Chen Xuan-Yin, Lan Min, Zhou Yang, Chen Wen-Zhao, Hu Dong, Liu Jia-Ming, Huang Shan-Hu, Liu Zhi-Li, Zhang Zhi-Hong
Department of Orthopaedic Surgery, the First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang, Jiangxi Province 330006, PR China.
J Bone Oncol. 2017 Nov 2;9:29-33. doi: 10.1016/j.jbo.2017.10.004. eCollection 2017 Nov.
The prognosis for renal cell carcinoma (RCC) is related to a high rate of metastasis, including 30% of bone metastasis. In this study, we investigate the correlation between diverse clinical factors and bone metastases secondary from renal cell cancer (RCC), and to identify potential risk factors for bone metastasis in newly diagnosed patients and those who have already received treatment.
The clinical data of 372 patients with RCC were reviewed from January 2000 to August 2016. The correlations between age, gender, histopathologic types, alkaline phosphotase (ALP), CEA, AFP, CA-125, CA-153, CA-199, calcium, hemoglobin (HB) and bone metastases were analyzed. And the risk factors for bone metastases in RCC were identified by multivariate logistic regression analysis. The cutoff value, sensitivity and specificity of the independent correlation factors were calculated by receiver operating characteristic (ROC) curve.
The bone is the second to the lung as a distant metastasis target site in patients with RCC. Thirty eight individuals were identified with bone metastases. Of these patients, significantly higher levels of ALP, calcium, HB were found than those without bone metastasis (P < 0.05, respectively). No significant differences were detected in CEA, AFP, CA-125, CA-153, CA-199, age, gender and histopathologic types between patients with and without bone metastases (P > 0.05, respectively). Multivariate logistic regression analysis indicated that ALP, calcium and HB were independent risk factors correlated with bone metastasis (P < 0.05, respectively). ROC curves demonstrated these factors had comparable accuracy at predicting bone metastasis (AUC were 0.749, 0.633 and 0.665, respectively). The cutoff values of ALP, calcium and HB were 105.5 U/L, 2.615 mmol/L and 111.5 g/L, respectively. The sensitivities of them were 57.9%, 36.8% and 71.1% for predicting bone metastasis, with specificities of 83.5%, 95.2% and 65.3%, respectively.
Based on our study, the concentrations of ALP, calcium and HB were potentially risk factors for bone metastasis in patients with RCC. For newly diagnosed patients, if the values of ALP>105.5 U/L, calcium>2.615 mmol/L and HB<111.5 g/L were detected, intensive monitoring and bone scanning are warranted for them.
肾细胞癌（RCC）的预后与高转移率相关，其中骨转移率达30%。本研究旨在探讨各种临床因素与肾细胞癌继发骨转移之间的相关性，确定新诊断患者及已接受治疗患者发生骨转移的潜在危险因素。
回顾2000年1月至2016年8月372例RCC患者的临床资料。分析年龄、性别、组织病理学类型、碱性磷酸酶（ALP）、癌胚抗原（CEA）、甲胎蛋白（AFP）、糖类抗原125（CA - 125）、糖类抗原153（CA - 153）、糖类抗原199（CA - 199）、钙、血红蛋白（HB）与骨转移之间的相关性。通过多因素逻辑回归分析确定RCC骨转移的危险因素。采用受试者工作特征（ROC）曲线计算独立相关因素的截断值、敏感性和特异性。
在RCC患者中，骨是仅次于肺的远处转移靶器官。38例患者被确诊有骨转移。这些患者的ALP、钙、HB水平显著高于无骨转移患者（P值均<0.05）。骨转移患者与无骨转移患者在CEA、AFP、CA - 125、CA - 153、CA - 199、年龄、性别和组织病理学类型方面均未检测到显著差异（P值均>0.05）。多因素逻辑回归分析表明，ALP、钙和HB是与骨转移相关的独立危险因素（P值均<0.05）。ROC曲线显示这些因素在预测骨转移方面具有相当的准确性（AUC分别为0.749、0.633和0.665）。ALP、钙和HB的截断值分别为105.5 U/L、2.615 mmol/L和111.5 g/L。它们预测骨转移的敏感性分别为57.9%、36.8%和71.1%，特异性分别为83.5%、95.2%和65.3%。
基于本研究，ALP、钙和HB的浓度可能是RCC患者发生骨转移的危险因素。对于新诊断的患者，如果检测到ALP>105.5 U/L、钙>2.615 mmol/L和HB<111.5 g/L，应对其进行密切监测和骨扫描。
