News

Markers predict bone recurrence in early breast cancer

Dawn O'Shea

Takeaway

High serum N-terminal propeptide of type-1 collagen (P1NP), C-telopeptide of type-1 collagen (CTX), and pyridinoline cross-linked carboxy-terminal telopeptide of type-1 collagen (1-CTP) shortly after diagnosis of early breast cancer (BCa) were associated with higher risk of developing bone metastasis during the disease course.
P1NP was the most sensitive marker but did not predict benefit from zoledronate.

Why this matters

The evidence showing adjuvant bisphosphonates can reduce development of bone metastases and death from BCa, but benefits are confined to postmenopausal patients at the time of bisphosphonate initiation.
There remains a need for a simple blood-based test in early breast cancer that can identify patients at high risk for bone metastasis.
The findings presented here show P1NP, CTX, or 1-CTP are clinically useful, easily measured markers with good prognostic ability for bone-specific BCa recurrence.

Key results

In adjusted continuous log-transformed analyses, increases in P1NP, CTX, or 1-CTP were strongly associated with statistically significantly increased risk of developing bone metastasis (P=.006, P=.009 and P=.008, repectively).
In categorical analyses, P1NP >70ng/mL (P=.03) and CTX >0.299ng/mL (P=.03) but not CTX >0.566ng/mL (P = .12) were prognostic for recurrence in bone at any time.
1-CTP >4.2ng/mL was not (P=.10).
No associations between baseline P1NP, CTX, or 1-CTP and development of distant recurrence at any site, demonstrating that the markers are prognostic of recurrence specifically in bone, but not distant metastasis as a whole.
Optimal cut-off point for P1NP was ~64nmol/mL.
Harrell’s c-index values for each biomarker (approximately 0.57) suggested low-to-moderate discrimination.

Study design

Limitations

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