Abstract
The objective of this study was to determine the sensitivity of tartrate-resistant acid phosphatase (Bone TRAP-5b) for early detection of bone metastases (BM) and to investigate the efficacy of bisphosphonates (BF) (zolendronic acid-ZA) in prevention of bone metastases in patients with Renal Cell Carcinoma (RCC). The 60 patients with RCC with proven BM were investigated to assess the sensitivity and specificity of Bone TRAP-5b. 95 patients with RCC with high level of tartrate-resistant acid phosphatase (Bone TRAP-5b) (8,5±0,2 IU/L) after radical surgical treatment were divided into two groups: 1-st group: (n=44) received zolendronic acid (ZA) (BF +), and 2-nd group (n=51) patients didn’t receive ZA (BF-). Patients of both subgroups were similar by age, sex, stage of disease. The levels of Bone TRAP-5b, Ca++, alkaline phosphatase, LDG were accessed every 3 months, and MRI imaging, bone scan with 99mTc every 6 month in both groups. We determined the high correlation between bone TRAP-5b and the presence of bone metastases (r=0,9; p <0,05), but its level wasn’t dependent with the number of BM. The results showed the high sensitivity and specificity of Bone TRAP-5b at the critical value of 5.2 IU/L (98,3 % and 90,0 %), (χ2=64,6; p<0.01). Using BF for the prevention of bone metastases in high risk group patients with RCC provides a significant difference in the incidence of bone metastases in patients.
Highlights
The metastatic tumors of musculoskeletal system are more prevalent than the primary, and take up to 96 % of all tumors of skeletal system [1]
Materials and methods The bone-TRAP 5b activity was determined in patients with Renal Cell Carcinoma (RCC) which were divided into two groups: 1-st 60 patients with RCC with clinical and radiologically proven BM and 2-nd – 95 patients with RCC after surgical treatment with elevated level of tartrate-resistant acid phosphatase (Bone TRAP-5b) (8,5±0,2 IU/L) (Table 1), as the high risk of bone metastases
The main goal of the treatment strategy of these patients is increasing of life expectancy, because the average survival rate for patients with RCC with multiple BM is 12 months, where 50 % of patients dying within 10 months and only 10 % of patients have five years survival rate [12]
Summary
The metastatic tumors of musculoskeletal system are more prevalent than the primary, and take up to 96 % of all tumors of skeletal system [1]. Bone metastases are usually diagnosed in 30–50 % of cases of RCC and take the third place in frequency after lung and liver metastases. In 48 % of patients RCC is diagnosed because of BM presence [2]. Diagnosis of BM is based both on the results of clinical and radiological methods of investigations. Both computer tomography (CT) and MRI can reveal the nature of bone structure changes, the prevalence of tumor components, their location, but despite the high informative properties of these modern methods of examination it can detect the tumor lesions when bone demineralization reaches 30–40 %, rather late stages of the disease [5]
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