Biphosphonates in Advanced Prostate and Renal Cell Cancer – Current Status and Potential Applications

Individualized assessment predictive models for risk and overall survival in elderly patients of primary kidney cancer with bone metastases: A large population-based study

Background

Elderly people are at high risk of metastatic kidney cancer (KC), and, the bone is one of the most common metastatic sites for metastatic KC. However, studies on diagnostic and prognostic prediction models for bone metastases (BM) in elderly KC patients are still vacant. Therefore, it is necessary to establish new diagnostic and prognostic nomograms.

Methods

We downloaded the data of all KC patients aged more than 65 years during 2010-2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression analyses were used to study independent risk factors of BM in elderly KC patients. Univariate and multivariate Cox regression analysis for the study of independent prognostic factors in elderly KCBM patients. Survival differences were studied using Kaplan-Meier (K-M) survival analysis. The predictive efficacy and clinical utility of nomograms were assessed by receiver operating characteristic (ROC) curve, the area under curve (AUC), calibration curve, and decision curve analysis (DCA).

Results

A final total of 17,404 elderly KC patients (training set: n = 12,184, validation set: n = 5,220) were included to study the risk of BM. 394 elderly KCBM patients (training set: n = 278, validation set: n = 116) were included to study the overall survival (OS). Age, histological type, tumor size, grade, T/N stage and brain/liver/lung metastasis were identified as independent risk factors for developing BM in elderly KC patients. Surgery, lung/liver metastasis and T stage were identified as independent prognostic factors in elderly KCBM patients. The diagnostic nomogram had AUCs of 0.859 and 0.850 in the training and validation sets, respectively. The AUCs of the prognostic nomogram in predicting OS at 12, 24 and 36 months were: training set (0.742, 0.775, 0.787), and validation set (0.721, 0.827, 0.799), respectively. The calibration curve and DCA also showed excellent clinical utility of the two nomograms.

Conclusion

Two new nomograms were constructed and validated to predict the risk of developing BM in elderly KC patients and 12-, 24-, and 36-months OS in elderly KCBM patients. These models can help surgeons provide more comprehensive and personalized clinical management programs for this population.

Establishment of predictive model for patients with kidney cancer bone metastasis: a study based on SEER database

Background

Bone is a common metastatic tissue of kidney cancer. Accurate prediction of the prognosis of patients with kidney cancer bone metastasis (KCBM) can help doctors and patients choose a further appropriate treatment.

Methods

During the period from January 1, 2010 to December 31, 2015, screening patients with kidney cancer diagnosed with bone metastases from the SEER database. Summary of demographic, pathology, number of other metastatic organs, and treatment for KCBM patients. All prognostic factors were plotted for Kaplan-Meier survival curves and log-rank test. Prognostic factors of P<0.001 in the log-rank test were chosen and used to establish nomograms of OS and KCSS. We used C-index, ROC curve, and calibration plot to test the prediction accuracy of two nomograms.

Results

A total of 4,234 KCBM patients were included in the study, and patients were diagnosed between January 1, 2010 and December 31, 2015. The model establishment group included 2,966 KCBM patients and the validation group included 1,268 KCBM patients. We have established nomograms for OS and KCSS respectively. These two nomograms included factors such as age, marital status, insurance status, histological type, grade, T stage, N stage, number of extra-bone metastatic organs, surgery, RT, and CT. The C-index of nomograms of OS and KCSS was 0.733 and 0.752, respectively. In all ROC curves, all AUC values were greater than 0.7, proving that the nomograms of both OS and KCSS have achieved medium prediction accuracy. The calibration plots of the model establishment group and the validation group showed good consistency between the predicted nomograms of OS and KCSS.

Conclusions

In this study, nomograms of OS and KCSS were established based on the published data of KCBM patients in the SEER database, and the model was validated internally and externally. The prediction accuracy of nomograms of OS and KCSS achieved satisfactory results. At present, this model has the ability to predict the prognosis of KCBM patients and can be used in clinical work.

Zoledronic acid therapy impacts risk and frequency of skeletal complications and follow-up duration in prostate cancer patients with bone metastasis

PURPOSE

To evaluate the effects of timing and length of zoledronic acid (ZA) treatment on outcomes for patients with prostate cancer in clinical practice.

MATERIALS AND METHODS

Patients with prostate cancer and first bone metastasis diagnosed from January 2003 to October 2006 were included. Patients were considered 'untreated' if no ZA was given, 'early ZA-treated' if ZA was initiated before skeletal complication (SC) occurrence or 'late ZA-treated' if one or more SC was documented before or at ZA initiation. Patients were classified with short (≤ 90 days), medium (91-180 days) or long (>180 days) treatment persistence. Assessments included follow-up duration (FUP) and risk of developing one or more SC.

RESULTS

Among eligible patients, 847 were untreated, 243 were early ZA-treated and 218 were late ZA-treated. For untreated versus early ZA-treated groups, median FUP was 263 versus 357 days (p < 0.0001), respectively, and time to first SC was 199 versus 273 days (p < 0.0001), respectively. ZA treatment was associated with significantly longer FUP and lower SC risk. The early ZA-treated group had significantly longer FUP versus the late ZA-treated group (median days, 357 vs. 299.5); the late ZA-treated group experienced significantly higher SC risk vs. the early ZA-treated group (odds ratio, 1.51). Compared with the long-persistence group, FUP was 56% and 40% shorter in the short and medium groups, respectively (p < 0.0001).

CONCLUSION

Treatment with and early initiation of ZA for patients with prostate cancer and bone metastasis significantly prolonged time to and reduced risk of developing SC, while extending FUP.

Zoledronic acid determines S-phase arrest but fails to induce apoptosis in cholangiocarcinoma cells

Cholangiocarcinoma is the second most common primary hepatic neoplasia and the only curative therapy is surgical resection or liver transplantation. Biphosphonates (BPs) are an emerging class of drugs widely used to treat bone diseases and also appear to possess direct antitumor activity. In two human cholangiocarcinoma cell lines (TFK-1 and EGI-1) we investigated, for the first time, the activity of zoledronic acid by determining proliferation, cell cycle analysis and apoptosis. The results obtained indicate that zoledronic acid induces cell-narrowing and growth inhibition, both reversed by 25 microM GGOH, and significantly affects the colony-forming ability of these cells. The inhibition by zoledronic acid of Rap1A prenylation was reversed in cell co-treated with GGOH. At 10-50 microM zoledronic acid exerted an S-phase cell cycle arrest which was confirmed by changes in the level of cyclins and of regulators p27(KIP1) and pRb. Interestingly, the expression level of cyclin A (putative S-phase marker) shows a dose-dependent increment in contrast to the decrement of cyclin D1 (putative G1 phase marker). However, neither hypodiploid cells nor cleaved PARP or caspase-3 was detected. The lack of TP53 or loss of its function, the large constitutive expressions of anti-apoptotic proteins Bcl-xL and HSP27 together with the low level of the pro-apoptotic Bax are the likely factors which protect cells from apoptosis. In conclusion, our study indicates that zoledronic acid induces S-phase arrest and cell-narrowing, both reversed by GGOH and, by changing the delicate balance between pro- and anti-apoptotic proteins, allows survival of cholangiocarcinoma cells.