Seaman E, Goluboff E T, Ross S, Sawczuk I S
J. Bentley Squier Urologic Clinic, Columbia-Presbyterian Medical Center, Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Urology. 1996 Nov;48(5):692-5. doi: 10.1016/S0090-4295(96)00236-1.
We assessed the frequency of bone metastases, their association with serum alkaline phosphatase (AP), and prognostic capabilities of AP in patients with renal cell carcinoma (RCC), using bone scan as the reference standard for diagnosis.
We conducted a retrospective review of patients with metastatic RCC treated with either autologous ex vivo activated T-lymphocytes and cimetidine (ALT) or cimetidine alone.
Twenty-eight of 90 patients (31%) had evidence of bone metastases by bone scan. With 100 mg/ dL as the upper limit of normal, 11 of 28 (39%) patients with bone metastases had normal AP levels. Of these 11 patients, 8 had bone pain. Of the 3 asymptomatic patients with bone metastasis and normal AP levels, only 1 had bone as the only site of metastasis and would have been incorrectly staged without the scan. Patients with bone metastases had a significantly shorter median survival than those without bone metastases (13.8 versus 25.3 months; P < 0.05). Among patients without bone metastases who had elevated AP levels, those treated with ALT had significantly longer median survivals than those treated with cimetidine alone (27.6 versus 14.5 months; P < 0.05). Overall, patients treated with ALT had a significantly longer median survival than the ones treated only with cimetidine (21 versus 8.5 months; P < 0.05). Overall, the median survival for patients with elevated AP levels (10 months) was not significantly different from that of those with normal AP levels (13 months).
In a high-risk group of patients with metastatic RCC, 31% had bone metastases. Elevated AP levels, the presence of bone pain, or the presence of other metastases correctly predicted bone metastasis in all but 1 patient. A bone scan may safely be omitted in patients with RCC, normal AP levels, and no bone pain. However, AP elevation itself had little prognostic capability in these patients.
以骨扫描作为骨转移诊断的参考标准，我们评估了肾细胞癌（RCC）患者骨转移的发生率、其与血清碱性磷酸酶（AP）的相关性以及AP的预后评估能力。
我们对接受自体体外激活T淋巴细胞联合西咪替丁（ALT）或仅接受西咪替丁治疗的转移性RCC患者进行了回顾性研究。
90例患者中有28例（31%）经骨扫描证实有骨转移。以100mg/dL作为正常上限，28例骨转移患者中有11例（39%）AP水平正常。在这11例患者中，8例有骨痛。在3例骨转移且AP水平正常的无症状患者中，只有1例骨是唯一转移部位，若不进行扫描则会出现分期错误。有骨转移的患者中位生存期明显短于无骨转移的患者（13.8个月对25.3个月；P<0.05）。在无骨转移但AP水平升高的患者中，接受ALT治疗的患者中位生存期明显长于仅接受西咪替丁治疗的患者（27.6个月对14.5个月；P<0.05）。总体而言，接受ALT治疗的患者中位生存期明显长于仅接受西咪替丁治疗的患者（21个月对8.5个月；P<0.05）。总体而言，AP水平升高患者的中位生存期（10个月）与AP水平正常患者的中位生存期（13个月）无显著差异。
在转移性RCC高危患者组中，31%有骨转移。AP水平升高、骨痛或其他转移的存在除1例患者外能正确预测骨转移。对于RCC、AP水平正常且无骨痛的患者，可安全地省略骨扫描。然而，AP升高本身在这些患者中预后评估能力有限。
