Background: Breast cancer (BC) is the most common cancer in women, and the bone is the first site of distant metastases in patients with BC. Bone lysis induced by cancer cells invading the bone, promotes degradation ofmineralmatrix, and represents one of themechanisms of cancer-induced hypercalcemia. Bone metastases (BMs) are usually detected by skeletal X-ray and whole body bone scintigraphy, which visualizes areas of increased osteoblastic activity but lacks specificity. Several urinary and serummarkers are altered inpatientswith BMs. The aim of this study was to assess the usefulness of two serum markers of bone remodelling in patients with BC and BMs. Patients andmethods: We studied 59 women (median age 61 years, range 47–70) with BC: 28 patients with confirmed BMs (GroupA), and 31 age-matched (60.0± 6.6 vs. 61.0±5.5 years; p=0.54) patients without BMs (Group B). Serum levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collegen (NTx), and bone formation marker bone alkaline phosphatase (BAP) were measured in both groups by enzymelinked immunosorbent assay. Results: NTx (35.1±7.2 vs. 25.3±3.2 nM BCE), and BAP (54.0±5.7 vs. 39.6±6.4 U/L) serum levels were significantly (p<0.001) different between groups (Avs. B). A significant (R=−0.85, p<0.001), and a weak (R=−0.53, p=0.002) inverse correlation between age and TNx were found in Groups A and B, respectively. Therewas no correlation between age and BAP (R=−0.31, p=0.11; R=0.027, p=0.88), and between NTx and BAP (R=0.40, p=0.037; R=0.10, p=0.58). Using a cut-off value of 30 (TNx) and 50 (BAP), the sensitivity, specificity, and accuracywere 67.86% (OR=30.61, 95% CI 5.95–157.45), 93.55%, and 81.4% (TNx), and 75.0% (OR=43.50, 95% CI 8.91–230.81), 93.55% and 84.7% (BAP), respectively. Conclusions: In patients with BC both NTx and BAP are specific bone remodelling markers, but their usefulness is limited in early diagnosis of BMs.
Relationship between serum N-telopeptide and bone alkaline phosphatase and their diagnostic value in patients with breast cancer and bone metastases
LUMACHI, FRANCO;CAMOZZI, VALENTINA;LUISETTO, GIOVANNI;ORLANDO, ROCCO;
2011
Abstract
Background: Breast cancer (BC) is the most common cancer in women, and the bone is the first site of distant metastases in patients with BC. Bone lysis induced by cancer cells invading the bone, promotes degradation ofmineralmatrix, and represents one of themechanisms of cancer-induced hypercalcemia. Bone metastases (BMs) are usually detected by skeletal X-ray and whole body bone scintigraphy, which visualizes areas of increased osteoblastic activity but lacks specificity. Several urinary and serummarkers are altered inpatientswith BMs. The aim of this study was to assess the usefulness of two serum markers of bone remodelling in patients with BC and BMs. Patients andmethods: We studied 59 women (median age 61 years, range 47–70) with BC: 28 patients with confirmed BMs (GroupA), and 31 age-matched (60.0± 6.6 vs. 61.0±5.5 years; p=0.54) patients without BMs (Group B). Serum levels of bone resorption marker cross-linked amino-terminal telopeptide of type I collegen (NTx), and bone formation marker bone alkaline phosphatase (BAP) were measured in both groups by enzymelinked immunosorbent assay. Results: NTx (35.1±7.2 vs. 25.3±3.2 nM BCE), and BAP (54.0±5.7 vs. 39.6±6.4 U/L) serum levels were significantly (p<0.001) different between groups (Avs. B). A significant (R=−0.85, p<0.001), and a weak (R=−0.53, p=0.002) inverse correlation between age and TNx were found in Groups A and B, respectively. Therewas no correlation between age and BAP (R=−0.31, p=0.11; R=0.027, p=0.88), and between NTx and BAP (R=0.40, p=0.037; R=0.10, p=0.58). Using a cut-off value of 30 (TNx) and 50 (BAP), the sensitivity, specificity, and accuracywere 67.86% (OR=30.61, 95% CI 5.95–157.45), 93.55%, and 81.4% (TNx), and 75.0% (OR=43.50, 95% CI 8.91–230.81), 93.55% and 84.7% (BAP), respectively. Conclusions: In patients with BC both NTx and BAP are specific bone remodelling markers, but their usefulness is limited in early diagnosis of BMs.
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