The clinical importance of bone metabolic markers in detecting bone metastasis of lung cancer (original) (raw)
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Usefulness of bone markers for detection of bone metastases in lung cancer patients
Clinical Biochemistry, 2002
Objectives: Lung cancer commonly causes destructive bone metastases. The aim of this study was to compare efficiency of biochemical bone markers in the detection of bone metastases in lung cancer patients. Design and methods: We measured serum calcium (Ca), alkaline phosphatase (ALP), bone isoenzyme of alkaline phosphatase (BALP), osteocalcin (OC) and urine deoxypyridinoline crosslinks (DPD) levels in 52 lung cancer patients; 27 patients with the evidence of bone metastases, 25 without metastases in bone when they were first diagnosed. BALP, OC and DPD were measured by specific immunoassays. ALP, Ca and urine creatinine levels were determined by colorimetric methods. Results: Ca, ALP, BALP, OC and DPD levels were significantly higher in the patients with bone metastases than those without bone metastases (p Ͻ 0.01 for BALP and OC, p Ͻ 0.001 for Ca, ALP and DPD). The sensitivity and specificities of all markers as follows: 89%-44% for BALP, 52%-88% for OC, 81%-76% for DPD, respectively. ROC curves were generated separately for BALP, OC and DPD to assess the diagnostic efficiency of markers in a different manner. DPD showed the best curve characteristics among the studied bone markers, followed by the BALP curve. OC curve showed poor characteristics. Conclusions: Our results suggest that the measurement of DPD and BALP may be useful in detecting bone metastases in lung cancer patients. Also it could help in the follow-up of bone metastases from lung cancer since they can be repeated more often than roentgenography and bone scintigraphy, at less cost and with less discomfort to the patients.
Predictive and Prognostic Biomarkers for Lung Cancer Bone Metastasis and Their Therapeutic Value
Frontiers in Oncology, 2021
Lung cancer is the leading cause of cancer-related death worldwide. Bone metastasis, which usually accompanies severe skeletal-related events, is the most common site for tumor distant dissemination and detected in more than one-third of patients with advanced lung cancer. Biopsy and imaging play critical roles in the diagnosis of bone metastasis; however, these approaches are characterized by evident limitations. Recently, studies regarding potential biomarkers in the serum, urine, and tumor tissue, were performed to predict the bone metastases and prognosis in patients with lung cancer. In this review, we summarize the findings of recent clinical research studies on biomarkers detected in samples obtained from patients with lung cancer bone metastasis. These markers include the following: (1) bone resorption-associated markers, such as N-terminal telopeptide (NTx)/C-terminal telopeptide (CTx), C-terminal telopeptide of type I collagen (CTx-I), tartrate-resistant acid phosphatase i...
Markers of Bone Metastases in Breast and Lung Cancers
Asian Pacific Journal of Cancer Prevention, 2012
Aim and Background: The aim of the present study was to evaluate correlations between serum osteocalcin, osteoprotegerin and NTX (Cross-linked N-telopeptides of Type I Collagen) and urinary NTX in breast and lung cancer patients with bone metastases. These four markers are considered to have important roles in bone formation, resorption and metastases. Methods: Four markers were determined in the sera of 60 breast cancer and 21 lung cancer patients and healthy controls (n=30). Serum levels were studied using ELISA and EIA. Results: The median levels of serum osteoprotegerin (p<0.001) and osteocalcin (p=0.003) were higher in patients. Significant correlations were observed between the serum NTX-osteocalcin (r=0.431; p<0.001), serum NTXosteoprotegerin (r=0.42; p=0.003) and serum NTX-urine NTX (r=0.255; p=0.022). Conclusion: We conclude that osteocalcin, osteoprotegerin and NTX are independent diagnostic tools. Due to the ease of urine collection, urine NTX may be applied routinely to allow early detection of bone metastases and indicate progression of the disease.
2009
prostate cancers in males, are most likely to spread to bones (1, 2). Bone metastases are often multiple at the time of diagnosis. The bones of the spine, pelvis, and ribs are the most commonly affected. The bones of the upper arm and upper leg also may be affected. More than 90% of metastases are found in this distribution (2, 12, 14). Although bone appears to be the most static of all the tissues in the body, it is actually very dynamic and active. Normal bone is constantly being remodeled, or broken down and rebuilt. Only 1% of the calcium in the body is available in circulation for these functions. The other 99% is locked in the bones. If blood calcium levels drop, calcium must be released from the bones through remodeling in order to maintain important physiological functions that require calcium. In the case of hypercalcemia, bone metastases cause an imbalance between bone formation and bone resorption resulting in the releasing excess calcium into the blood. As noted, tumor-induced hypercalcemia is essentially due to an increase in osteoclast-induced breakdown of the bone into the blood. During this process of bone destruction, substances such as growth factors are released that promote tumor cell growth (4, 5, and 6). Hypercalcemia of malignancy occurs in approximately 10% of patients with advanced cancers. The occurrence of hypercalcemia may rise as high as 40% in some types of cancer, including breast, lung and multiple myeloma (4, 5, 6, 7, 16, 18). Elevation of EsR, total phosphatase alkaline and tumor specific antigens such as CEA, CA 15.3 and PsA in patients with bone metastases were found to be more than in patients without bone metastases (6,11,14,15). Recently studies report about the increased efficiency of CT, MRI and PET-CT in detection of bone metastases (19, 20, 21, 22). In patients with a diagnosed primary cancer the bone pain usually is considered to be highly suggestive of bone metastases. Occasionally, patients with bone metastases may present with a pathological fractures. In addition, patients may present with complications of bone metastases such as neurological impairment due to spinal epidural compression (1, 13, 14, 17).
