• Gastric cancer
• Hemoglobin
• Mendelian randomization
• Modifiable factors
• Type 2 diabetes mellitus

• Humans
• Male
• Prostatic Neoplasms/pathology
• Prostatic Neoplasms/diagnosis
• Bone Neoplasms/secondary
• Bone Neoplasms/diagnosis
• Nomograms
• Aged
• Middle Aged
• Retrospective Studies
• Risk Factors
• ROC Curve
• China/epidemiology
• Risk Assessment/methods

• the National Natural Science Foundation of China
• Talent’s start-up fund from Yangzhou University
• Postgraduate Research & Practice Innovation Program of Jiangsu Province

• bone marrow metastasis
• computed tomography
• gastric cancer
• machine learning
• micrometastasis
• radiomics

• MSIP, 2022R1F1A1071702 National Research Foundation (NRF) grant funded by the Korea government, Ministry of Science and ICT

• Body composition
• Gastrectomy
• Stomach neoplasms
• Subcutaneous fat

• Humans
• Gastrectomy/adverse effects
• Male
• Female
• Subcutaneous Fat/diagnostic imaging
• Intra-Abdominal Fat/diagnostic imaging
• Aged
• Retrospective Studies
• Stomach Neoplasms/surgery
• Middle Aged
• Tomography, X-Ray Computed
• Osteoporosis/etiology
• Osteoporosis/diagnostic imaging
• Body Composition
• Bone Density
• Adenocarcinoma/surgery

• Gastric cancer
• bone metastases
• overall survival
• progression-free survival

• Lung cancer
• bone metastases
• monocyte
• nomogram

• Incidence
• Neoplasm metastasis
• Propensity score
• Stomach neoplasms
• Survival analysis

• R01 AG049321 NIA NIH HHS

Bones are one of the most common target organs for cancer metastasis. Early evaluation of bone metastasis (BM) status is clinically significant. Cancer patients often experience a hypercoagulable state.

To evaluate the correlation between coagulation indicators and the burden of BM in gastric cancer (GC).

We conducted a single-center retrospective study and enrolled 454 patients. Clinical information including routine blood examination and coagulation markers were collected before any treatment. Patients were grouped according to the status of BM. Receiver operating characteristic curves were used to assess diagnostic performance and determine the optimal cutoff values of the above indicators. Cutoff values, sensitivity and specificity were based on the maximum Youden index. Univariate and multivariate logistic regression analyses were used to evaluate the relationships between biomarkers and BM.

Of the 454 enrolled patients, 191 patients were diagnosed with BM. The receiver operating characteristic curve analysis suggested that prothrombin time (PT) [cutoff: 13.25; sensitivity: 0.651; specificity: 0.709; area under receiver operating characteristic curve (AUC) = 0.738], activated partial thromboplastin time (aPTT) (cutoff: 35.15; sensitivity: 0.640; specificity: 0.640; AUC = 0.678) and fibrin degradation products (FDP) (cutoff: 2.75; sensitivity: 0.668; specificity: 0.801; AUC = 0.768) act as novel predictors for BM. Based on multivariate logistic regression analysis, the results showed the independent correlation between PT [odds ratio (OR): 3.16; 95% confidence interval (CI): 1.612-6.194; P = 0.001], aPTT (OR: 2.234; 95%CI: 1.157-4.313; P = 0.017) and FDP (OR: 3.17; 95%CI: 1.637-6.139; P = 0.001) and BM in patients with GC. Moreover, age, carcinoembryonic antigen, erythrocyte and globulin were found to be significantly associated with BM.

Coagulation markers, namely PT, aPTT and FDP, might be potential predictors for screening BM in patients with GC.

• Gastric cancer
• Bone metastasis
• Coagulation markers
• Risk factor
• Activated partial thromboplastin time
• Prothrombin time
• Fibrin degradation products

• Bone turnover markers
• Carboxy-terminal cross-linked telopeptide of type i collagen
• Circadian rhythm
• Fibroblast growth factor 23
• Osteocalcin
• Parathyroid hormone
• Pro-collagen type I N-terminal propeptide
• Sclerostin

• Circadian Rhythm
• Bone and Bones
• Collagen Type I
• Biomarkers
• Osteocalcin

• alkaline phosphatase
• giant cell tumor of bone
• hemoglobin
• lactate dehydrogenase
• lymphocyte-monocyte ratio
• modified Glasgow prognostic score
• neutrophil-lymphocyte ratio
• platelet-lymphocyte ratio
• prognostic nutrient index

