Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study
Incidence of patients with bone metastases at diagnosis of solid tumors in adults: a large population-based study
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DOI：
10.21037/atm.2020.03.55
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发表时间：
2020-04-01
影响因子：
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通讯作者：
Wu, Aimin
中科院分区：
文献类型：
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作者：
Huang, Jin-Feng;Shen, Jianfei;Wu, Aimin
背景：骨是实体肿瘤最常见的转移部位之一。骨转移可显著增加癌症患者的死亡率并降低其生活质量。在美国，每年约有35万人死于骨转移。本研究旨在分析和更新癌症诊断时实体瘤骨转移的发病率和预后，以及每种实体癌的发病率。方法：我们使用监测、流行病学和最终结果（SEER）数据库，查找2010年至2016年期间诊断为骨关节外实体癌的患者。数据按年龄、性别和种族分层。原位肿瘤或骨转移分期未知的患者被排除在外。然后，我们选择了大多数癌症经常发生的部位，留下2，207，796例患者进行最终的发病率分析。对于生存分析，如果患者在尸检或死亡证明中被诊断，或随访时间未知，则将其排除。比较不同原发肿瘤部位患者的骨转移发生率和总生存率。结果：我们确定了2，470，634例患者，包括426，594例转移性疾病患者和113，317例骨转移患者，用于发生率分析。骨转移的发生率在前列腺癌、乳腺癌和肾癌中分别为88.74%、53.71%和38.65%。按发病率降序排列，有泌尿生殖系统其他癌症患者（肾癌、膀胱癌、前列腺癌和睾丸癌除外）（37.91%），肺腺癌（ADC）（36.86%），其他妇科恶性肿瘤（36.02%）、小细胞肺癌（SCLC）（34.56%）、未另行说明的非小细胞肺癌和其他[NSCLC（NOS/其他）]（33.55%）和膀胱癌（31.08%）。骨转移率在SCLC中为23.19%，在NSCLC（NOS/其他）中为22.50%，在ADC中为20.28%，在肺鳞状细胞癌（SCC）中为8.44%，在细支气管肺泡癌[NSCLC（BAC）]中为4.11%。在消化系统中，食管的总骨转移率为7.99%，胃癌为4.47%，肝胆癌为4.42%，胰腺为3.80%，其他消化器官为3.26%，结直肠为1.24%，肛门为1.00%。总体而言，整个队列中的乳腺癌和前列腺癌骨转移的发病率分别为3.73%和5.69%.Conclusions：本研究的结果提供了基于人群的估计，在最初诊断的实体瘤骨转移患者的发病率。这些发现有助于临床医生通过骨筛查早期发现骨转移，预测症状的发生，改善预后。
Background: Bones are one of the most common metastatic sites for solid malignancies. Bone metastases can significantly increase mortality and decrease the quality of life of cancer patients. In the United States, around 350,000 people die each year from bone metastases. This study aimed to analyze and update the incidence and prognosis of bone metastases with solid tumors at the time of cancer diagnosis and its incidence rate for each solid cancer.Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to find patients diagnosed with solid cancers originating from outside the bones and joints between 2010 and 2016. Data were stratified by age, sex, and race. Patients with a tumor in situ or with an unknown bone metastases stage were excluded. We then selected most of the sites where cancer often occurred, leaving 2,207,796 patients for the final incidence analysis. For the survival analysis, patients were excluded if they were diagnosed at their autopsy or on their death certificate, or had unknown follow-ups. The incidence of bone metastases and overall survival was compared between patients with different primary tumor sites.Results: We identified 2,470,634 patients, including 426,594 patients with metastatic disease and 113,317 patients with bone metastases, for incidence analysis. The incidence of bone metastases among the metastatic subset was 88.74% in prostate cancer, 53.71% in breast cancer, and 38.65% in renal cancer. In descending order of incidence, there were patients with other cancers in the genitourinary system (except for renal, bladder, prostate, and testicular cancer) (37.91%), adenocarcinoma of the lung (ADC) (36.86%), other gynecologic cancers (36.02%), small- cell lung cancer (SCLC) (34.56%), non-small cell lung cancer not otherwise specified and others [NSCLC (NOS/others)] (33.55%), and bladder (31.08%) cancers. The rate of bone metastases is 23.19% in SCLC, 22.50% in NSCLC (NOS/others), 20.28% in ADC, 8.44% in squamous cell carcinoma of the lung (SCC), and 4.11% in bronchioloalveolar carcinoma [NSCLC (BAC)]. As for the digestive system, the overall bone metastases rate was 7.99% in the esophagus, 4.47% in the gastric cancer, 4.42% in the hepatobiliary cancer, 3.80% in the pancreas, 3.26% in other digestive organs, 1.24% in the colorectum, and 1.00% in the anus. Overall, the incidence rate of bone metastases among the entire cohort in breast and prostate cancer was 3.73% and 5.69%, respectively.Conclusions: The results of this study provide population-based estimates for the incidence rates of patients with bone metastases at initial diagnosis of their solid tumor. The findings can help clinicians to early detect bone metastases by bone screening to anticipate the occurrence of symptoms and favorably improve the prognosis.