting” biomarkers.

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Prospective studies are needed before any clinical application of such biomarkers.

Breast cancer (BC) is the most frequent malignancy and the first cause of cancer-related death in women.

The majority of patients with advanced BC develop skeletal metastases which may ultimately lead to serious complications, termed skeletal-related events, that often dramatically impact on quality of life and survival.

Therefore, the identification of biomarkers able to stratify BC patient risk to develop bone metastases (BM) is fundamental to define personalized diagnostic and therapeutic strategies, possibly at the earliest stages of the disease.

In this regard, the advent of “omics” sciences boosted the investigation of several putative biomarkers of BC osteotropism, including deregulated genes, proteins and microRNAs.

The present review revisits the current knowledge on BM development in BC and the most recent studies exploring potential BM-predicting biomarkers, based on the application of omics sciences to the study of primary breast malignancies.

c-Met expression in renal cell carcinoma with bone metastases

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Bone is a common metastatic site in renal cell carcinoma (RCC).

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HGF/c-Met pathway is particularly relevant in tumors with bone metastases.

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c-Met/HGF pathway is involved in RCC progression, conferring poor prognosis.

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Several c-Met targeting therapies are currently in clinical development.

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c-Met expression is an important therapeutic target in RCC with bone metastases.

Hepatocyte growth factor (HGF)/c-Met pathway is implicated in embryogenesis and organ development and differentiation. Germline or somatic mutations, chromosomal rearrangements, gene amplification, and transcriptional upregulation in MET or alterations in autocrine or paracrine c-Met signalling have been associated with cancer cell proliferation and survival, including in renal cell carcinoma (RCC), and associated with disease progression. HGF/c-Met pathway has been shown to be particularly relevant in tumors with bone metastases (BMs). However, the efficacy of targeting c-Met in bone metastatic disease, including in RCC, has not been proven. Therefore, further investigation is required focusing the particular role of HGF/c-Met pathway in bone microenvironment (BME) and how to effectively target this pathway in the context of bone metastatic disease.

The need for bone biopsies in the diagnosis of new bone lesions in patients with a known primary malignancy: A comparative review of 117 biopsy cases

Objective

This study used a clinical dataset to investigate the proportion of the newly found bone lesions in malignant patients diagnosed by biopsy as being benign, malignant but unrelated to the primary malignancy, or bone metastases of the primary malignancy. The clinical factors that might affect the correlation between bone lesions and the primary malignancy were also analyzed. It is expected to obtain some information contributing to the clinical decision-making regarding the need for biopsy of these lesions from the research results.

Methods

Data from patients with a single known malignant tumor who had undergone biopsy of newly found bone lesions at our research institution between January 2012 and December 2017 were reviewed. Based on the pathology results, included cases were divided into a bone-metastasis-of-primary-tumor group (Group 1) and a non-bone-metastasis-of-primary-tumor group (Group 2). The sex, age, diagnostic interval time between the primary malignancy and bone lesions, clinical symptoms, number of involved bones, sites of bone biopsy, and ¹⁸F-FDG PET/CT results were compared between groups.

Results

A total of 117 patients (92 in Group 1 and 25 in Group 2) were included in the study. There was no significant difference in the sex, age or diagnostic interval time between patient groups. Of all the cases, 17.9% (21/117) were identified to be benign lesions such as fibrous dysplasia (n = 2), bone tuberculosis (n = 1), simple bone cyst (n = 1), aneurysmal bone cyst (n = 1), or solitary fibrous tumor (n = 1). Meanwhile, 3.4% (4/117) were new malignancies including chondrosarcoma (n = 1), plasmacytoma (n = 1) and bone metastases unrelated to the primary malignancy (n = 2). Bone metastases pertinent to the primary tumor accounted for 78.6% (92/117) of cases. Liver (n = 18), kidney (n = 14), breast (n = 13) and lung (n = 12) were the most common cancers among cases. Cases with clinical symptoms exhibited a higher likelihood of their bone lesions being diagnosed as bone metastases of their primary malignancy than those without clinical symptoms (81.3% (87/107) vs. 50.0% (5/10)) (P = 0.021). Neither the number of bone lesions nor the biopsy sites appeared to influence whether the bone lesions were metastases of the primary malignancy or not. In PET/CT examination, the mean maximum standardized uptake values of the two groups were similar.

Conclusions

This study indicated that more than 1/5 of newly identified bone lesions in patients with a single known malignancy were not clinically associated with their primary tumors. Furthermore, 3.4% of these were newly discovered malignant bone tumors. The presence of clinical symptoms may be a significant factor affecting whether a new bone lesion is clinically linked to a patient's primary malignancy. Based on the experience from these patients, as for the newly found bone lesions, it is worthy to perform an active biopsy on those asymptomatic ones to avoid misdiagnosis and less biopsy on symptomatic ones for the sake of less cost and risks.

Metastatic bone disease: Pathogenesis and therapeutic options: Up-date on bone metastasis management

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Bone metastases negatively impact on patients’ quality of life (QoL).

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Skeletal related events have a detrimental effect on both QoL and survival.

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Both local and systemic treatments are often required to manage bone metastases.

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Bone turnover modulators reduce the risk of skeletal complications and improve pain.

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Novel agents may deserve further investigation for the management of bone metastases.

Bone metastases (BM) are a common complication of cancer, whose management often requires a multidisciplinary approach. Despite the recent therapeutic advances, patients with BM may still experience skeletal-related events and symptomatic skeletal events, with detrimental impact on quality of life and survival.

A deeper knowledge of the mechanisms underlying the onset of lytic and sclerotic BM has been acquired in the last decades, leading to the development of bone-targeting agents (BTA), mainly represented by anti-resorptive drugs and bone-seeking radiopharmaceuticals. Recent pre-clinical and clinical studies have showed promising effects of novel agents, whose safety and efficacy need to be confirmed by prospective clinical trials.

Among BTA, adjuvant bisphosphonates have also been shown to reduce the risk of BM in selected breast cancer patients, but failed to reduce the incidence of BM from lung and prostate cancer. Moreover, adjuvant denosumab did not improve BM free survival in patients with breast cancer, suggesting the need for further investigation to clarify BTA role in early-stage malignancies.

The aim of this review is to describe BM pathogenesis and current treatment options in different clinical settings, as well as to explore the mechanism of action of novel potential therapeutic agents for which further investigation is needed.