Magnusson Per, Sääf Maria, Martling Anna, Svanström Röjvall Annika, Atanasova Diana, Wilamowski Franciszek, Flöter Rådestad Angelique, Buchli Christian, Segelman Josefin
Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SE-581 85, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SE-171 77, Sweden.
JBMR Plus. 2024 Jul 10;8(9):ziae087. doi: 10.1093/jbmrpl/ziae087. eCollection 2024 Sep.
Preoperative radiotherapy (RT) for non-metastatic rectal cancer reduces local recurrence rates but can cause pelvic insufficiency fractures. Despite the high morbidity from RT-induced skeletal injuries, predictive and preventive measures are lacking. How these injuries are reflected by bone biomarkers are largely unknown. The aim was to assess longitudinal changes in bone biomarkers and their relation to RT-related bone injuries in women with rectal cancer. This longitudinal cohort study includes 47 women with non-metastatic rectal cancer treated with surgery ± preoperative RT with or without chemotherapy. Sclerostin, bioactive sclerostin, C-terminal telopeptide cross-links of collagen type I (CTX), bone-specific alkaline phosphatase (BALP), and type I procollagen intact N-terminal propeptide (PINP) were measured at baseline, after RT, and 1 yr postoperatively. Pelvic magnetic resonance imaging was used for detection of skeletal injury. Sixteen of 36 (44%) irradiated women had radiation-induced bone injuries and were compared to 11 women (RT-) and 20 women (RT+) without bone injuries. Serum CTX, BALP, and PINP increased during the first year after RT in women with radiation-induced bone injuries. The difference in mean change of CTX (=.037) and BALP (=.042) was conferred by longitudinal regression analyses adjusted for serum estradiol. Serum sclerostin and bioactive sclerostin remained stable over time. Taken together, bone markers may be of interest for future research on fracture prediction or preventive measures in women susceptible to radiation-induced bone injury. Due to few measure points, the full pattern cannot be captured regarding the relation over time between bone biomarkers and skeletal injury from irradiation.
非转移性直肠癌的术前放疗（RT）可降低局部复发率，但会导致骨盆不全骨折。尽管放疗引起的骨骼损伤发病率很高，但缺乏预测和预防措施。这些损伤如何通过骨生物标志物反映在很大程度上尚不清楚。目的是评估直肠癌女性患者骨生物标志物的纵向变化及其与放疗相关骨损伤的关系。这项纵向队列研究纳入了47例接受手术±术前放疗（有或无化疗）的非转移性直肠癌女性患者。在基线、放疗后和术后1年测量硬化素、生物活性硬化素、I型胶原C末端交联肽（CTX）、骨特异性碱性磷酸酶（BALP）和I型前胶原完整N末端前肽（PINP）。采用盆腔磁共振成像检测骨骼损伤。36例接受放疗的女性中有16例（44%）发生了放疗引起的骨损伤，并与11例无骨损伤的女性（未放疗组）和20例无骨损伤的女性（放疗组）进行比较。发生放疗引起骨损伤的女性患者，放疗后第一年血清CTX、BALP和PINP升高。经血清雌二醇校正的纵向回归分析显示，CTX（=0.037）和BALP（=0.042）的平均变化存在差异。血清硬化素和生物活性硬化素随时间保持稳定。综上所述，骨标志物可能对未来研究易发生放疗引起骨损伤的女性骨折预测或预防措施具有意义。由于测量点较少，无法全面了解骨生物标志物与放疗引起的骨骼损伤之间随时间的关系。
