Lauriane Chambard1, Nicolas Girard2, Edouard Ollier3, Jean-Charles Rousseau4, François Duboeuf5, Marie-Christine Carlier6, Marie Brevet7, Pawel Szulc8, Jean-Baptiste Pialat9, Julien Wegrzyn10, Philippe Clezardin11, Cyrille B Confavreux12. 1. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Rheumatology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France. Electronic address: lauriane.chambard@chu-lyon.fr. 2. Respiratory Medicine Department, Hospices Civils de Lyon, Bron F-69500, France. Electronic address: ed.ollier@gmail.com. 3. Université Claude Bernard Lyon 1, Villeurbanne F-69100, France. 4. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France. Electronic address: jean-charles.rousseau@inserm.fr. 5. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France. Electronic address: francois.duboeuf@inserm.fr. 6. Central Laboratory of Biochemistry, Hospices Civils de Lyon, Pierre-Bénite F-69495, France. Electronic address: marie-christine.carlier@chu-lyon.fr. 7. Pathology Department, Hospices Civils de Lyon, Bron F-69500, France. Electronic address: marie.brevet01@chu-lyon.fr. 8. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France. Electronic address: pawel.szulc@inserm.fr. 9. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Radiology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France. Electronic address: jean-baptiste.pialat@chu-lyon.fr. 10. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Orthopedic Department, Hospices Civils de Lyon, Lyon F-69003, France. Electronic address: julien.wegrzyn@chu-lyon.fr. 11. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France. Electronic address: philippe.clezardin@inserm.fr. 12. INSERM UMR1033-LYOS, Université de Lyon, Lyon F-69003, France; Rheumatology Department, Hospices Civils de Lyon, Pierre-Bénite F-69495, France. Electronic address: cyril.confavreux@inserm.fr.
Abstract
BACKGROUND: Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. PATIENTS AND METHODS: POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. RESULTS: Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10-2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01-1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10-7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40-6.27]; p = .005). CONCLUSIONS: In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.
BACKGROUND:Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinomapatients with synchronous bone metastases. PATIENTS AND METHODS: POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. RESULTS: Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multivariate analysis, HbA1c (HR = 1.69 [1.10-2.63] per 0.5% decrease; p = .02), DKK1 (HR = 1.28 [1.01-1.61] per 10 ng/mL increase; p = .04), and hypercalcaemia (HR = 2.83 [1.10-7.30]; p = .03) were independently associated with poorer survival. In the subgroup of patients with DEXA, sarcopenia was also associated with poorer survival (HR = 2.96, 95%CI [1.40-6.27]; p = .005). CONCLUSIONS: In patients with lung adenocarcinoma and synchronous bone metastases, bone, sarcopenia, and metabolic parameters were predictors of poor overall survival independently of common prognostic factors. We suggest that, in addition to oncological therapy, supportive treatment dedicated to bone metastases, muscle wasting, and energy metabolism are essential to improve prognosis.
Authors: E Massy; J C Rousseau; M Gueye; E Bonnelye; M Brevet; L Chambard; M Duruisseaux; O Borel; C Roger; R Guelminger; J B Pialat; E Gineyts; L Bouazza; M Millet; J M Maury; P Clézardin; N Girard; Cyrille B Confavreux Journal: J Bone Oncol Date: 2021-06-05 Impact factor: 4.072