Serum cross-linked n-telopeptides of type 1 collagen (NTx) in patients with solid tumors

Abstract

CONTEXT AND OBJECTIVE: Cross-linked N-telopeptides of type I collagen (NTx) increase in concentration in situations in which bone resorption is increased, such as osteoporosis and bone metastasis (BM). We aimed to evaluate the serum concentrations of NTx in a sample of patients with several types of solid tumors. DESIGN AND SETTING:Cross-sectional analytical study with a control group in a tertiary public hospital. METHODS:We performed the quantitative enzyme-linked immunosorbent assay (ELISA) on serum NTx levels in 19 subjects without a history of cancer and 62 patients with various solid tumors who had been referred for a bone scan. Three experienced analysts read all bone scans. RESULTS:The serum NTx levels in patients with cancer and BM, with cancer but without BM and without cancer were 46.77 ± 2.58, 32.85 ± 2.05 and 22.32 ± 2.90 respectively (P < 0.0001). We did not find any significant correlations of serum NTx with age, gender, history of bone pain, tumor type and bone alkaline phosphatase levels. We found a significant correlation between serum NTx and alkaline phosphatase levels (R 2 = 0.08; P = 0.022).CONCLUSIONS: Serum NTx levels are significantly higher in patients with solid tumors and bone metastases than they are in patients without bone metastases and in normal controls.RESUMO CONTEXTO E OBJETIVO: Os N-telopeptídeos do colágeno tipo-I (NTx) elevam-se quando a reabsorção óssea está aumentada, devido a condições como osteoporose e metástase óssea. Sendo assim, temos por objetivo avaliar os níveis séricos de NTx em uma população heterogênea de pacientes com tumores sólidos. TIPO DE ESTUDO E LOCAL:Estudo transversal analítico com grupo controle, realizado em hospital público terciário.MÉTODOS: 19 pacientes sem história de câncer e 62 pacientes com tumores sólidos de vários tipos, encaminhados para estadiamento e investigação dos sintomas esqueléticos, foram avaliados pela técnica de ELISA (Enzyme Linked Immuno Sorbent Assay) quantitativa para a dosagem de NTx. Três especialistas leram todas as imagens ósseas.RESULTADOS: O nível de NTx encontrado em pacientes com câncer e metástase óssea, sem metástase óssea e sem diagnóstico de câncer foi 46,77 ± 2,58, 32,85 ± 2,05 e 22,32 ± 2,90, respectivamente (P < 0,0001). Não encontramos correlação entre o NTx, idade, sexo, história de dor óssea, tipo de tumor e níveis de fosfatase alcalina óssea. Encontramos correlação significativa entre os níveis de NTx e de Fosfatase Alcalina (r² = 0,08, P = 0,022).CONCLUSÃO: O NTx sérico é significativamente mais elevado em pacientes com tumores sólidos e metástases ósseas quando comparado com pacientes sem metástases ósseas e controles normais.

Serum crosslinked-N-terminal telopeptide of type I collagen (NTx) has prognostic implications for patients with initial prostate carcinoma (PCa): A pilot study

“…Interestingly in this same study by Leeming et al [12], there was considerable overlap between those with absence and those with a small burden of bone metastatic disease. Similar findings were reported previously by our group [9]. The overlap between serum NTx in PCa patients with and without bone metastasis may indicate that some patients without overt skeletal involvement at study entry but with higher serum NTx concentrations may indeed harbor subclinical bone metastatic disease.…”

“…NTx is a metabolite of type I collagen, the main constituent of the bone matrix, which has been previously shown to be increased in patients with BM [2,3,7]. NTx can also be measured in serum, as a biochemical marker of bone resorption, with results similar to those obtained with urinary NTx [1,8].…”

“…Our team has previously observed that serum NTx is increased in patients with solid tumors and bone metastasis [7,9]. Because of the potential prognostic value of bone turnover markers is patients with known bone metastasis [2,3], it is possible that serum NTx could increase even before overt symptomatic skeletal involvement.…”

Phase II studies of two different schedules of dasatinib in bone metastasis predominant metastatic breast cancer: SWOG S0622

“…[16] We studied a panel of collagen markers of bone turnover based on abundant evidence that these are raised in the blood and urine of a high percentage of patients with progressive skeletal metastases. [4, 9, 11, 14, 17, 29–31, 33] Although we observed a baseline elevation in bone metabolism marker levels in these patients with bone metastases [15, 29], treatment with dasatinib did not have a discernable effect on these markers. Antiresorptive agents, such as the bisphosphonate class of compounds and denosumab, a RANKL inhibitor, elicit a rapid and sustained suppression of these bone collagen breakdown markers in patients with skeletal metastases who are responding favorably to this form of therapy.…”

Relationships between Markers of Bone Metabolism Used in the Treatment of Osteoporosis

“…Results can also be used to screen for bone metastases from tumorous lesions 6 . Changes in bone metabolism markers can occur due to age, sex, a b c Fig.…”