Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0153690 (bone metastases)
 6,382 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Carcinoma of the breast is the most common malignancy in women and is frequently associated with metastatic bone disease and its associated osteolytic morbidity and mortality. Traditional radiological methods for mass screening bony secondaries are not cost-effective. We examined the value of the tumour marker 'CA15-3' as an alternative to conventional isotope bone scintigraphy. A total of 218 patients with breast cancer was evaluated over a 4-year period. Venous CA15-3 levels were obtained at 3-monthly intervals and bone scintigraphy annually or if the patient developed locomotor symptoms or exhibited elevated CA15-3 levels. Of these patients, 33 with metastatic breast carcinoma had an elevated tumour marker level at the time of diagnosis of their metastases; bone metastases alone = 15/17 (88%), soft tissue metastases alone = 2/6 (33%), simultaneous bony and soft tissue metastases = 7/10 (70%). The preponderance of an elevated CA15-3 in metastatic bone disease, be it in isolation or in combination with non-bone metastases, yields a sensitivity, specificity and positive predictive value of 81.5%, 66% and 92%, respectively. Although 22 of the 27 patients had an elevated CA15-3 at the time of diagnosis of their bone metastases, the remaining five patients (with tumour marker levels in the normal range) showed a similar, albeit a delayed, increase (median = 3 months). Thus, all metastatic bone disease patients demonstrated elevated marker levels. We recommend CA15-3 as a simple, reliable and inexpensive screening method for detecting bone metastases in the patient with breast carcinoma.
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PMID:CA15-3: a reliable indicator of metastatic bone disease in breast cancer patients. 173 5

Serum activities of bone alkaline phosphatase (b-ALP) and of tartrate resistant acid phosphatase (tr-ACP) were evaluated in 271 cancer patients; 120 of them had bone metastases (BM) and 151 had none. Correlation coefficients, specificities, sensitivities, negative and positive predicting values were computed. They showed the important contribution that these isoenzymes can bring to the diagnosis of BM in 80 patients with prostate cancer, and to the followup of 191 patients with breast cancer. The assay results were analysed in parallel with bone scan and radiography. They were also compared to those of serum antigens: PSA and PAP for prostate cancer, and CEA and CA15.3 for breast cancer. These results clearly indicate that both isoenzymes are better correlated with BM than antigens, these antigens being markers of the whole tumor burden--primary tumor, metastases, recurrence--whereas b-ALP and tr-ACP are specific markers of bone metabolism.
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PMID:[Evaluation of two serum isoenzyme phosphatases as bone metastasis markers]. 208 Dec 81

An immunoradiometric assay (IRMA) has been used to determine circulating levels of the breast cancer-associated antigen, CA15-3. Of 1,050 normal control subjects, serum from 99 (9.4%) had CA15-3 antigen levels greater than 22 U/mL, while that from 58 (5.5%) and 14 (1.3%) had levels greater than 25 U/mL and 30 U/mL, respectively. In contrast, 115 of 158 patients (73%) with metastatic breast cancer had CA15-3 levels greater than 22 U/mL. Thirteen of 26 patients (50%) with only local metastases, 27 of 34 (79%) of those with only bone metastases, and 20 of 24 (83%) with hepatic metastases had CA15-3 levels greater than 22 U/mL. Furthermore, nine of 31 patients (29%) with primary breast cancer had CA15-3 levels greater than 22 U/mL. CA15-3 and carcinoembryonic antigen (CEA) levels were compared for the same patient population. Significantly more patients with metastatic breast cancer had elevated CA15-3 levels than had elevated CEA levels (P less than .001). Furthermore, the CA15-3 IRMA was more sensitive than the CEA assay in patients with only bone metastases, as well as those with only local metastases. Significantly more patients with primary carcinoma of the breast also had elevated CA15-3 than had elevated CEA levels (P less than .02). CA15-3 levels were greater than 22 U/mL in patients with nonmalignant conditions, including five of 25 patients (20%) with benign breast diseases, and 23 of 52 patients (44%) with benign liver diseases. Furthermore, CA15-3 levels were also greater than 22 U/mL in 24 of 54 patients (44%) with gastrointestinal (GI) malignancies, 12 of 17 patients (71%) with bronchogenic carcinoma, and 29 of 44 patients (66%) with epithelial ovarian carcinoma. Serial CA15-3 levels correlated with clinical disease course. Nineteen of 21 patients (91%) with tumor progression had at least a 25% increase in CA15-3 levels. Conversely, seven of nine patients (78%) with tumor regression had at least a 50% decrease in CA15-3 levels. Among 27 patients with stable disease, 16 (59%) had levels that did not vary by more than +/- 25% of the original CA15-3 levels. These results indicate that the CA15-3 antigen is a sensitive marker for the evaluation and monitoring of patients with breast cancer.
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PMID:Comparison of circulating CA15-3 and carcinoembryonic antigen levels in patients with breast cancer. 242 49

