肾癌骨转移的相关预测及诊断因素分析

Risk factors for predicting or diagnosing bone metastases from renal cell cancer

目的:探讨碱性磷酸酶(ALP)、血钙和血红蛋白(Hb)在预测和诊断肾癌骨转移的价值。方法:纳入病理诊断为肾透明细胞癌且后期随访有骨转移的患者14例为骨转移组。同期按1∶3匹配性别、年龄、肿瘤病理类型和随访时间,纳入肾癌无骨转移的患者42例为无骨转移组。分析两组之间各项指标的差异,明确肾癌骨转移的相关预测及诊断因素。结果:骨转移组患者的各项指标均显著高于无骨转移组(P<0.05)。二项式Logistic回归分析显示初诊肾癌ALP、骨转移后的ALP和骨转移独立相关(P<0.05)。ROC曲线显示初诊肾癌时患者ALP水平能较准确的预测骨转移风险(AUC=0.855),Cut-off值为108.5U/L;后期随访患者ALP水平能较准确的诊断骨转移风险(AUC=0.927),Cut-off值为81.5U/L。结论:初诊肾癌时,患者ALP>108.5U/L可预测后期发生骨转移的风险,肾癌后期随访的ALP>81.5U/L是判断患者是否合并骨转移的危险因素。

Objective：To explore the clinical significance of some risk factors for predicting or diagnosing bone metastases from renal cell cancer（RCC）.Method：Fifty-six（14 cases of RCC with bone metastases and 42 cases without bone metastases）age-and sex-matched patients with renal clear cell carcinoma were included in this study.The correlations between clinical-pathological parameters and bone metastases from RCC were analyzed and risk factors for predicting or diagnosing bone metastases were identified.Result：The levels of alkaline phosphatase（ALP）,calcium and hemoglobin（HB）were significantly higher in bone metastases group than those in non bone metastases（P0.05,respectively）.Binary logistic regression analysis indicated the ALP of newly diagnosed patients,and ALP of patients in follow-up period were independent risk factors correlated with bone metastases（P0.05,respectively）.And these factors had comparable accuracy on predicting or diagnosing institutionalization（AUC of 0.855,0.927 respectively）.The cut off values of it were 108.5 U/L,81.5 U/L respectively.Conclusion：For newly diagnosed patients,the concentrations of ALP108.5 U/L could be used as additional factors for determining the risk of developing bone metastases in RCC.Serum ALP81.5 U/L of patients in follow-up period may be used as a valuable biochemical marker to diagnose bone metastases in early stage.