• Humans
• Prognosis
• Giant Cell Tumor of Bone
• Lymphocytes/pathology
• Neutrophils
• Nutrition Assessment

• bone metastasis
• nomogram
• prediction
• risk
• thyroid cancer

• Humans
• Nomograms
• Thyroid Neoplasms
• Bone Neoplasms/secondary
• ROC Curve

While bone metastasis is not common in gastric adenocarcinoma (GaC), it can have important impacts on prognosis. This large cohort study aimed at exploring factors associated with bone metastasis in GaC and investigating the time-dependent cumulative mortalities and prognostic factors in GaC patients with bone metastasis at the population level.

Data on patients with GaC diagnosed in 2010–2016 were retrieved from a large population-based database. We explored factors associated with bone metastasis using the multivariable-adjusted logistic model. We then calculated the time-dependent cancer-specific mortalities in GaC patients with bone metastasis using the cumulative incidence function and compared mortalities across subgroups using Gray’s test. We further assessed factors associated with mortality using the multivariable-adjusted Fine–Gray subdistribution hazard model.

Together 11,072 eligible patients with metastatic GaC were enrolled, which comprised 1,511 (14%) people with bone metastasis and 9,561 (86%) with other metastasis, encompassing 6,999 person-years of follow-up. Bone metastasis was more frequently detected in 2014 or later, in younger patients, in patients with gastric cardia cancers, in people with signet-ring cell carcinoma, and in those with poorly differentiated/undifferentiated cancers; it was less commonly observed in black patients. Bone metastasis was associated with more frequent brain and lung metastases. The median survival of patients with bone metastasis was 4 months; the 6-month and 3-year cancer-specific cumulative mortalities were 56% and 85%, respectively. In patients receiving chemotherapy, American Indians/Alaskan Natives, patients with gastric antrum/pylorus cancers, and those with positive lymph nodes had higher mortality risks, while those undergoing resection had lower mortality hazards.

In GaC patients, bone metastasis was associated with various clinicopathologic factors including age, ethnicity, tumor location, histology, differentiation, and metastasis to other sites. Patients with bone metastasis had poor prognosis which was associated with ethnicity, tumor location, lymph node involvement, and treatment. Our findings provide important hints for tailed patient management and for further mechanistic investigations.

• Fine–Gray subdistribution hazard regression
• bone metastasis
• competing risk analysis
• cumulative incidence function
• gastric adenocarcinoma
• large population-based cohort study
• long-term survival

• Ewing’s sarcoma
• glutathione
• osteosarcoma
• oxidative stress

Purpose: To develop an effective diagnostic model for bone metastasis of gastric cancer by combining ¹⁸F-FDG PET/CT and clinical data.

Materials and Methods: A total of 212 gastric cancer patients with abnormal bone imaging scans based on ¹⁸F-FDG PET/CT were retrospectively enrolled between September 2009 and March 2020. Risk factors for bone metastasis of gastric cancer were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by using receiver operating characteristic curves and calibration plots.

Results: The diagnostic power of the binary logistic regression model incorporating skeleton-related symptoms, anemia, the SUVmax of bone lesions, bone changes, the location of bone lesions, ALP, LDH, CEA, and CA19-9 was significantly higher than that of the model using only clinical factors (p = 0.008). The diagnostic model for bone metastasis of gastric cancer using a combination of clinical and imaging data showed an appropriate goodness of fit according to a calibration test (p = 0.294) and good discriminating ability (AUC = 0.925).

Conclusions: The diagnostic model combined with the ¹⁸F-FDG PET/CT findings and clinical data showed a better diagnosis performance for bone metastasis of gastric cancer than the other studied models. Compared with the model using clinical factors alone, the additional ¹⁸F-FDG PET/CT findings could improve the diagnostic efficacy of identifying bone metastases in gastric cancer.

