Background:The prognosis for patients with lung cancer bone metastases has improved with the use of novel systemic agents. These patients might need surgery or radiotherapy to alleviate symptoms or maintain function. However, there is currently no disease specific algorithm to guide multidisciplinary decisions.Methods: The inclusion criteria encompassed studies with ≥10 patients offering multivariate analysis data on survival that were published after 2000 until September 2023. Clinical factors were categorized based on their characteristics and the pooled hazard ratios (HRs) for each category were calculated. A treatment algorithm was proposed based on clinical importance and the pooled HRs.Results: Fifteen studies involving 3759 patients with lung cancer bone metastases were included. The median survival ranged between 1.8–28.3 months (median: 12.4). Among the studies involving patients with EGFR+ or treated with TKIs, the median survival ranged between 19.5–28.3 months. The most reported significant factor was ECOG performance (nine studies) followed by chemotherapy use (six studies). In the pooled analyses, the pooled HR [95% confidence interval (CI)] of the EGFR status category was 2.109 (1.345–3.305); the ECOG performance category was 2.007 (1.536–2.622); the visceral metastases category was 2.060 (1.370–3.098); the bone metastases characteristics category (e.g., multiplicity, weight-bearing bone metastases) was 1.910 (1.443–2.527); the body weight category was 1.805 (1.334–2.442); the anti-absorbants category was 1.784 (1.448–2.196); the systemic treatment category was 1.695 (1.407–2.041); the skeletal-related event category was 1.616 (1.063–2.458); the smoking status category was 1.530 (1.306–1.793); the gender category was 1.482 (1.270–1.729); and the histology category was 1.450 (1.186–1.772).Conclusions: Oncological prognoses are influenced by various interrelated factors. Our treatment algorithm supports multidisciplinary strategies for managing NSCLC bone metastases, considering the complex factors influencing prognosis.
背景：随着新型全身治疗药物的应用，肺癌骨转移患者的预后已有所改善。这些患者可能需要手术或放疗来缓解症状或维持功能。然而，目前尚无针对该疾病的特定诊疗路径来指导多学科决策。 方法：纳入标准包括2000年至2023年9月期间发表、样本量≥10例且提供多变量生存分析数据的研究。根据临床特征对影响因素进行分类，并计算各类别的汇总风险比（HR）。基于临床重要性和汇总HR值，提出了一套治疗路径。 结果：共纳入15项研究，涉及3759例肺癌骨转移患者。中位生存期为1.8-28.3个月（中位数：12.4个月）。在涉及EGFR阳性或接受TKI治疗患者的研究中，中位生存期为19.5-28.3个月。最常报道的显著影响因素是ECOG体能状态（9项研究），其次是化疗应用（6项研究）。汇总分析显示：EGFR状态类别的汇总HR[95%置信区间(CI)]为2.109（1.345-3.305）；ECOG体能状态类别为2.007（1.536-2.622）；内脏转移类别为2.060（1.370-3.098）；骨转移特征类别（如多发性、承重骨转移）为1.910（1.443-2.527）；体重类别为1.805（1.334-2.442）；骨吸收抑制剂类别为1.784（1.448-2.196）；全身治疗类别为1.695（1.407-2.041）；骨相关事件类别为1.616（1.063-2.458）；吸烟状态类别为1.530（1.306-1.793）；性别类别为1.482（1.270-1.729）；组织学类型类别为1.450（1.186-1.772）。 结论：肿瘤预后受多种相互关联的因素影响。本治疗路径综合考虑影响预后的复杂因素，为NSCLC骨转移的多学科管理策略提供了支持。
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