Cancer Surgery
Open Access

Metastases; Lung Cancer; Cancer surgery

Introduction

Additional studies are required for Small-cell lung cancer (SCLC), which is extremely malignant, prone to distant metastasis, and has a poor survival rate, accounts for approximately 15-20 percent of lung cancer cases. SCLC patients' survival has not significantly improved over the past 30 years. In the treatment of extensive SCLC, it had previously been suggested that the addition of immunotherapy may result in a significant improvement in survival rates. Nevertheless, survival rates remain low, particularly for extensive SCLC. One of the most common locations for metastases in extensive SCLC is the skeletal system [1]; approximately two-thirds of SCLC patients have bone metastases at diagnosis. Once bone metastases develop, they may result in significant morbidity, such as severe bone pain, pathologic fracture, and spinal cord compression, all of which lower quality of life. The patient's life expectancy should guide the choice of treatment for bone metastases. Therefore, it is of great clinical importance to predict the survival time of SCLC patients with bone metastases. The natural history of NSCLC patients with bone metastases has been the subject of numerous studies. However, there is no scoring system for SCLC life expectancy and very little research has been done on the prognostic factors and characteristics of SCLC. The purpose of this study was to develop a scoring system that would help doctors figure out how long these SCLC patients with bone metastases would be alive at the time of their initial diagnosis [2].

Method

Between May 2010 and May 2015, 103 patients with SCLC and bone metastases were the subject of a retrospective review at our hospital. One patient was ruled out due to incomplete in-formation. As a result, 102 patients were analyzed in our study. A review of the histopathological findings and typical clinical indicators were used to make a diagnosis for each patient. For the purpose of determining the stage of the tumor, chest and abdominal computed tomography (CT), radionuclide bone scan, brain MRI or integrated PET-CT were not utilized. Consequently, routine radionuclide bone scans or PET-CTs were carried out to stage bone metastases. Magnetic resonance imaging, computed tomography, or radiography were required to determine whether bone metastases were present if the radionuclide bone scan or PET-CT revealed suspicious bone lesions, particularly a single suspicious bone lesion. The diagnosis was confirmed by at least one physician and a radiologist. This report looked at the imaging. Patients with two adjacent vertebral metastases were included in the multiple metastases category based on the number of bone metastases they had. One patient belonged to the group with multiple metastases because she had two adjacent vertebral metastases [3]. provides a summary of the characteristics of the patient. Twenty patients, or 19.6%, were female, while eighty-two patients, or 80.4%, were male. The average age was 60, with ages ranging from 42 to 85. The evaluation of the potential prognostic factors below: sex (male versus female), age (65 versus 65), smoking status (yes versus no), coexisting extra osseous metastases (yes versus no), number of bone metastases (single versus multiple), appendicular bone metastases (yes versus no), number of vertebral metastases (three versus three), T stage (T1/T2 versus T3/T4), N stage (N0/N1/N2 versus N3), LDH level The KPS was not analyzed in this study because there were only 12 patients with a KPS of less than 80. According to the Response Evaluation and Criteria in Solid Tumors (RECIST), tumor response was evaluated [4].

Result

All patients received EP (30 mg/m2 cisplatin from days 1 to 3;) in addition to chemotherapy. CE (500 mg carboplatin on day one; 100 mg etoposide from days 1 to 5); From days 1 to 5, 100 mg of etoposide, or platinum-based chemotherapy, as the initial treatment. Six cycles of chemotherapy were typically administered to patients. 49 patients received TRT, which began after at least two chemotherapy cycles. The total dose was 30 to 45 Gy at a rate of 3 Gy per fraction or 40 to 60 Gy at a rate of 1.8 to 2 Gy per fraction. Prophylactic cranial irradiation was administered to only three patients (2.9 percent). Bisphosphonates were used to treat 87 patients, 12 of whom received zoledronic acid and 75 of whom received pamidronate disodium [5].

Overall survival (OS) was the primary outcome, and it was measured from the first day of treatment to the date of death or the last follow-up. Patients were censored at the time of their last follow-up, and they were followed up until death [6]. The distribution of time until death was estimated using the Kaplan–Meier method.

The significant factors associated with longer survival were identified using multivariate Cox regression analysis. For each factor, an adjusted hazard ratio with a 95% confidence interval was presented. A result was considered statistically significant when p 0.05 in any of the statistical tests had a two-sided effect. For the purpose of statistical analysis, SPSS version 18.0 was utilized [7].

Discussion

The multivariate analysis's hazard ratios of significant prognostic factors served as the basis for the scoring system. When the hazard ratio was less than 0.5, the score of a factor was either 2 or 0. When the hazard ratio was greater than 2, a factor's score was either -2 or 0. When the hazard ratio was between 0 and 1, the factor's score was either 1 or 0. When the hazard ratio was between 1 and 2, the factor's score was either -1 or 0. The scores for each factor were added together to get the prognostic score.

Conclusion

26 patients, or 25.6%, had only one bone metastasis, while 76 patients, or 74.5 percent, had multiple metastases. There were 68 patients who had fewer than three vertebral metastases, while 34 patients had more than three. Sixty-six patients, or 64.7%, had bone metastases in their spines, which were the most common site. The ribs (48%), pelvis (36.3%), and femur were additional common bone metastasis sites. The median survival time was 10.4 months, and the 2-year survival rate was 10.3%. With only one bone metastasis and no extraosseous distant metastases, 17 patients (16.6%) had a median survival time of 17.8 months and a 2 year survival rate of 38%. The univariate analysis took into account age, sex, smoking, the presence of extraosseous distant metastases, the number of bone metastases, appendicular bone metastases, vertebral metastases, T stage and N stage, LDH level, and ALP level. In the univariate analysis, significant prognostic factors included age, the presence of extraosseous distant metastases, the number of vertebral bone metastases, the number of bone metastases, the N stage, and the LDH level. Age, the presence of extraosseous distant metastases, and the number of bone metastases were all found to be significant predictors of overall survival in multivariate analysis. In the group with only one bone metastasis, the median survival time was 11.5 months, and the 2-year survival rate was 28.3 months (p=0.026). In the group with multiple bone metastases, the median survival time was 9.3 months, and the 2-year survival rate was 5.3% (p=0.026). The median survival time for patients with extraosseous distant metastases was 8 months, with a 2-year survival rate of 2.1%, whereas the median survival time for patients without coexisting distant metastases was 12.2 months, with a 2-year survival rate of 17.7% (p=0.000).

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