Walls J, Assiri A, Howell A, Rogers E, Ratcliffe W A, Eastell R, Bundred N J
Department of Surgery, University Hospital of South Manchester, UK.
Br J Cancer. 1999 Jun;80(8):1265-70. doi: 10.1038/sj.bjc.6690496.
Objective assessment of response in bone metastases from breast cancer using radiological techniques takes up to 6 months of treatment to be certain of a response, and sclerotic metastases are not evaluable. Standard serum and urinary tumour markers may not always be utilized to predict response, as they may not be elevated, and therefore may not change on treatment. The development of the urinary pyridinoline cross-link assays which measure mature bone breakdown products have been shown to be highly sensitive and specific as a measure of bone change in osteoporosis. We have measured pyridinoline (Pyr) and deoxypyridinoline (Dpyr) cross-links sequentially in 36 breast cancer patients with bone metastases, to determine if the measurement of these analytes predicts response at an earlier stage than radiological assessment. Response was assessed by UICC criteria. Seventeen women responded to hormonal therapy, whilst 19 developed progressive disease. Both Pyr and Dpyr increased sequentially in women with progressive disease with changes becoming apparent by 8 weeks (P<0.03). In responding women, cross-link levels did not change significantly. Pyr and Dpyr were more sensitive and specific than the standard serum tumour marker CA 15-3. Urinary cross-link measurements provide a novel objective method of assessing response to treatment in women with bone metastases. Initial elevated urinary cross-link markers identify patients who tend not to respond to changes in hormonal therapy.
使用放射技术对乳腺癌骨转移的反应进行客观评估，需要长达6个月的治疗时间才能确定反应情况，而且硬化性转移灶无法进行评估。标准的血清和尿液肿瘤标志物并不总是可用于预测反应，因为它们可能不升高，因此在治疗过程中可能不会改变。测量成熟骨分解产物的尿吡啶啉交联测定法的发展已被证明作为骨质疏松症骨变化的一种测量方法具有高度的敏感性和特异性。我们对36例乳腺癌骨转移患者依次测量了吡啶啉（Pyr）和脱氧吡啶啉（Dpyr）交联物，以确定这些分析物的测量是否比放射学评估能更早地预测反应。根据国际抗癌联盟（UICC）标准评估反应。17名女性对激素治疗有反应，而19名病情进展。病情进展的女性中，Pyr和Dpyr均依次升高，8周时变化明显（P<0.03）。有反应的女性中，交联水平无明显变化。Pyr和Dpyr比标准血清肿瘤标志物CA 15-3更敏感和特异。尿交联物测量为评估骨转移女性对治疗的反应提供了一种新的客观方法。最初升高的尿交联标志物可识别出对激素治疗变化往往无反应的患者。