Bone alkaline phosphatase (B-ALP) and tartrate resistant acid phosphatase (TR-ACP) are markers of osteoblastic and osteoclastic activities respectively. During a period of up to two years, these isoenzymes have been assayed in the sera of 191 breast cancer patients; 80 had bone metastases (BM). In BM bearing patients, B-ALP activity was 261 IU/l and 63 IU/l for patients without BM; TR-ACP was respectively 6.6 and 3.3 IU/l. Specificity and sensitivity were calculated according to several criteria. These isoenzyme serum levels were well correlated with those of two breast cancer markers (CEA and CA15.3) and radiograph.
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PMID:Isoenzymes of alkaline and acid phosphatases as bones metastasis marker in breast cancer patients. 281 92

Bone scan flare seriously complicates evaluations of the therapeutic response of bone metastases. The value of bone metabolic markers in monitoring the therapeutic response for bone metastases in breast cancer was assessed. Twenty-three breast cancer patients with bone metastases treated by combined chemotherapy of cyclophosphamide, doxorubicin, and 5-fluorouracil (CAF) were monitored using bone scans; a bone resorption marker, pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP); a bone formation marker, bone-specific alkaline phosphatase (BAI-p); and a tumor-specific marker (CA15-3). Bone scans were performed before and 3 or 4 months after therapy. After CAF therapy, markers were measured monthly. As a control, the markers of nine patients without bone metastases who received adjuvant CAF therapy were also measured monthly. The therapeutic effect on bone metastases was assessed after the study. Five patients had progression of disease (PD), three had no change (NC), and 15 patients had partial responses (PR). Bone scan flare-up was seen in five PR patients. In patients who received adjuvant therapy, ICTP, BAI-p, and CA15-3 did not change. ICTP increased significantly in PD patients. ICTP did not increase in either NC or PR, including bone scan flare patients. BAI-p and CA15-3 did not show any discernible pattern among PD, PR, flare, and NC patients. Thus measuring ICTP could distinguish PD from NC or PR patients' responses to CAF therapy. This was true also for patients who showed bone scan flare-up. Measuring a bone resorption marker, ICTP, allows clinicians to monitor patients' responses to CAF therapy and may prevent prolonged ineffective therapy or unnecessary changes in therapy as a result of the flare phenomenon.
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PMID:Bone metabolic markers in the evaluation of bone scan flare phenomenon in bone metastases of breast cancer. 989 Apr 87

