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目的 :分析血清骨代谢标志物Ⅰ型胶原羧基端肽β特殊序列(βisomer of the C-terminal telopeptide of typeⅠcollagen,β-CTX)和骨钙素N-端中分子片段(N-terminal midfragment of osteocalcin,N-MID)在老年肺癌骨转移患者接受唑来膦酸治疗过程中的变化情况,探讨二者对老年肺癌骨转移患者临床预后的预测价值。方法:在本项前瞻性研究中,选取年龄>60岁的肺癌骨转移患者126例,肺癌无骨转移患者110例,同时入组的正常对照为89例。所有肺癌骨转移患者均应用唑来膦酸治疗,每4周1次(4 mg静脉滴注)。采用放射免疫法动态监测肺癌骨转移患者在治疗前和唑来膦酸治疗后2、4、6、8、10和12个月的血清β-CTX和N-MID水平,并记录研究期间患者发生骨相关事件(skeletal-related events,SREs)和总生存的情况。结果:肺癌骨转移组血清β-CTX和N-MID基线水平明显高于肺癌无骨转移组及正常对照组(P值均<0.001),而唑来膦酸治疗后肺癌骨转移组的β-CTX和N-MID水平较治疗前基线水平明显下降(P值均<0.01)。多因素分析结果显示,β-CTX和N-MID是影响SREs发生的独立危险因素[比值比(odds ratio,OR)=6.367,P=0.001;OR=3.015,P=0.025)。高水平β-CTX组发生SREs的中位时间和中位生存时间均短于低水平β-CTX组,差异均有统计学意义(6.0个月vs 10.5个月,P=0.031;13.0个月vs 16.5个月,P=0.028);高水平N-MID组发生SREs的中位时间也低于低水平N-MID组(6.5个月vs 10.5个月,P=0.046),但是二者的中位生存时间无明显差异(14.5个月vs 17.0个月,P=0.226)。结论:血清β-CTX和N-MID是预测老年肺癌骨转移患者发生SREs的有效指标,同时β-CTX可能对评估老年肺癌骨转移患者的预后有一定价值。
OBJECTIVE: To analyze the expression of serum β-catenin of the C-terminal telopeptide of typeⅠcollagen (β-CTX) and N-terminal midfragment of osteocalcin N-MID) in the elderly patients with bone metastasis of lung cancer zoledronic acid treatment in the course of change, and explore the prognosis of elderly patients with bone metastasis of lung cancer prognostic value. Methods: In this prospective study, 126 patients with bone metastases from lung cancer aged 60 years and 110 patients with no bone metastasis from lung cancer were enrolled in this prospective study and 89 patients were enrolled as normal controls. All lung cancer patients with bone metastases should be treated with zoledronic acid, once every 4 weeks (4 mg intravenous infusion). Radioimmunoassay was used to dynamically monitor the levels of serum β-CTX and N-MID in patients with bone metastasis of lung cancer before treatment and at 2, 4, 6, 8, 10 and 12 months after treatment with zoledronic acid and to record the occurrence of patients during the study period Skeletal-related events (SREs) and overall survival. Results: The serum levels of β-CTX and N-MID in lung cancer patients with bone metastasis were significantly higher than those in non-bone metastasis lung cancer patients and normal controls (all P <0.001) The levels of CTX and N-MID were significantly lower than those before treatment (all P <0.01). Multivariate analysis showed that β-CTX and N-MID were independent risk factors for the development of SREs (odds ratio = 6.367, P = 0.001; OR = 3.015, P = 0.025). The median and median survival time of SREs in high-level β-CTX group was shorter than that in low-level β-CTX group (6.0 months vs. 10.5 months, P = 0.031; 13.0 months vs 16.5 months, P = 0.028). Median time to SREs in the high-grade N-MID group was also lower than in the low-grade N-MID group (6.5 months vs 10.5 months, P = 0.046) There was no significant difference in survival time (14.5 months vs 17.0 months, P = 0.226). CONCLUSIONS: Serum β-CTX and N-MID are effective predictors of SREs in elderly patients with bone metastasis of lung cancer. Meanwhile, β-CTX may be of value in assessing the prognosis of elderly patients with bone metastasis of lung cancer.