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No prognostic impact of staging bone scan in patients with stage IA non-small cell lung cancer

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Abstract

Objective

To investigate the survival benefit of preoperative bone scan in asymptomatic patients with early-stage non-small cell lung cancer (NSCLC).

Methods

This retrospective study included patients with radical resection for stage T1N0M0 NSCLC between March 2013 and December 2018. During postoperative follow-up, we monitored patient survival and the development of bone metastasis. We compared overall survival, bone metastasis-free survival, and recurrence-free survival in patients with or without preoperative bone scan. Propensity score matching and inverse probability of treatment weighting were used to minimize election bias.

Results

A total of 868 patients (58.19 ± 9.69 years; 415 men) were included in the study. Of 87.7% (761 of 868) underwent preoperative bone scan. In the multivariable analyses, bone scan did not improve overall survival (hazard ratio [HR] 1.49; 95% confidence intervals [CI] 0.91–2.42; p = 0.113), bone metastasis-free survival (HR 1.18; 95% CI 0.73–1.90; p = 0.551), and recurrence-free survival (HR 0.89; 95% CI 0.58–1.39; p = 0.618). Similar results were obtained after propensity score matching (overall survival [HR 1.28; 95% CI 0.74–2.23; p = 0.379], bone metastasis-free survival [HR 1.00; 95% CI 0.58–1.72; p = 0.997], and recurrence-free survival [HR 0.76; 95% CI 0.46–1.24; p = 0.270]) and inverse probability of treatment weighting.

Conclusion

There were no significant differences in overall survival, bone metastasis-free survival, and recurrence-free survival between asymptomatic patients with clinical stage IA NSCLC with or without preoperative bone scan.

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Data availability

Participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Abbreviations

NSCLC:

Non-small cell lung cancer

BM:

Bone metastases

HR:

Hazard ratio

CI:

Confidence intervals

CT:

Computed tomography

References

  1. Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv192–237.

    Article  CAS  PubMed  Google Scholar 

  2. Weissensteiner J, Babusikova E. The value of human epididymis protein 4 (HE4) as a serum tumor marker for accurate bone metastases finding by whole-body bone scintigraphy in lung cancer patients. Neoplasma. 2019;66(6):1024–30.

    Article  CAS  PubMed  Google Scholar 

  3. Damle NA, Bal C, Bandopadhyaya GP, Kumar L, Kumar P, Malhotra A, et al. The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan. Jpn J Radiol. 2013;31(4):262–9.

    Article  PubMed  Google Scholar 

  4. Riihimäki M, Hemminki A, Fallah M, Thomsen H, Sundquist K, Sundquist J, et al. Metastatic sites and survival in lung cancer. Lung Cancer (Amsterdam, Netherlands). 2014;86(1):78–84.

    Article  PubMed  Google Scholar 

  5. da Silva GT, Bergmann A, Thuler LCS. Incidence and risk factors for bone metastasis in non-small cell lung cancer. Asian Pac J Cancer Prev APJCP. 2019;20(1):45–51.

    Article  PubMed  Google Scholar 

  6. Jiao W, Qiu T. Necessity of preoperative bone scintigraphy for cT1N0 lung cancer: evidence from retrospective to prospective study. Thoracic Cancer. 2021;12(4):413–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kuchuk M, Kuchuk I, Sabri E, Hutton B, Clemons M, Wheatley-Price P. The incidence and clinical impact of bone metastases in non-small cell lung cancer. Lung Cancer (Amsterdam, Netherlands). 2015;89(2):197–202.

    Article  PubMed  Google Scholar 

  8. Wu S, Pan Y, Mao Y, Chen Y, He Y. Current progress and mechanisms of bone metastasis in lung cancer: a narrative review. Transl Lung Cancer Res. 2021;10(1):439–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Remon J, Soria JC, Peters S. Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical Practice Guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol. 2021;32(12):1637–42.

    Article  CAS  PubMed  Google Scholar 

  10. Chen WM, Chen M, Hsu JG, Lee TS, Shia BC, Wu SY. Use of preoperative FDG PET/CT and survival of patients with resectable non-small cell lung cancer. Radiology. 2022;305(1):219–27.

    Article  PubMed  Google Scholar 

  11. Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, et al. Two decades of SPECT/CT—the coming of age of a technology: an updated review of literature evidence. Eur J Nucl Med Mol Imaging. 2019;46(10):1990–2012.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Li H, Hu H, Wang R, Zhang Y, Xiang J, Liu Q, et al. When should 99mTc bone scintigraphy be performed in cT1N0 non-small cell lung cancer patients? Medicine. 2015;94(51): e2309.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thoracic Oncol Off Publ Int Assoc Study Lung Cancer. 2016;11(1):39–51.

    Google Scholar 

  14. Kandathil A, Kay FU, Butt YM, Wachsmann JW, Subramaniam RM. Role of FDG PET/CT in the eighth edition of TNM staging of non-small cell lung cancer. Radiogr Rev Publ Radiol Soc N Am. 2018;38(7):2134–49.

    Google Scholar 

  15. Kim H, Goo JM, Suh YJ, Hwang EJ, Park CM, Kim YT. Measurement of multiple solid portions in part-solid nodules for T categorization: evaluation of prognostic implication. J Thoracic Oncol Off Publ Int Assoc Study Lung Cancer. 2018;13(12):1864–72.

    Google Scholar 

  16. Kim H, Goo JM, Kim YT, Park CM. Clinical T category of non-small cell lung cancers: prognostic performance of unidimensional versus bidimensional measurements at CT. Radiology. 2019;290(3):807–13.

