Short-term effects of pamidronate on bone turnover: can bone markers be considered predictive of the analgesic response?

Use of urinary markers in cancer setting: A literature review

INTRODUCTION

In bone metastases, the disruption of normal bone processes results in increased resorption and formation rates, which can often be quantitatively measured by biomarkers in the urine and blood. The purpose of this review is to summarize relevant studies of urinary markers used as a diagnostic and/or prognostic tool, as well as its potential and advances in directing therapy.

METHODS

A literature search was conducted using Ovid MEDLINE (1950 to July 2014), EMBASE (1950 to 2014 week 30) and Cochrane Central Register of Controlled Trials (3rd Quarter 2014) to identify studies that detailed the use of urinary markers in the cancer setting, specifically involving markers for bone metastases. Search terms included "urinary markers", "cancer", and "bone metastases".

RESULTS

A total of 35 articles, with 24 original studies, were identified. In general, urinary markers can be used to detect early signs of bone metastases prior to skeletal imaging, but still must be used in conjunction with imaging to avoid false positive results. The use of urinary markers, such as N-telopeptide, as a prognostic tool remains controversial, but can provide information on the relative risk of skeletal related events (SREs), disease progression, as well as death. Finally, while urinary markers have shown to be potentially useful in confirming the efficacy of bone metastases treatments, exploring the appropriate dosages for treatment, and directing therapy, it is still unclear to what extent urinary markers should be reduced by.

CONCLUSION

The potential use of urinary markers in the management of bone metastases is promising as it can allow for earlier and more convenient detection of bone metastases in comparison to other techniques. However, additional studies involving prospective clinical trials are suggested to further examine the potential of urinary markers in developing appropriate treatment strategies and endpoints, especially in developing a clearer protocol on the extent urinary markers should be reduced by to correlate with achievement of clinical benefit.

Patient-reported outcome instruments used to assess pain and functioning in studies of bisphosphonate treatment for bone metastases

Purpose

When treating metastatic bone disease, relief of bone pain is often a key outcome. Because pain cannot be quantified with objective clinical measures, patient-reported outcome (PRO) measures are required to assess patients' subjective experience. The goal of the current review was to examine measures used to assess pain, as well as the impact of pain on functional status and health-related quality of life (HRQL), in trials of bisphosphonates for the treatment of bone metastases.

Methods

A literature search focused on articles published from January 1999 to April 2009.

Results

A total of 49 articles were located that used PROs to assess pain-related outcomes of bisphosphonate treatment for bone metastases. The Brief Pain Inventory was the most commonly used multi-item instrument. However, the most common approach for assessing pain was to administer a single-item scale such as a visual analog scale, numerical rating scale, or verbal rating scale. Of the 49 studies, 19 included a PRO assessing functional status or HRQL.

Conclusions

Although pain is an important outcome of trials examining treatment for bone metastases, the current review suggests that there is little consistency in PRO measurement across studies. Furthermore, presentation of measures often lacked clear description, information on measurement properties, citations, clarity regarding method of administration, and consistent instrument names. Recommendations are provided for instrument validation within the target population, assessment of content validity, use of PRO instruments recently developed for patients with bone metastases, clear description of instruments, and implementation of measures consistent with recommendations from instrument developers.

[Diagnostic value of bone metabolic markers ICTP and BAP in lung cancer patients with bone metastases]

背景与目的

骨代谢标志物是一类源于骨基质或骨细胞的代谢指标，可反映骨代谢情况。本研究旨在探讨血清骨代谢生化指标Ⅰ型胶原交联羧基端肽（cross-linked telopeptide of type Ⅰ collage, ICTP）和骨特异性碱性磷酸酶（bone-specific alkaline phosphatase, BAP）在肺癌骨转移诊断中的意义及其临床应用价值。

方法

采用前瞻性对照方法，共入组110例，分为3组。初治肺癌患者共90例，临床分期为Ⅳ期，分为骨转移组50例和非骨转移组40例，健康对照组20例，采用酶联免疫法和电化学发光免疫测定法检测所有入组者治疗前的血清骨代谢生化指标ICTP和BAP水平，对骨转移的各因素与血清ICTP和BAP的相关性进行统计学分析。

结果

骨转移组的血清ICTP和BAP水平显著高于非骨转移组和健康对照组（P < 0.05）。多发性骨转移组（骨转移数≥3）的血清BAP水平显著高于少发性骨转移组（骨转移数 < 3）（P < 0.05）。混合性骨转移组的血清BAP水平显著高于溶骨性骨转移组（P < 0.05）。ICTP和BAP在肺癌骨转移诊断中的敏感性分别为18%和40%，特异性分别为98.3%和95%，准确度分别为61.8%和70%。联合检测血清ICTP和BAP可提高其敏感性和准确度（分别为52%和74.5%）。

结论

由于检测方便、无创性、成本较低，血清骨代谢生化指标ICTP和BAP在肺癌骨转移的临床诊断中有一定的实用价值。