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Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain

  • Authors:
    • Qinzhi Zhang
    • Bo Qu
    • Jiazhen Fan
    • Chunyu Liu
    • Bin Shan
    • Chunrong Chen
    • Yue Gao
  • View Affiliations / Copyright

    Affiliations: Department of Radiotherapy, The First Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang 161041, P.R. China, Department of Radiochemotherapy, Qiqihar First Hospital, Qiqihar, Heilongjiang 161000, P.R. China
    Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 429
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    Published online on: July 7, 2025
       https://doi.org/10.3892/ol.2025.15175
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Abstract

Bone metastasis is a severe complication in advanced lung cancer, which notably affects the quality of life and prognosis in patients. The present study investigated risk factors for bone metastasis and evaluated the effects of radiotherapy and opioids on bone metastasis‑related pain. Clinical data from 200 patients with lung cancer (100 with and 100 without bone metastasis) were retrospectively analyzed. Risk factors were identified using logistic regression analyses and a predictive model was validated with receiver operating characteristic curve and decision curve analyses. Pain relief from radiotherapy, opioids and combined therapy was assessed using visual analog scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) scores. Larger tumor diameter, respiratory symptoms, EGFR mutations (85 vs. 35%; P<0.001) and elevated serum markers (including carcinoembryonic antigen, neuron‑specific enolase and alkaline phosphatase, all P<0.001; and CA199, P=0.043) were significant risk factors for bone metastasis. The predictive model achieved an area under the curve value of 0.996, which demonstrated enhanced accuracy and clinical utility. Combined therapy provided improved pain relief, and markedly improved VAS and PSQI scores compared with monotherapy. Key risk factors for bone metastasis were identified and a robust predictive model was established. Combined radiotherapy and opioids effectively manage bone metastasis pain and potentially offer novel insights for early detection and treatment strategies in the future.
View Figures

Figure 1

Receiver operating characteristic
curve illustrating the ability to predict bone metastasis in lung
cancer using a multivariate logistic regression model. (A) Training
cohort. The AUC of 0.996 demonstrated excellent discriminative
power. An optimal cut-off value of 0.5 was identified, which
achieved a sensitivity of 0.99 and a specificity of 1.00. (B)
Validation cohort. The model was validated in a validation cohort,
where it achieved an AUC of 0.983, which further confirmed its
predictive accuracy. AUC, area under curve.

Figure 2

Calibration curve for the predictive
model distinguishing lung cancer with bone metastasis from lung
cancer without bone metastasis. (A) Training cohort. (B) Validation
cohort. Calibration curve of the predictive model, which compared
the predicted probabilities to the actual outcomes. The
bias-corrected curve closely approximated the ideal curve, which
demonstrated excellent alignment and confirmed the precision of the
model in distinguishing between lung cancer with and without bone
metastasis. The mean absolute error of the model was 0.01 in the
training cohort and 0.032 in the validation cohort. ‘Apparent’
indicates the calibration curve was based on apparent
probabilities, ‘Bias-corrected’ indicates the curve was adjusted
for bias using bootstrapping and ‘Ideal’ indicates the curve where
predicted probabilities perfectly matched actual outcomes.

Figure 3

Nomogram for predicting the risk of
differentiating lung cancer with bone metastasis from lung cancer
without bone metastasis. A nomogram based on the predictive model,
which provided a visual representation of the risk scoring system
used to differentiate between lung cancer with bone metastasis and
without bone metastasis. By converting clinical indicator values
into total points, the present nomogram enabled the estimation of
the probability of a patient having bone metastasis. CEA,
carcinoembryonic antigen.

Figure 4

DCA for the predictive model
distinguishing lung cancer with bone metastasis from lung cancer
without bone metastasis. (A) Training cohort. (B) Validation
cohort. A DCA curve, which evaluated the net benefits of the model
at varying high-risk thresholds. The model compared these benefits
to the scenarios where all patients in the present study were
classified as high-risk and where none were classified as
high-risk. ‘DCA Model’ represents the DCA for the predictive model,
‘All’ indicates the assumption that all patients are at high-risk
and ‘None’ indicates the assumption that no patients are at
high-risk. DCA, decision curve analysis.

Figure 5

Comparison of VAS and PSQI before and
after treatment for different therapeutic modalities. (A) VAS
scores of patients before and after radiotherapy. (B) VAS scores
before and after opioid treatment. (C) VAS scores before and after
combination therapy. (D) PSQI scores of patients before and after
radiotherapy. (E) PSQI scores before and after opioid treatment.
(F) PSQI scores before and after combination therapy. VAS, visual
analog scale; PSQI, Pittsburgh Sleep Quality Index.
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Copy and paste a formatted citation
Spandidos Publications style
Zhang Q, Qu B, Fan J, Liu C, Shan B, Chen C and Gao Y: Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain. Oncol Lett 30: 429, 2025.
APA
Zhang, Q., Qu, B., Fan, J., Liu, C., Shan, B., Chen, C., & Gao, Y. (2025). Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain. Oncology Letters, 30, 429. https://doi.org/10.3892/ol.2025.15175
MLA
Zhang, Q., Qu, B., Fan, J., Liu, C., Shan, B., Chen, C., Gao, Y."Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain". Oncology Letters 30.3 (2025): 429.
Chicago
Zhang, Q., Qu, B., Fan, J., Liu, C., Shan, B., Chen, C., Gao, Y."Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain". Oncology Letters 30, no. 3 (2025): 429. https://doi.org/10.3892/ol.2025.15175
Copy and paste a formatted citation
x
Spandidos Publications style
Zhang Q, Qu B, Fan J, Liu C, Shan B, Chen C and Gao Y: Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain. Oncol Lett 30: 429, 2025.
APA
Zhang, Q., Qu, B., Fan, J., Liu, C., Shan, B., Chen, C., & Gao, Y. (2025). Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain. Oncology Letters, 30, 429. https://doi.org/10.3892/ol.2025.15175
MLA
Zhang, Q., Qu, B., Fan, J., Liu, C., Shan, B., Chen, C., Gao, Y."Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain". Oncology Letters 30.3 (2025): 429.
Chicago
Zhang, Q., Qu, B., Fan, J., Liu, C., Shan, B., Chen, C., Gao, Y."Risk factors for bone metastasis in lung cancer and the efficacy of palliative radiotherapy and opioid analgesics in alleviating bone metastasis pain". Oncology Letters 30, no. 3 (2025): 429. https://doi.org/10.3892/ol.2025.15175
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