血清骨转换标志物在伴有骨转移的前列腺癌患者中的意义。

Implications of serum bone turnover markers in prostate cancer patients with bone metastasis.

机构信息

Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan.

出版信息

Urology. 2010 Jun;75(6):1446-51. doi: 10.1016/j.urology.2009.11.049. Epub 2010 Mar 5.

DOI:10.1016/j.urology.2009.11.049

PMID:20206975

Abstract

OBJECTIVES

To assess the diagnostic accuracy of serum bone turnover markers for detection of bone metastasis in patients with prostate cancer (PCa) and to assess the usefulness of these markers as predictors of mortality from PCa.

METHODS

Serum total alkaline phosphatase, bone-specific alkaline phosphatase, carboxy-terminal pyridinoline cross-linked telopeptide parts of type-I collagen (1CTP), tartrate-resistant acid phosphatase type 5 b, and prostate-specific antigen (PSA) levels were measured in 222 patients (58 with bone metastasis, 57 with T2M0 PCa, 55 with T3M0 PCa, and 52 without PCa). Multivariate stepwise logistic regression analysis was used to identify independent predictors of bone metastasis. Correlation of serum marker levels with bone metastasis was assessed using receiver operating characteristics analysis. Multivariate Cox proportional hazards analysis was used to predict cause-specific survival in PCa patients with bone metastasis.

RESULTS

Serum total alkaline phosphatase, bone-specific alkaline phosphatase, 1CTP, tartrate-resistant acid phosphatase type 5 b, and PSA levels were significantly elevated in patients with bone metastasis, and correlated significantly with the extent of disease on bone scintigraphy. Multivariate stepwise logistic regression analysis demonstrated that serum PSA and 1CTP were significant predictors of bone metastasis. Receiver operating characteristics analyses showed that serum 1CTP level was the most reliable predictor of bone metastasis (area under the curve = 0.85). Multivariate Cox proportional hazards analysis revealed that only serum 1CTP was an independent prognostic factor for PCa-related death.

CONCLUSIONS

Serum 1CTP level was a more reliable marker than the others to detect bone metastatic spread and to predict survival probability in PCa patients with bone metastasis.

摘要

目的

评估血清骨转换标志物在检测前列腺癌（PCa）患者骨转移中的诊断准确性，并评估这些标志物作为 PCa 患者死亡率预测因子的有用性。

方法

在 222 例患者（58 例有骨转移，57 例 T2M0 PCa，55 例 T3M0 PCa，52 例无 PCa）中测量血清总碱性磷酸酶、骨特异性碱性磷酸酶、I 型胶原羧基末端吡啶啉交联肽片段（1CTP）、抗酒石酸酸性磷酸酶 5b 和前列腺特异性抗原（PSA）水平。使用多变量逐步逻辑回归分析确定骨转移的独立预测因子。使用受试者工作特征分析评估血清标志物水平与骨转移的相关性。使用多变量 Cox 比例风险分析预测有骨转移的 PCa 患者的特定原因生存。

结果

有骨转移的患者血清总碱性磷酸酶、骨特异性碱性磷酸酶、1CTP、抗酒石酸酸性磷酸酶 5b 和 PSA 水平显著升高，与骨闪烁扫描上疾病的严重程度显著相关。多变量逐步逻辑回归分析表明，血清 PSA 和 1CTP 是骨转移的显著预测因子。受试者工作特征分析显示，血清 1CTP 水平是骨转移最可靠的预测因子（曲线下面积=0.85）。多变量 Cox 比例风险分析显示，只有血清 1CTP 是 PCa 相关死亡的独立预后因素。