• 18F-FDG PET/CT
• bone metastasis
• clinical factor
• diagnostic model
• gastric cancer

• Albumin-to-alkaline phosphatase ratio
• gastric cancer
• prognosis

• 25-Hydroxylase
• 25-Hydroxyvitamin D
• Alkaline phosphatase
• CYP2R1
• Vitamin D

• Adolescent
• Adult
• Aged
• Alkaline Phosphatase/metabolism
• Animals
• Bone and Bones/enzymology
• Humans
• Liver Function Tests
• Male
• Middle Aged
• Rabbits
• Retrospective Studies
• Vitamin D/metabolism
• Vitamin D Deficiency/epidemiology
• Vitamin D Deficiency/metabolism
• Young Adult

• Università degli Studi della Campania Luigi Vanvitelli

Antiprogestins have demonstrated promising activity against breast and gynecological cancers, but liver-related safety concerns limited the advancement of this therapeutic class. Onapristone is a full progesterone receptor antagonist originally developed as an oral contraceptive and later evaluated in phase II studies for metastatic breast cancer. Because of liver enzyme elevations identified during clinical studies, further development was halted. Evaluation of antiprogestin pharmacology and pharmacokinetic data suggested that liver enzyme elevations might be related to off-target or metabolic effects associated with clinical drug exposure.

We explored whether the use of a pharmaceutic strategy targeting efficacious systemic dose concentrations, but with diminished peak serum concentrations and/or total drug exposure would mitigate hepatotoxicity. Twice-daily dosing of an extended-release formulation of onapristone was developed and clinically evaluated in light of renewed interest in antiprogestin therapy for treating progesterone receptor-positive breast and gynecologic cancers. The hepatotoxic potential of extended-release onapristone was assessed from two phase I–II studies involving patients with breast, ovarian, endometrial, and prostate cancer.

Among the 88 patients in two phase I–II studies in progesterone receptor-positive malignancies treated with extended-release onapristone, elevated alanine aminotransferase/aspartate aminotransferase levels were found in 20% of patients with liver metastases compared with 6.3% without metastases. Of five patients with grade 3 or higher alanine aminotransferase elevations with or without bilirubin elevations (four with breast cancer and one with endometrial cancer), four were assessed as unrelated to extended-release onapristone by the safety data review committee. Furthermore, while the fifth patient’s liver enzyme elevations were considered possibly drug related by the study investigator, they were adjudicated as unlikely to be related (< 25% likelihood) by a subsequent independent hepatologist.

These results suggest that the extended-release formulation by reducing drug exposure may be associated with a reduced risk of hepatotoxicity, and supports the continued clinical evaluation of extended-release onapristone for treating progesterone receptor-positive cancers.

Bone metastases (BM) from colorectal cancer (CRC) are often accompanied by extraosseous metastases, resulting in a dismal prognosis. The present study aimed to determine the risk factors for BM in metastatic CRC (mCRC) and the prognostic factors for CRC patients with BM.

The study was based on a training cohort of 214 mCRC patients (of which, 101 patients had BM) from our center, and a validation cohort of 511 mCRC patients (of which, 173 patients had BM) from another institute. Risk and prognostic nomograms for BM were developed using univariate and multivariate analyses. The goodness of fit, discrimination, and calibration performance of the nomograms were assessed by R², concordance statistics (C-statistics), and the calibration curve. The results were internally validated using bootstrap resampling in the training cohort, and externally validated in the validation cohort.

The novel BM risk nomogram comprised seven variables [degree of tumor differentiation, N-stage, serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), carcinoembryonic antigen (CEA), liver metastasis, and lung metastasis]. It showed good performance, with an R² of 0.447 and a C-statistic of 0.846 [95% confidence interval (CI), 0.793 to 0.898] in the training cohort, and an R² of 0.325 and a C-statistic of 0.792 (95% CI, 0.750 to 0.834) in the validation cohort. The optimal cutoff value to identify individuals at low or high risk was 56% probability, with a sensitivity of 71.3% and a specificity of 89.4%. The prognostic nomogram included five factors (tumor differentiation, number of extra-BM organs, number of BM lesions, ALP, and LDH), and had an R² of 0.284 and a C-statistic of 0.723 (95% CI, 0.657 to 0.789) in the training set. This nomogram was externally validated in the validation cohort, with an R² of 0.182 and a C-statistic of 0.682 (95% CI, 0.638 to 0.726).

The developed and validated risk and prognostic nomograms showed good performance for predicting the occurrence of BM in mCRC as well as the prognosis of CRC patients with BM. The risk nomogram can be used as a cost-effective preliminary screening tool prior to bone scanning.

