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Abstract：
BACKGROUND: This study aimed to examine the clinical characteristics of bone metastasis (BoM) in patients with non-small cell lung cancer (NSCLC) who have an epidermal growth factor receptor (EGFR) mutation and to identify the most effective treatment strategy using EGFR-tyrosine kinase inhibitors (TKIs).
METHODS: The study included patients with stage IV EGFR-mutated NSCLC who were receiving first-line treatment with EGFR-TKIs between January 2014 and December 2020. These patients were divided into two groups based on the presence or absence of BoM at the time of initial diagnosis. The BoM group was further subdivided based on whether they received denosumab or not.
RESULTS: The final analysis included 247 patients. Those with BoM at initial diagnosis had shorter progression-free survival (12.6 vs. 10.5 months, p = 0.002) and overall survival (OS) (49.7 vs. 30.9 months, p = 0.002) compared to those without BoM. There was a difference in the location of metastatic sites between the two groups, with a higher incidence of extrathoracic metastasis in the BoM group (p < 0.001). The incidence of T790M was higher in patients with BoM than in those without (47.4% vs. 33.9%, p = 0.042). Multivariate Cox regression analysis revealed that sequential osimertinib treatment and the addition of antiangiogenic therapy (AAT) and denosumab therapy improved OS in patients with BoM.
CONCLUSIONS: The presence of BoM is a negative prognostic factor for NSCLC patients with an EGFR mutation, possibly due to the presence of extrathoracic metastases. However, adding AAT and denosumab, along with sequential osimertinib, to the treatment regimen for patients with BoM can improve survival outcomes.
METHODS: The study included patients with stage IV EGFR-mutated NSCLC who were receiving first-line treatment with EGFR-TKIs between January 2014 and December 2020. These patients were divided into two groups based on the presence or absence of BoM at the time of initial diagnosis. The BoM group was further subdivided based on whether they received denosumab or not.
RESULTS: The final analysis included 247 patients. Those with BoM at initial diagnosis had shorter progression-free survival (12.6 vs. 10.5 months, p = 0.002) and overall survival (OS) (49.7 vs. 30.9 months, p = 0.002) compared to those without BoM. There was a difference in the location of metastatic sites between the two groups, with a higher incidence of extrathoracic metastasis in the BoM group (p < 0.001). The incidence of T790M was higher in patients with BoM than in those without (47.4% vs. 33.9%, p = 0.042). Multivariate Cox regression analysis revealed that sequential osimertinib treatment and the addition of antiangiogenic therapy (AAT) and denosumab therapy improved OS in patients with BoM.
CONCLUSIONS: The presence of BoM is a negative prognostic factor for NSCLC patients with an EGFR mutation, possibly due to the presence of extrathoracic metastases. However, adding AAT and denosumab, along with sequential osimertinib, to the treatment regimen for patients with BoM can improve survival outcomes.
摘要：
背景：本研究旨在研究表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者骨转移（BoM）的临床特征，并确定使用EGFR酪氨酸激酶抑制剂（TKIs）的最有效治疗策略。
方法：本研究纳入了2014年1月至2020年12月接受EGFR-TKIs一线治疗的IV期EGFR突变NSCLC患者。根据初始诊断时是否存在BoM，将这些患者分为两组。BoM组根据是否接受denosumab进行了进一步细分。
结果：最终分析包括247例患者。初次诊断时患有BoM的患者无进展生存期较短（12.6vs.10.5个月，p=0.002）和总生存率（OS）（49.7vs.30.9个月，p=0.002)与没有BoM的那些相比。两组之间转移部位的位置存在差异，BoM组的胸腔外转移发生率较高（p<0.001）。有BoM患者的T790M发生率高于无BoM患者(47.4%vs.33.9%,p=0.042)。多因素Cox回归分析显示，序贯奥希替尼治疗以及添加抗血管生成治疗（AAT）和地诺舒马治疗可改善BoM患者的OS。
结论：对于EGFR突变的非小细胞肺癌患者，BoM的存在是一个负预后因素，可能是由于胸腔外转移的存在。然而,添加AAT和denosumab，以及序贯奥希替尼，BoM患者的治疗方案可以改善生存结局。
方法：本研究纳入了2014年1月至2020年12月接受EGFR-TKIs一线治疗的IV期EGFR突变NSCLC患者。根据初始诊断时是否存在BoM，将这些患者分为两组。BoM组根据是否接受denosumab进行了进一步细分。
结果：最终分析包括247例患者。初次诊断时患有BoM的患者无进展生存期较短（12.6vs.10.5个月，p=0.002）和总生存率（OS）（49.7vs.30.9个月，p=0.002)与没有BoM的那些相比。两组之间转移部位的位置存在差异，BoM组的胸腔外转移发生率较高（p<0.001）。有BoM患者的T790M发生率高于无BoM患者(47.4%vs.33.9%,p=0.042)。多因素Cox回归分析显示，序贯奥希替尼治疗以及添加抗血管生成治疗（AAT）和地诺舒马治疗可改善BoM患者的OS。
结论：对于EGFR突变的非小细胞肺癌患者，BoM的存在是一个负预后因素，可能是由于胸腔外转移的存在。然而,添加AAT和denosumab，以及序贯奥希替尼，BoM患者的治疗方案可以改善生存结局。
