ArticleJournal of bone oncology2026
Skeletal metastatic burden as a strong prognostic factor of survival in advanced NSCLC treated with chemo-immunotherapy: An exploratory imaging-based analysis.
Article in Journal of bone oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
23 authors.
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Abstract
Background: Metastatic burden is a key determinant of prognosis in advanced solid tumors, yet current RECIST 1.1-based assessment does not fully capture total or site-specific disease extent. Emerging evidence suggests that quantitative imaging-derived metrics may improve prognostic stratification beyond binary metastatic classification. Methods: We retrospectively analyzed 52 patients with advanced non-oncogene-addicted lung cancer. Baseline clinical variables and imaging-derived metastatic lesions were assessed across multiple organ sites (lung, lymph nodes, bone, brain, liver and adrenal glands). Lesion area was calculated using an elliptical approximation and summed per organ and globally. Overall survival was evaluated using multivariable Cox regression models with restricted cubic splines to account for non-linear effects. Analyses included: binary metastatic status, continuous site-specific tumor burden, and relative contribution of each site to total metastatic load. Results: Median age was 67 years, and bone (53%) and brain (27%) were frequent metastatic sites. Across all analytical levels, bone metastases consistently showed the strongest prognostic impact. Bone involvement was associated with worse overall survival both as a binary variable (HR 2.93, Conclusion: Quantitative assessment of metastatic burden identified skeletal disease as a consistent prognostic signal in this exploratory cohort, supporting further investigation of imaging-derived measures of metastatic burden and spatial disease distribution.
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