In the majority of patients, the cause of death will be a metastatic disease most of which is concentrated in the bone. A number of markers of bone turnover are measurable in blood or urine, usually categorized as markers of bone formation or bone resorption. The IOF and IFCC recommend the measurement of serum procollagen type I N propeptide (PINP) and C-terminal telopeptide of type I collagen (CTX) as reference analytes in clinical studies. However, non-collagenous proteins, such as the enzyme of osteoclast origin tartrate-resistant acid phosphatase 5b (TRACP), have also been investigated as marker of osteoclast activity. The objective of this study was to evaluate the usefulness of TRACP5b assay in the early detection of bone metastases (BMs) in patients with lung cancer (LC) and breast cancer (BC). Patients and Methods: A series of 33 patients (12 men, 21 women, median age 59 years, range 34–68 years) with radiologically confirmed BMs from LC (N=17, Group 1) and BC (N=16, Group 2) were enrolled in this retrospective study. Controls were 18 and 19 stage-matched patients with advanced LC and BC, respectively, in whom 18 F-FDG PET/CT excluded the presence of BMs. TRACP5b was measured in all patients at the time of discovering BMs, using a commercially available two-site quantitative enzyme- linked sandwich assay (ELISA). Results: The results are the following (95 %CI): sensitivity=81.2 % (63.5–92.7), specificity=91.9 % (78.1–98.2), PPV=89.7% (72.6–97.7), NPV=85.0 % (70.1–94.2), prevalence=46.4 (34.3–58.8). TRACO5b was more sensitive (93.7 vs. 68.7 %; χ2=204.7, p<0.001, OR=6.66, 95 %CI 5.08–0.04) and specific (94.4 vs. 89.5 %; χ2=1.09, p=0.29, OR=1.74, 95%CI 0.61–4.98) in patients with LC in respect of those with BC. The accuracy was 94.1 and 80.0 % (χ2=8.66, p=0.003, OR=3.92, 95 %CI 1.50–10.23), respectively. Conclusion: TRAPCO5b is a useful marker of BMs especially in patients with mixed osteolytic and PRHrP-related bone involvement, such as those with BC.
Value of tartrate resistant acid phosphatase (TRACO) isoform 5b in patients with advanced lung and breast cancer who developed bone metastases
LUMACHI, FRANCO;
2015
Abstract
In the majority of patients, the cause of death will be a metastatic disease most of which is concentrated in the bone. A number of markers of bone turnover are measurable in blood or urine, usually categorized as markers of bone formation or bone resorption. The IOF and IFCC recommend the measurement of serum procollagen type I N propeptide (PINP) and C-terminal telopeptide of type I collagen (CTX) as reference analytes in clinical studies. However, non-collagenous proteins, such as the enzyme of osteoclast origin tartrate-resistant acid phosphatase 5b (TRACP), have also been investigated as marker of osteoclast activity. The objective of this study was to evaluate the usefulness of TRACP5b assay in the early detection of bone metastases (BMs) in patients with lung cancer (LC) and breast cancer (BC). Patients and Methods: A series of 33 patients (12 men, 21 women, median age 59 years, range 34–68 years) with radiologically confirmed BMs from LC (N=17, Group 1) and BC (N=16, Group 2) were enrolled in this retrospective study. Controls were 18 and 19 stage-matched patients with advanced LC and BC, respectively, in whom 18 F-FDG PET/CT excluded the presence of BMs. TRACP5b was measured in all patients at the time of discovering BMs, using a commercially available two-site quantitative enzyme- linked sandwich assay (ELISA). Results: The results are the following (95 %CI): sensitivity=81.2 % (63.5–92.7), specificity=91.9 % (78.1–98.2), PPV=89.7% (72.6–97.7), NPV=85.0 % (70.1–94.2), prevalence=46.4 (34.3–58.8). TRACO5b was more sensitive (93.7 vs. 68.7 %; χ2=204.7, p<0.001, OR=6.66, 95 %CI 5.08–0.04) and specific (94.4 vs. 89.5 %; χ2=1.09, p=0.29, OR=1.74, 95%CI 0.61–4.98) in patients with LC in respect of those with BC. The accuracy was 94.1 and 80.0 % (χ2=8.66, p=0.003, OR=3.92, 95 %CI 1.50–10.23), respectively. Conclusion: TRAPCO5b is a useful marker of BMs especially in patients with mixed osteolytic and PRHrP-related bone involvement, such as those with BC.
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