Bone scintigraphy (BS) is commonly performed in the staging and postoperative monitoring of breast cancer. Nevertheless, due to low specificity it often demonstrates hot spots with equivocal interpretation, which may be misleading in the management of these patients. The aim of this study was to assess the value of a serum tumour marker panel in selecting among the patients with equivocal BS those with bone metastases. Between January 1986 and December 1995, 297 breast cancer patients were followed-up after mastectomy with serial determinations of a CEA-TPA-CA15.3 tumour marker panel, BS and liver echography. The tumour marker panel was used to select patients with equivocal BS for examination of suspicious bone areas by further imaging techniques. Up to December 1995, 158 (53%) patients showed an equivocal BS and 47 patients developed bone metastases. In the 158 patients with equivocal BS, prolonged clinical and imaging follow-up over 45 months (mean; range 12-120) was used to ascertain the presence or absence of bone metastases. In these 158 patients the negative predictive value and positive predictive value of the tumour marker panel to predict bone metastases was 97% and 75% respectively. This study shows that in breast cancer patients the CEA-TPA-CA15.3 tumour marker panel has a high value in selecting those patients with bone metastases, or at high risk of developing clinically-evident bone metastases, among the large number of subjects with equivocal BS.
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PMID:The role of tumour markers in predicting skeletal metastases in breast cancer patients with equivocal bone scintigraphy. 1018 88

This study was designed to evaluate new bone resorption and tumour markers as possible alternatives to serial plain radiographs for the assessment of response to treatment. Thirty-seven patients with newly diagnosed bone metastases from breast cancer, randomized to receive oral pamidronate or placebo tablets in addition to anticancer treatment within the context of a multicentre EORTC trial, who were both assessable for radiographic response in bone and had serum and urine samples collected for more than 1 month were studied. The markers of bone metabolism measured included urinary calcium (uCa), hydroxyproline (hyp), the N-telopeptide cross-links of type I collagen (NTx) and total alkaline phosphatase. The tumour markers measured were CA15-3 and cancer-associated serum antigen (CASA). Before treatment, levels of Ntx, uCa and Hyp were elevated in 41%, 24% and 28% respectively, and CA15-3 and CASA increased in 69% and 50%. For assessment of response and identification of progression, Ntx was the most useful bone marker. All markers behaved similarly in no change (NC) and partial response (PR) patients. There was a significant difference (P < or = 0.05) in Ntx levels (compared to baseline) at 1 and 4 months and in CA15-3/CASA at 4 months between patients with PR or NC and those with progressive disease (PD), and at 4 months between those with time to progression (TP) > 7 and those with TP < or = 7 months. The diagnostic efficiency (DE) for prediction of PD following a > 50% increase in Ntx or CA15-3 was 78% and 62% respectively. An algorithm to predict response to therapy has been developed for future prospective evaluation.
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PMID:Assessment of bone response to systemic therapy in an EORTC trial: preliminary experience with the use of collagen cross-link excretion. European Organization for Research and Treatment of Cancer. 1039

Breast cancer commonly metastasizes to bones, producing both osteolytic and osteoblastic deposits. Different markers for quantitative determination of bone turnover have been developed to evaluate bone metastases of breast cancer. The urinary deoxypyridinoline (Dpd), a crosslink product of collagen molecules found in bone and excreted in urine during bone degradation, and bone specific alkaline phosphatase (B-ALP), an isoenzyme localized in the membrane of osteoblasts and released in circulation during bone formation, were recently described as a group of markers of bone turnover in metastatic cancer. The urinary Dpd/creatinine (Cre) ratios and the serum B-ALP activity were determined in the samples from 148 patients who suffered from breast cancer (BC patients) with or without bone metastases, and 42 healthy women. For comparison, other biochemical markers, e.g. carcinoembryonic antigen (CEA), CA15-3, tissue polypeptide antigen (TPA), tissue polypeptide specific antigen (TPSA), and total alkaline phosphatase (T-ALP) in these samples were also evaluated. The results showed that there was a significant difference in urinary Dpd/Cre ratio between the control group and the patients with breast cancer (BC group) (mean +/- S.D., 5.69 +/- 1.26 vs. 8.19 +/- 3.95 nM/mM, P < 0.05). However, there was no significant difference between their B-ALP activities in the two groups. In addition, the BC patients with bone metastases showed elevated urinary Dpd/Cre ratios and B-ALP activities and ratios of (Dpd/Cre)/B-ALP in compare with BC patients without bone metastases (P < 0.05). Meanwhile, the urinary Dpd/Cre ratios (10.50 +/- 5.04 nmol/mmol) in the advanced stage of BC patients were higher than those in an early stage (7.45 +/- 3.23 nmol/mmol) (P < 0.05), but their serum B-ALP activities increased only in stage IV (P < 0.05). The urinary Dpd/Cre ratios also increased progressively according to the degree of bone metastases (P < 0.05), but their serum B-ALP activities only increased in severe bone metastases (P < 0.05). The results showed that the increase of a bone osteolytic activity took place earlier than that of a bone osteoblastic activity in the metastatic BC patients. In compare with other conventional markers, the best diagnostic efficiency of biochemical markers, analyzed by step wise discriminate analysis, was provided by CEA followed by Dpd/Cre ratio, CA15-3, TPA, TPSA, B-ALP and T-ALP. We conclude that showed the urinary Dpd/Cre ratio was a useful tumor marker to evaluate breast cancer with bone metastases.
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PMID:Biochemical markers for assessment of bone metastases in patients with breast cancer. 1051 61

