Department of Urology, P D Hinduja National Hospital and Medical Research Centre, Mumbai, India.
Gulf J Oncolog. 2022 Jan;1(38):24-30.
To evaluate the role of alkaline phosphatase (ALP) as marker of bone metastases in patients of genitourinary cancers compared to bone scan, and to correlate with NCCN guidelines.
This retro-prospective, observational study included all newly diagnosed patients of renal, bladder (muscle invasive) and prostate cancers who presented from July 2014 to March 2017. For diagnosis of bone metastases, ALP groups (raised/normal) were compared with bone scan (positive/negative). Sub-group analysis was done on patients with normal ALP levels and positive bone scan.
150 patients were included and stratified depending on bone scan findings. Hemoglobin values were significantly different between two groups in renal and prostate cancers (p=0.015 and 0.002 respectively). AL values were significantly different between two groups in prostate cancers (p=0.0008), but not for others. Three out of seven patients with bone metastases for renal cancers (42.9%) and all three for bladder cancers had normal ALP values, no bone symptoms, and would have been missed. For prostate cancers, out of 23 who had bone metastases, ALP was normal in ten. All these ten had Gleason score of > 8 and all except one had S. PSA > 20ng/ml. All cases would have been detected irrespective of ALP values.
ALP has limited sensitivity but reasonable negative predictive value for bone metastases in genitourinary cancers. Current guidelines may miss significant number of cases with bone metastases for renal and bladder cancers. Current guidelines have good accuracy for prostate cancers, since PSA and Gleason score are independent predictors of bone metastases.
评估碱性磷酸酶（ALP）作为泌尿生殖系统癌症患者骨转移标志物的作用，与骨扫描进行比较，并与 NCCN 指南相关联。
本回顾性观察性研究纳入了 2014 年 7 月至 2017 年 3 月期间所有新诊断为肾、膀胱（肌层浸润性）和前列腺癌的患者。为了诊断骨转移，将 ALP 组（升高/正常）与骨扫描（阳性/阴性）进行比较。对 ALP 水平正常且骨扫描阳性的患者进行了亚组分析。
共纳入 150 例患者，并根据骨扫描结果进行分层。肾和前列腺癌患者的血红蛋白值在两组之间有显著差异（p=0.015 和 0.002 分别）。前列腺癌患者的 AL 值在两组之间有显著差异（p=0.0008），但其他癌症则无差异。7 例肾癌症患者中有 3 例（42.9%）和 3 例膀胱癌患者的骨转移患者的 ALP 值正常，没有骨症状，可能会被漏诊。对于前列腺癌，23 例有骨转移的患者中有 10 例 ALP 正常。这 10 例患者的 Gleason 评分均>8，除 1 例外其余患者的 PSA>20ng/ml。所有这些病例无论 ALP 值如何都会被检测到。
ALP 对泌尿生殖系统癌症的骨转移具有有限的敏感性，但具有合理的阴性预测值。目前的指南可能会漏诊肾和膀胱癌的大量骨转移病例。对于前列腺癌，目前的指南具有较高的准确性，因为 PSA 和 Gleason 评分是骨转移的独立预测因素。
