Abstract：
OBJECTIVE: To evaluate the role of alkaline phosphatase (ALP) as marker of bone metastases in patients of genitourinary cancers compared to bone scan, and to correlate with NCCN guidelines.
METHODS: This retro-prospective, observational study included all newly diagnosed patients of renal, bladder (muscle invasive) and prostate cancers who presented from July 2014 to March 2017. For diagnosis of bone metastases, ALP groups (raised/normal) were compared with bone scan (positive/negative). Sub-group analysis was done on patients with normal ALP levels and positive bone scan.
RESULTS: 150 patients were included and stratified depending on bone scan findings. Hemoglobin values were significantly different between two groups in renal and prostate cancers (p=0.015 and 0.002 respectively). AL values were significantly different between two groups in prostate cancers (p=0.0008), but not for others. Three out of seven patients with bone metastases for renal cancers (42.9%) and all three for bladder cancers had normal ALP values, no bone symptoms, and would have been missed. For prostate cancers, out of 23 who had bone metastases, ALP was normal in ten. All these ten had Gleason score of > 8 and all except one had S. PSA > 20ng/ml. All cases would have been detected irrespective of ALP values.
CONCLUSIONS: ALP has limited sensitivity but reasonable negative predictive value for bone metastases in genitourinary cancers. Current guidelines may miss significant number of cases with bone metastases for renal and bladder cancers. Current guidelines have good accuracy for prostate cancers, since PSA and Gleason score are independent predictors of bone metastases.
METHODS: This retro-prospective, observational study included all newly diagnosed patients of renal, bladder (muscle invasive) and prostate cancers who presented from July 2014 to March 2017. For diagnosis of bone metastases, ALP groups (raised/normal) were compared with bone scan (positive/negative). Sub-group analysis was done on patients with normal ALP levels and positive bone scan.
RESULTS: 150 patients were included and stratified depending on bone scan findings. Hemoglobin values were significantly different between two groups in renal and prostate cancers (p=0.015 and 0.002 respectively). AL values were significantly different between two groups in prostate cancers (p=0.0008), but not for others. Three out of seven patients with bone metastases for renal cancers (42.9%) and all three for bladder cancers had normal ALP values, no bone symptoms, and would have been missed. For prostate cancers, out of 23 who had bone metastases, ALP was normal in ten. All these ten had Gleason score of > 8 and all except one had S. PSA > 20ng/ml. All cases would have been detected irrespective of ALP values.
CONCLUSIONS: ALP has limited sensitivity but reasonable negative predictive value for bone metastases in genitourinary cancers. Current guidelines may miss significant number of cases with bone metastases for renal and bladder cancers. Current guidelines have good accuracy for prostate cancers, since PSA and Gleason score are independent predictors of bone metastases.
摘要：
目的：与骨扫描相比，评估碱性磷酸酶（ALP）作为泌尿生殖系统癌症患者骨转移标志物的作用，并与NCCN指南相关。
方法：这种回顾性的，观察性研究包括所有新诊断的肾脏患者，2014年7月至2017年3月出现的膀胱癌(肌肉浸润性)和前列腺癌。为了诊断骨转移，ALP组（升高/正常）与骨扫描（阳性/阴性）进行比较。对ALP水平正常和骨扫描阳性的患者进行亚组分析。
结果：纳入150例患者，并根据骨扫描结果进行分层。肾癌和前列腺癌两组之间的血红蛋白值显着不同（分别为p=0.015和0.002）。两组前列腺癌患者的AL值有显著差异（p=0.0008），但不是为了其他人。7例肾癌骨转移患者中有3例（42.9％）和3例膀胱癌患者的ALP值正常，没有骨头症状,会被错过的.对于前列腺癌，在23名有骨转移的人中，10例ALP正常。所有这10个都具有>8的Gleason评分,并且除了一个之外的所有具有>20ng/ml的S.PSA。无论ALP值如何，都会检测到所有病例。
结论：ALP对泌尿生殖系统肿瘤骨转移的敏感性有限，但具有合理的阴性预测值。目前的指南可能会错过大量肾癌和膀胱癌骨转移病例。目前的指南对前列腺癌有很好的准确性，因为PSA和Gleason评分是骨转移的独立预测因子。
方法：这种回顾性的，观察性研究包括所有新诊断的肾脏患者，2014年7月至2017年3月出现的膀胱癌(肌肉浸润性)和前列腺癌。为了诊断骨转移，ALP组（升高/正常）与骨扫描（阳性/阴性）进行比较。对ALP水平正常和骨扫描阳性的患者进行亚组分析。
结果：纳入150例患者，并根据骨扫描结果进行分层。肾癌和前列腺癌两组之间的血红蛋白值显着不同（分别为p=0.015和0.002）。两组前列腺癌患者的AL值有显著差异（p=0.0008），但不是为了其他人。7例肾癌骨转移患者中有3例（42.9％）和3例膀胱癌患者的ALP值正常，没有骨头症状,会被错过的.对于前列腺癌，在23名有骨转移的人中，10例ALP正常。所有这10个都具有>8的Gleason评分,并且除了一个之外的所有具有>20ng/ml的S.PSA。无论ALP值如何，都会检测到所有病例。
结论：ALP对泌尿生殖系统肿瘤骨转移的敏感性有限，但具有合理的阴性预测值。目前的指南可能会错过大量肾癌和膀胱癌骨转移病例。目前的指南对前列腺癌有很好的准确性，因为PSA和Gleason评分是骨转移的独立预测因子。
