Prognostic significance of disordered calcium metabolism in hormone-refractory prostate cancer patients with metastatic bone disease
Prognostic significance of disordered calcium metabolism in hormone-refractory prostate cancer patients with metastatic bone disease
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DOI：
10.1038/pcan.2008.10
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发表时间：
2009-03-01
影响因子：
4.8
通讯作者：
Berruti, A.
中科院分区：
文献类型：
--
作者：
Tucci, M.;Mosca, A.;Berruti, A.
骨转移性前列腺癌中发生的骨代谢破坏可导致钙代谢紊乱。在一系列连续的难治性骨转移性前列腺癌患者中评估了低钙血症或高钙血症的预后作用。对192例患者进行了血清钙测定。低钙血症和高钙血症的存在与基线生化和临床特征相关，并评估了这两种钙紊乱在预测预后和不良肾脏相关事件（SRE）中的作用。与正常血钙患者相比，低血钙患者（n = 51）的骨肿瘤负荷更高（P = 0.005），较高的血浆嗜铬粒蛋白A（CgA，P = 0.01），血清碱性磷酸酶（P = 0.01），尿N端肽（NTX，P = 0.002）和较低的血红蛋白值（P = 0.01），而高钙血症患者（n=16）的血浆CgA（P = 0.001）和血清乳酸脱氢酶值（P = 0.001），更高的骨痛（P = 0.003）和更低的频率纯成骨细胞病变（P = 0.001）。高钙血症与不良预后显著相关：风险比（HR）为1.9（95%置信区间（CI）为1.2-3.3），发生SRE的风险更高，HR为2.5（95% CI为1.2-5.2，P=0.01），而低钙血症与不良预后无关。在校正经验证的预后参数后，高钙血症的预后作用在多变量分析中保持不变：HR，2.72（95% CI 1.1-6.8，P = 0.03）。这些数据表明，血清钙水平应考虑在骨转移性前列腺癌患者的临床决策过程。无症状性高钙血症的患者可以从严格的随访和立即的双磷酸盐治疗中获益。需要进一步的前瞻性临床试验来证实这一发现。
Bone metabolic disruption that occurs in bone metastatic prostate cancer could lead to disturbances of calcium metabolism. The prognostic role of either hypocalcemia or hypercalcemia was assessed in a consecutive series of hormone-refractory bone metastatic prostate cancer patients. Serum calcium was measured in 192 patients. The presence of hypocalcemia and hypercalcemia was related with baseline biochemical and clinical characteristics and the role of these two calcium disturbances in predicting prognosis and adverse skeletal-related events (SREs) was assessed. As compared to normocalcemic patients, hypocalcemic patients (n = 51) had higher tumor load in bone (P = 0.005), higher plasma chromogranin A (CgA, P = 0.01), serum alkaline phosphatase (P = 0.01), urinary N-telopeptide (NTX, P = 0.002) and lower hemoglobin values (P = 0.01), while hypercalcemic patients (n=16) had higher plasma CgA (P = 0.001) and serum lactate dehydrogenase values (P = 0.001), higher bone pain (P = 0.003) and a lower frequency of pure osteoblastic lesions (P = 0.001). Hypercalcemia was significantly associated with poor prognosis: hazard ratio (HR), 1.9 (95% confidence Interval (CI) 1.2-3.3) and higher risk to develop SREs HR, 2.5 (95% CI 1.2-5.2, P=0.01), while hypocalcemia was not associated with poor prognosis. The prognostic role of hypercalcemia was maintained in multivariate analysis after adjusting for validated prognostic parameters: HR, 2.72 (95% CI 1.1-6.8, P = 0.03). These data suggest that serum calcium levels should be taken into account in the clinical decision-making process of bone metastatic prostate cancer patients. Patients with asymptomatic hypercalcemia could benefit of a strict follow-up and an immediate bisphosphonate treatment. Further prospective clinical trials are needed to confirm this finding.