| Objective:To study the clinical significance of the quantitative assays of serum pyridinoline cross-linked N-telopeptides of type I collagen (NTx) and serum bone sialoprotein (BSP) to diagnose bone metastases from paytients with lung cancer and breast cancer.Methods:The patients were pathologically conformed to have lung cancer and breast cancer and then were divided into two groups: with or without bone metastases. The levels of serum NTx and serum BSP measured by ELISA. After at least six months'follow-up, all the patients were evaluated the survival status. Statistical analyses were performed with SPSS 14.0 for Windows.Results:105 patients were included in this study, 50 patients with bone metastases (31 patients with lung cancer and 19 patients with breast cancer), 55 patients without bone metastasis (33 patients with lung cancer and 22 patients with breast cancer).The level of serum NTx and serum BSP in patients with bone metastasis were significantly higher than those in the patients without bone metastases (P<0.01). The sensitivity and specificity for serum NTx in the diagnosis of bone metastasis were 90% and 67.3%, respectively. The sensitivity and specificity of serum BSP in the diagnosis of bone metastases were 84% and 70.9%, respectively. Besides, The levels of serum NTx and serum BSP were significangly different between the groups with bone metastases and without bone metastases (P<0.05). It is suggested that the two markers were specific serum markers to diagnose bone metastases. The level serum of NTx was significantly correlative to the level of serum BSP (r=0.632, P<0.01). The above results showed that the levels of serum NTx and serum BSP play important roles in diagnosis of bone metastases. The higher the levels of serum NTx or serum BSP, the more painful the patients felt (P<0.01). However, there is no correlation between the locations or the numbers of involvement of bone metastases and two biomarkers. There were 32 patients with bone metastases occurred skeletal related events (SRE). The patients with SREs, specially those with pathological fractures, had significantly higher levels of serum NTx (P<0.05). The level of serum BSP had no relation to adverse events of SREs. These results showed there was significant correlation between clinical symptoms and the levels of the serum NTx and serum BSP.During the follow-up, 21 patients were diagnosed with new-onset bone metastases that conformed by bone scan, X-ray or CT. Using COX to analyze the risk factors of bone metastases, it was showed that age and the level of serum NTx were the risk factors for patients with lung cancer and breast cancer. The relative risk ratio for the higher level of serum NTx was 1.127. Further analysis of the risk factors for patients with breast cancer to develop bone metastases showed that the level of serum BSP was the only risk factor(P<0.01) with the relative risk 1.058.During the follow-up, 33 patients died and among them 28 cases were with lung cancer and 5 with breast cancer. The cum survival for the patients with higher level of serum BSP was lower than the group with the normal level of serum BSP. It was suggested that serum BSP was prognostic factor.Conclusion:The serum NTx and BSP were important biomarkers to diagnose bone metastasis. The two marker could respond the level of bone metabolism and be regarded as risk factors for bone metastasis. Patients with lung cancer and breast cancer had a poorer prognosis if the level of BSP was above normal. In summary, the measurement of levels of serum NTx and BSP could help diagnose bone metastasis in the early stage, rule out patients with higher risk factors, and even have a prospect to prognose the survivals of patients with bone metastasis. |
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