血清BALP/TALP比值诊断儿童和青少年骨肉瘤的临床意义

Clinical significance of serum BALP/TALP ratio in diagnosis of osteosarcoma in children and adolescents

目的分析血清骨型碱性磷酸酶(BALP)/总碱性磷酸酶(TALP)比值用于诊断儿童和青少年骨肉瘤的价值及预测预后的意义。方法回顾性纳入2018年9月至2021年9月间在北京大学人民医院骨肿瘤科接受治疗的200例四肢骨肉瘤患者(骨肉瘤组),以及同期就诊的50例良性骨肿瘤患者(良性骨肿瘤组)及50例正常对照者(对照组)。采用化学发光免疫分析仪检测血清中BALP和TALP含量,并计算BALP/TALP。比较其含量与骨肉瘤临床病理特征的关系。采用受试者工作曲线(ROC)评价BALP/TALP诊断骨肉瘤的效能,并计算曲线下面积(AUC)。Kaplan-meier法绘制生存曲线,生存差异行Log-rank检验。采用Cox风险比例回归模型分析影响骨肉瘤预后的因素。结果骨肉瘤组血清BALP、TALP、BALP/TALP分别为71.52 IU/L(44.26,135.68)、192.00 IU/L(162.00,233.50)和0.37(0.21,0.67),均高于良性骨肿瘤组、健康对照组,差异具有统计学意义(P<0.05)。血清BALP/TALP水平诊断骨肉瘤的灵敏度为82.0%、特异度为89.5%,约登指数为0.715,截断值为0.19,AUC为0.925(95%CI:0.901~0.949,P<0.001)。血清BALP/TALP水平与肿瘤直径、分化程度、组织学类型、Enneking分期和局部/远隔转移等有关(P<0.05);与年龄、性别、肿瘤位置、Huvos分级等均无关。血清BALP/TALP水平≥0.37的骨肉瘤患者中位生存期低于血清BALP/TALP水平<0.37者(P<0.05)。Cox风险比例回归模型分析,血清BALP/TALP水平≥0.37为影响骨肉瘤患者预后的独立危险因素(P=0.001)。结论血清BALP/TALP水平诊断儿童与青少年骨肉瘤效能较高,且能有效预测预后。

Objective To evaluate the value of serum bone type alkaline phosphatase(BALP)/total alkaline phosphatase(TALP)ratio in the diagnosis and prognosis of osteosarcoma in children and adolescents.Methods Two hundred patients with osteosarcoma of the four limbs(osteosarcoma group),50 patients with benign bone tumor(benign bone tumor group)and 50 normal controls(control group)received treatment in the Department of bone Oncology,Peking University People′s Hospital from September 2018 to September 2021 were retrospectively included.The content of BALP and TALP in serum was detected by chemiluminescence immunoassay,and BALP/TALP was calculated.To compare the relationship between its content and the clinicopathologic features of osteosarcoma.The effectiveness of BALP/TALP in diagnosing osteosarcoma was evaluated by receiver operating curve(ROC),and the area under the curve(AUC)was calculated.Kaplan-meier drew the survival curve,and survival differences were tested by Log-rank.Cox proportional regression model was used to analyze the prognostic factors of osteosarcoma.Results Serum BALP,TALP and BALP/TALP in osteosarcoma group were 71.52 IU/L(44.26,135.68),192.00 IU/L(162.00,233.50)and 0.37(0.21,0.67),respectively,which were higher than those in benign bone tumor group and healthy control group.The difference was statistically significant(P<0.05).The sensitivity and specificity of serum BALP/TALP levels in the diagnosis of osteosarcoma were 82.0%,89.5%,0.715,0.19,and 0.925(95%CI:0.901-0.949,P<0.001).Serum BALP/TALP levels were correlated with tumor diameter,differentiation degree,histological type,Enneking stage and local/distant metastasis(P<0.05).There was no correlation with age,sex,tumor location or Huvos grade.The median survival of osteosarcoma patients with serum BALP/TALP level≥0.37 was lower than that of patients with serum BALP/TALP level<0.37(P<0.05).Cox proportional regression analysis showed that serum BALP/TALP level≥0.37 was an independent risk factor for the prognosis of osteosarcoma patients(P=0.001).Conclusion Serum BALP/TALP level is effective in the diagnosis of osteosarcoma in children and adolescents,and can effectively predict the prognosis.