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Brown J, Rathbone E, Hinsley S, Gregory W, Gossiel F, Marshall H, Burkinshaw R, Shulver H, Thandar H, Bertelli G, Maccon K, Bowman A, Hanby A, Bell R, Cameron D, Coleman R. Associations Between Serum Bone Biomarkers in Early Breast Cancer and Development of Bone Metastasis: Results From the AZURE (BIG01/04) Trial. J Natl Cancer Inst 2019; 110:871-879. [PMID: 29425304 PMCID: PMC6093369 DOI: 10.1093/jnci/djx280] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 12/06/2017] [Indexed: 01/21/2023] Open
Abstract
Background Adjuvant therapies can prevent/delay bone metastasis development in breast cancer. We investigated whether serum bone turnover markers in early disease have clinical utility in identifying patients with a high risk of developing bone metastasis. Methods Markers of bone formation (N-terminal propeptide of type-1 collagen [P1NP]) and bone resorption (C-telopeptide of type-1 collagen [CTX], pyridinoline cross-linked carboxy-terminal telopeptide of type-1 collagen [1-CTP]) were measured in baseline (pretreatment blood samples from 872 patients from a large randomized trial of adjuvant zoledronic acid (AZURE-ISRCTN79831382) in early breast cancer. Cox proportional hazards regression and cumulative incidence functions (adjusted for factors having a statistically significant effect on outcome) were used to investigate prognostic and predictive associations between recurrence events, bone marker levels, and clinical variables. All statistical tests were two-sided. Results When considered as continuous variables (log transformed), P1NP, CTX, and 1-CTP were each prognostic for future bone recurrence at any time (P = .006, P = .009, P = .008, respectively). Harrell’s c-indices were a P1NP of 0.57 (95% confidence interval [CI] = 0.51 to 0.63), CTX of 0.57 (95% CI = 0.51 to 0.62), and 1-CTP of 0.57 (95% CI = 0.52 to 0.63). In categorical analyses based on the normal range, high baseline P1NP (>70 ng/mL) and CTX (>0.299 ng/mL), but not 1-CTP (>4.2 ng/mL), were also prognostic for future bone recurrence (P = .03, P = .03, P = .10, respectively). None of the markers were prognostic for overall distant recurrence; that is, they were bone metastasis specific, and none of the markers were predictive of treatment benefit from zoledronic acid. Conclusions Serum P1NP, CTX, and 1-CTP are clinically useful, easily measured markers that show good prognostic ability (though low-to-moderate discrimination) for bone-specific recurrence and are worthy of further study.
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Affiliation(s)
- Janet Brown
- Academic Unit of Clinical Oncology and Sheffield ECMC, University of Sheffield, Weston Park Hospital, Sheffield, UK.,Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Emma Rathbone
- Academic Unit of Clinical Oncology and Sheffield ECMC, University of Sheffield, Weston Park Hospital, Sheffield, UK.,Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK.,Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Samantha Hinsley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Walter Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Fatma Gossiel
- Academic Unit of Bone Metabolism, Metabolic Bone Centre, University of Sheffield, Northern General Hospital, Sheffield, UK
| | - Helen Marshall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Roger Burkinshaw
- Academic Unit of Clinical Oncology and Sheffield ECMC, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Helen Shulver
- Academic Unit of Clinical Oncology and Sheffield ECMC, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | | | | | - Keane Maccon
- Cancer Trials Ireland, University College Hospital, Galway, Ireland
| | - Angela Bowman
- University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Andrew Hanby
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - David Cameron
- University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Robert Coleman
- Academic Unit of Clinical Oncology and Sheffield ECMC, University of Sheffield, Weston Park Hospital, Sheffield, UK
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