Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China.
Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
Breast Cancer Res Treat. 2023 Nov;202(2):233-244. doi: 10.1007/s10549-023-07066-z. Epub 2023 Jul 31.
Numerous studies had reported the diagnostic value of alkaline phosphatase (ALP) and its bone-specific isoforms (BAP) in the metastases of breast cancer (BC). The purpose of this meta-analysis was to summarize the diagnostic value of serum ALP and BAP in metastatic BC, especially focused on bone metastases.
We searched comprehensively in the PubMed, Cochrane Library, and EMBASE for studies to explore the diagnostic accuracy of serum ALP/BAP level for metastatic BC. Qualities of including studies were assessed and pooled sensitivity, specificity, and summary receiver operating characteristic curve were calculated. Publication bias was assessed and meta-regression was conducted.
We finally included 25 studies with a total of 12,155 BC patients (1681 metastatic cases and 10,474 controls). According to the QUADAS-2 tool to assessment the methodological quality, most of the included studies were judged as high risk of patient selection bias. High serum levels of ALP/BAP in bone metastatic BC patients could be found compared with non-metastatic BC patients. The pooled sensitivity and specificity of ALP for BC bone metastases were 0.62 and 0.86, and the area under the curve (AUC) was 0.80. The pooled sensitivity and specificity of ALP for all site metastases (mainly bone and liver) were 0.56 and 0.91, and the AUC was 0.90. The pooled sensitivity and specificity of BAP for BC bone metastases were 0.66 and 0.92, and the AUC was 0.89.
Although not promising, serum ALP and BAP could bring useful information for the early detection of BC metastases especially for the bone metastases.
许多研究报告了碱性磷酸酶（ALP）及其骨特异性同工酶（BAP）在乳腺癌（BC）转移中的诊断价值。本荟萃分析的目的是总结血清 ALP 和 BAP 在转移性 BC 中的诊断价值，特别是侧重于骨转移。
我们全面检索了 PubMed、Cochrane 图书馆和 EMBASE 中的研究，以探讨血清 ALP/BAP 水平对转移性 BC 的诊断准确性。评估纳入研究的质量，并计算汇总敏感性、特异性和汇总受试者工作特征曲线。评估发表偏倚并进行荟萃回归分析。
我们最终纳入了 25 项研究，共有 12155 名 BC 患者（1681 例转移性病例和 10474 例对照）。根据 QUADAS-2 工具评估方法学质量，大多数纳入的研究被判断为患者选择偏倚的高风险。与非转移性 BC 患者相比，骨转移性 BC 患者的血清 ALP/BAP 水平较高。ALP 对 BC 骨转移的汇总敏感性和特异性分别为 0.62 和 0.86，曲线下面积（AUC）为 0.80。ALP 对所有部位转移（主要是骨和肝）的汇总敏感性和特异性分别为 0.56 和 0.91，AUC 为 0.90。BAP 对 BC 骨转移的汇总敏感性和特异性分别为 0.66 和 0.92，AUC 为 0.89。
尽管并不理想，但血清 ALP 和 BAP 可为 BC 转移的早期检测，特别是骨转移提供有用信息。