Biochemical Markers of Bone Turnover in Patients with Metastatic Bone Disease
Several biochemical markers of bone formation and bone resorption have recently been developed. These markers have been evaluated for clinical utility in patients with metabolic bone disease, including Paget disease and osteoporosis, and for their potential use in cancer patients whose disease has metastasized to bone. We have evaluated seven markers of bone turnover in the plasma and urine of 94 patients with newly diagnosed or progressive malignancy with and without clinical evidence of bone metastases. As determined by a positive bone scan and (or) bone survey, 30 patients had metastases to bone; 51 patients had metastatic cancer without overt bony involvement; and 13 patients had local disease without bone metastases. To evaluate the predictive value of these markers in the metastatic population, we utilized a "Z-score" and logistic regression analysis to distinguish patients with documented bone metastatic disease from those patients without clinical evidence of bone metastases. The higher the Z-score, the better the marker predicts the presence of bone metastases. With this statistical approach, urine N-telopeptide measurements had the highest Z-score and the most significant association with the probability of bone metastases. Urine deoxypyridinoline was the second most predictive marker of bone metastases. Thus, biochemical markers of bone resorption might be of use to predict the presence of bone metastases in cancer patients and to monitor the efficacy of antiresorptive therapy in patients treated for metastatic bone disease.
Bone, 2018
Lung adenocarcinoma regularly induces bone metastases that are responsible for impaired quality of life as well as significant morbidity, including bone pain and fractures. We aimed at identifying whether bone and metabolic biomarkers were associated with the prognosis of lung adenocarcinoma patients with synchronous bone metastases. POUMOS is a prospective cohort of patients diagnosed with lung adenocarcinoma and synchronous bone metastases. All patients underwent biopsy of bone metastases to confirm diagnosis, including genotyping of oncogenic drivers such as EGFR and KRAS. Whole-body composition was assessed using DEXA scan. Serum levels of C-reactive protein, HbA1C, calcaemia, sCTX, and DKK1 were also measured. Sixty four patients, aged (mean ± SD) 65 ± 11 years, were included. Thirty-nine (61%) patients had a good performance status (PS 0-1); 56% had >5 bone lesions, and 41% a weight-bearing bone (femour or tibia) involvement. Median overall survival was 7 months. In multiva...
Cancer Treatment Reviews, 2008
Background-Bone metastases are prevalent among patients with advanced solid tumors. Metastatic bone disease alters bone homeostasis, resulting in reduced bone integrity and, consequently, increased skeletal complications. Biochemical markers of bone metabolism may meet an unmet need for useful, noninvasive, and sensitive surrogate information for following patients' skeletal health. Materials and methods-Data for this review were identified by searches of PubMed, and references from relevant articles using the search terms "bone markers" or individual bone marker nomenclature, "cancer," and "metastases." Abstracts and reports from meetings were included
Prevention and Management of Bone Metastases in Lung Cancer: A Review
Journal of Thoracic Oncology, 2009
Approximately 30 to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. Total medical care costs are greater among patients with bone metastases who develop skeletal complications. A randomized phase III trial of the third generation bisphosphonate zoledronic acid has shown clinical benefit in the management of a subgroup of patients with bone metastases from lung cancer. Zoledronic acid treatment was associated with a reduction in both the risk of, and time to, a skeletal-related event. One of the markers of bone resorption, N-telopeptide, is both prognositic for development of skeletalrelated events and predictive for benefit from zoledronic acid. In preclinical models, bisphosphonates have also demonstrated antitumor activity and are therefore currently being evaluated in adjuvant trials. Inhibition of the receptor activator of nuclear factor kappa B ligand-RANK pathway can reduce osteoclast-mediated bone resorption, and trials comparing receptor activator of nuclear factor kappa B ligand inhibitors with bisphosphonates are ongoing, including patients with lung cancer. In this article, we review the management of bone metastases and hypercalcemia as well as potential future directions for bone directed therapies in patients with lung cancer.