Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States.
Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States.
复制标题
DOI：
10.1186/s12885-017-3922-0
复制
发表时间：
2018-01-06
期刊：
影响因子：
3.8
通讯作者：
Lyman GH
中科院分区：
文献类型：
--
作者：
Hernandez RK;Wade SW;Reich A;Pirolli M;Liede A;Lyman GH
骨转移通常与实体瘤一起发生，并与严重的骨并发症相关。基于人群的骨转移发生率估计是有限的，通常基于尸检数据，并且可能无法反映当前的治疗模式。电子病历（OSCER，肿瘤服务综合电子记录，569,000 名患者，52 个美国癌症中心）用于识别 2004 年 1 月 1 日至 2013 年 12 月 31 日期间记录的 18 岁以上的实体瘤诊断患者，不包括患有血液肿瘤或多原发肿瘤的患者。每个患者的索引日期被设置为他或她在选择期间首次诊断出实体瘤的日期。 Kaplan-Meier 分析用于量化骨转移的累积发生率，并从索引日期到以下事件中最早的事件对每位患者进行随访：OSCER 数据库中的最后一次临床就诊、新的原发肿瘤或骨转移的发生、研究结束（2014 年 12 月 31 日）。提供所有肿瘤类型长达 10 年的随访的发病率估计值和相关的 95% 置信区间 (CI)，并按诊断时的肿瘤类型和分期进行组合和分层。在 382,733 名研究患者（平均年龄 64 岁；平均随访 940 天）中，乳腺癌 (36%)、肺癌 (16%) 和结直肠癌 (12%) 肿瘤最常见。骨转移的平均时间为 400 天（1.1 年）。 30天时骨转移的累积发生率为2.9% (2.9–3.0)，一年时为4.8% (4.7–4.8)，两年时为5.6% (5.5–5.6)，五年时为6.9% (6.8–7.0)，十年时为8.4% (8.3–8.5)。不同肿瘤类型的发病率差异很大，前列腺癌患者的风险最高（18% – 29%），其次是肺癌、肾癌或乳腺癌。骨转移的累积发生率在诊断时逐阶段增加，在IV期诊断的患者中发生率明显更高，其中11%在30天内诊断出骨转移。这些骨转移发生率的估计代表了比之前发表的随访时间更长的人群的经验，并且代表了最近治疗领域的经验。鉴于对编码诊断的依赖，可能会低估，但电子病历中提供的临床详细信息有助于这些估计的准确性。
Bone metastases commonly occur in conjunction with solid tumors, and are associated with serious bone complications. Population-based estimates of bone metastasis incidence are limited, often based on autopsy data, and may not reflect current treatment patterns. Electronic medical records (OSCER, Oncology Services Comprehensive Electronic Records, 569,000 patients, 52 US cancer centers) were used to identify patients ≥18 years with a solid tumor diagnosis recorded between 1/1/2004 and 12/31/2013, excluding patients with hematologic tumors or multiple primaries. Each patient’s index date was set to the date of his or her first solid tumor diagnosis in the selection period. Kaplan-Meier analyses were used to quantify the cumulative incidence of bone metastasis with follow-up for each patient from the index date to the earliest of the following events: last clinic visit in the OSCER database, occurrence of a new primary tumor or bone metastasis, end of study (12/31/2014). Incidence estimates and associated 95% confidence intervals (CI) are provided for up to 10 years of follow-up for all tumor types combined and stratified by tumor type and stage at diagnosis. Among 382,733 study patients (mean age 64 years; mean follow-up 940 days), breast (36%), lung (16), and colorectal (12%) tumors were most common. Mean time to bone metastasis was 400 days (1.1 years). Cumulative incidence of bone metastasis was 2.9% (2.9–3.0) at 30 days, 4.8% (4.7–4.8) at one year, 5.6% (5.5–5.6) at two years, 6.9% (6.8–7.0) at five years, and 8.4% (8.3–8.5) at ten years. Incidence varied substantially by tumor type with prostate cancer patients at highest risk (18% – 29%) followed by lung, renal or breast cancer. Cumulative incidence of bone metastasis increased by stage at diagnosis, with markedly higher incidence among patients diagnosed at Stage IV of whom11% had bone metastases diagnosed within 30 days. These estimates of bone metastasis incidence represent the experience of a population with longer follow-up than previously published, and represent experience in the recent treatment landscape. Underestimation is possible given reliance on coded diagnoses but the clinical detail available in electronic medical records contributes to the accuracy of these estimates.