The clinical utility of magnetic resonance imaging (MRI) in judging therapeutic response of bone metastases was evaluated in 18 patients with advanced breast cancer. Treatment efficacy was assessed by MRI and conventional methods such as plain radiograph, bone scan, pain and analgesic scale, and serum CA15-3. The response by MRI was evaluated mainly on T1-weighted sequences by measuring the volume of the bone lesion and soft tissue component. The patient was assumed to be a conventional responder if a complete or partial response was observed in any of the conventional methods described above. Response was most concordant between plain radiographs and MRI findings (91%, 10/11, 95% confidence interval [CI]: 58.7-99.8). The rate of concordance was 61% (11/18, 95% CI 35.8-82.7) for all conventional methods and MRI. MRI revealed response in four patients in whom progressive disease was observed by bone scan and the marker response was not measurable. This pilot study suggests that posttherapy evaluation with MRI may provide useful clinical information in breast cancer patients with bone metastases and may be a valuable adjunct to conventional methods with conflicting results.
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PMID:Response evaluation of bone metastases in breast cancer: value of magnetic resonance imaging. 1059 64

TPS and CA 15-3 have been applied for monitoring treatment in patients with advanced breast cancer and the relationship between the initial marker levels and the changes of the markers during chemotherapy has been established. Both markers have demonstrated high sensitivity for detecting visceral and bone metastases in the patients (90-95%) compared to soft tissues and locally advanced disease (45-50%). The marker combination, TPS and CA15-3, showed the highest sensitivity for detecting bone/visceral metastases (98%) and soft tissue/locally advanced metastases (75%). TPS showed a more frequent decrease in marker level (> 50%) compared to CA 15-3 as well as the highest correlation (68%) to the clinically confirmed events CR, PR compared to CA 15-3 (54%). In the subgroup of metastatic breast cancer patients, demonstrating increased marker levels (> 25%) during follow-up, TPS showed the highest correlation compared to the clinically confirmed progressive disease. In the subgroup of patients with clinically confirmed progression, contemporary measurements of the marker values resulted in correlation with the clinical findings in 78% for TPS and 58% for CA 15-3. TPS appears to be superior to CA 15-3 for follow-up of metastatic breast cancer patients. TPS and CA 15-3 marker increase preceded the clinical and/or radiological signs of distant metastases in most of the patients; 1.5 and 1.1 months, respectively. The time elapsed between tumor marker increase and clinically confirmed progression was very short, which is also related to the frequent follow-up visits for metastatic breast cancer patients receiving chemotherapy. TPS appears to indicate the changes in the disease state earlier than clinical criteria or than the established tumor burden markers. The simultaneous determination of TPS and CA 15-3 provided additive information in advanced breast cancer patients and might guide management decisions in the individual patients.
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PMID:Use of TPS and CA 15-3 assays for monitoring chemotherapy in metastatic breast cancer patients. 1132 74


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