    Article  PubMed  Google Scholar 

  17. Kim H, Goo JM, Kim YT, Park CM. Clinical T categorization in stage IA lung adenocarcinomas: prognostic implications of CT display window settings for solid portion measurement. Eur Radiol. 2019;29(11):6069–79.

    Article  PubMed  Google Scholar 

  18. Subramanian M, McMurry T, Meyers BF, Puri V, Kozower BD. Long-term results for clinical stage IA lung cancer: comparing lobectomy and sublobar resection. Ann Thorac Surg. 2018;106(2):375–81.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gregoire J. Guiding principles in the management of synchronous and metachronous primary non-small cell lung cancer. Thorac Cardiovasc Surg. 2021;31(3):237–54.

    Google Scholar 

  20. Wang Y, Yeung JC, Hanna WC, Allison F, Paul NS, Waddell TK, et al. Metachronous or synchronous primary lung cancer in the era of computed tomography surveillance. J Thorac Cardiovasc Surg. 2019;157(3):1196–202.

    Article  PubMed  Google Scholar 

  21. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.

    Article  PubMed  Google Scholar 

  22. Xie W, Regan MM, Buyse M, Halabi S, Kantoff PW, Sartor O, et al. Metastasis-free survival is a strong surrogate of overall survival in localized prostate cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2017;35(27):3097–104.

    Article  CAS  Google Scholar 

  23. Sun GW, Shook TL, Kay GL. Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis. J Clin Epidemiol. 1996;49(8):907–16.

    Article  CAS  PubMed  Google Scholar 

  24. Travis WD, Brambilla E, Nicholson AG, Yatabe Y, Austin JHM, Beasley MB, et al. The 2015 World Health organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thoracic Oncol Off Publ Int Assoc Study Lung Cancer. 2015;10(9):1243–60.

    Google Scholar 

  25. Wang H, Zhang Y, Zhu H, Yu J. Risk factors for bone metastasis in completely resected non-small-cell lung cancer. Future Oncol (London, England). 2017;13(8):695–704.

    Article  CAS  Google Scholar 

  26. Wu XT, Zhou JW, Pan LC, Ge T. Clinical features and prognostic factors in patients with bone metastases from non-small cell lung cancer. J Int Med Res. 2020;48(5):300060520925644.

    Article  CAS  PubMed  Google Scholar 

  27. Zappa C, Mousa SA. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res. 2016;5(3):288–300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Coleman RE, Croucher PI, Padhani AR, Clézardin P, Chow E, Fallon M, et al. Bone metastases. Nat Rev Dis Primers. 2020;6(1):83.

    Article  PubMed  Google Scholar 

  29. Decroisette C, Monnet I, Berard H, Quere G, Le Caer H, Bota S, et al. Epidemiology and treatment costs of bone metastases from lung cancer: a French prospective, observational, multicenter study (GFPC 0601). J Thoracic Oncol Off Publ Int Assoc Study Lung Cancer. 2011;6(3):576–82.

    Google Scholar 

  30. Gomez DR, Liao KP, Swisher SG, Blumenschein GR, Erasmus JJ, Buchholz TA, et al. Time to treatment as a quality metric in lung cancer: staging studies, time to treatment, and patient survival. Radiother Oncol. 2015;115(2):257–63.

    Article  PubMed  Google Scholar 

  31. Richardet E, Villavicencio R, Hernandez P, Acosta L, Molina M, Dicalbo L, et al. P1.09: delays in the diagnosis and treatment of lung cancer. J Thoracic Oncol Off Publ Int Assoc Study Lung Cancer. 2016;11(10):S185.

    Google Scholar 

  32. Knapp BJ, Devarakonda S, Govindan R. Bone metastases in non-small cell lung cancer: a narrative review. J Thorac Dis. 2022;14(5):1696–712.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Port JL, Kent MS, Korst RJ, Libby D, Pasmantier M, Altorki NK. Tumor size predicts survival within stage IA non-small cell lung cancer. Chest. 2003;124(5):1828–33.

    Article  PubMed  Google Scholar 

  34. Roviaro G, Varoli F, Vergani C, Nucca O, Maciocco M, Grignani F. Long-term survival after videothoracoscopic lobectomy for stage I lung cancer. Chest. 2004;126(3):725–32.

    Article  PubMed  Google Scholar 

  35. Nam JG, Hong H, Choi SH, Park CM, Goo JM, Kim YT, et al. No prognostic impact of staging brain MRI in patients with stage IA non-small cell lung cancer. Radiology. 2022;303(3):632–43.

    Article  PubMed  Google Scholar 

  36. Brenner AI, Koshy J, Morey J, Lin C, DiPoce J. The bone scan. Semin Nucl Med. 2012;42(1):11–26.

    Article  PubMed  Google Scholar 

Download references

Funding

This research was funded by National Natural Science Foundation of China [82001986], Yunnan digitalization, development and application of biotic resource [202002AA100007], the Outstanding Youth Science Foundation of Yunnan Basic Research Project [202101AW070001], and the Yunnan Basic Research Project [202201AT070010].

Author information

Author notes

  1. Xia Zheng, Chunxia Li and Jing Ai contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, No. 519 Kunzhou Road, Xishan District, Kunming, 650118, Yunnan, China

    Xia Zheng, Jing Ai, Guili Dong, Man Long, Mingyi Li, Shilin Qiu, Guangjun Yang & Zhenhui Li

  2. Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China

    Chunxia Li & Tao Zhang

  3. Department of Nuclear Medicine, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, 650118, China

    Yanni Huang

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  1. Xia Zheng
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Correspondence to Zhenhui Li.

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Zheng, X., Li, C., Ai, J. et al. No prognostic impact of staging bone scan in patients with stage IA non-small cell lung cancer. Ann Nucl Med (2024). https://doi.org/10.1007/s12149-024-01927-3

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