• Colorectal cancer (CRC)
• bone metastases (BM)
• nomogram
• prognosis
• risk factors

Bee pollen is considered an interesting feed supplement with beneficial health impacts. It contains many basic nutritional compounds that improve growth performance, development and immune response of animals. However, its effect on bone structure has been studied to a limited extent and the results published so far are ambiguous. Therefore, the impact of bee pollen supplementation on selected bone characteristics of rats was investigated in our study. We determined a dose-dependent effect of bee pollen administration on macroscopic and microscopic structure of femoral bone. Several negative effects of bee pollen supplementation at the level of 0.75% on bone features have been demonstrated, while the level of 0.5% did not influence these properties in rats.

Bee pollen has been successfully used as a feed additive with beneficial impacts on productive, reproductive, and immune conditions of animals. However, its effect on bone structure and bone health remains controversial. Therefore, the purpose of our study was to examine the impact of bee pollen supplementation on macroscopic and microscopic structure of a femoral bone using rats as suitable animal models. Male rats (1 month-old) were assigned into three groups: control (C group) that was fed a standard diet without bee pollen and two bee pollen supplemented groups (P1 and P2 groups) that received an experimental diet including 0.5% and 0.75% of bee pollen, respectively, for 3 months. A number of unfavorable effects of 0.75% bee pollen administration on bone weight, cortical bone thickness, calcium content, alkaline phosphatase activity, sizes of primary osteons’ vascular canals, Haversian canals and secondary osteons in the cortical bone have been recorded, whereas these bone parameters were significantly decreased in the P2 group versus the C group. On the contrary, the concentration of 0.5% did not affect any of bone features mentioned above. In conclusion, the impact of bee pollen supplementation on femoral bone structure of rats depends on the dose used.

• bee pollen
• bone health
• bone structure
• nutrition
• rat

Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have been reported in the literature. Nevertheless, it is unclear how the metastatic sites may affect the prognosis. In particular, knowledge about the impact of bone metastases on GC patients’ outcome is scant, and this may be related to the rarity of bone lesions and/or their underestimation at the time of diagnosis. In fact, there is still a lack of specific recommendation for their detection at the diagnosis. Then, the majority of the evidences in this field came from retrospective analysis on very heterogeneous study populations. In this context, the aim of this narrative review is to delineate an overview about the evidences existing about bone metastases in GC patients, focusing on their incidence and biology, the prognostic role of bone involvement, and their possible implication in the treatment choice.

• RANK-L
• bone flare
• metastatic gastric cancer
• stage IV
• target therapy
• treatment

• blood markers
• bone metastasis
• clinical features
• digestive tract
• malignant tumor

Gastric cancer (GC) is characterized by a low 5-year survival rate. The prognosis is still not satisfactory although it has significantly improved due to developments in medicine. Thus, the identification of more efficient indices for the evaluation of GC prognosis is required. We propose, for the first time, that the alkaline phosphatase (ALP) to prealbumin (PA) ratio (APR) can be used as an independent prognostic factor in GC.

To evaluate the prognostic value the APR in GC.

According to the exclusion strategy, we collected the preoperative serologic examination results and clinical information of 409 GC patients treated in Shandong Provincial Hospital from January to December, 2016. By calculating the APR, the neutrophil and lymphocyte ratio (NLR), C-reactive protein (CRP) and albumin (ALB) ratio, platelet and lymphocyte ratio, lymphocyte and monocyte ratio, and the relationship with clinical information, we verified the role of preoperative APR ratio in the prognosis of GC. In addition, we used a Cox model combined with the APR and tumor stage to demonstrate its efficacy in assessing the prognosis of GC patients.

Preoperative APR was an independent prognostic factor for GC. The median age of patients in the APR-high group was greater compared with that in the APR-low group. Patients with a higher APR had a more advanced clinical stage, higher neutrophil to lymphocyte, CRP to ALB, and platelet to lymphocyte ratios, but a lower lymphocyte to monocyte ratio (P < 0.05). The APR-high group also had higher glycoprotein antigen 199 and carbohydrate antigen 125 levels than the APR-low group (P < 0.05). Median overall survival and disease-free survival were significantly longer in the APR-low group than in the APR-high group. In addition, a Cox model based on the APR and tumor stage was more effective in evaluating the prognosis of patients than models based on stage alone or stage plus the NLR.

A higher APR is an independent and negative prognostic factor for GC. The prognosis of GC can be better evaluated using a Cox model based on the APR and stage.

• Gastric cancer
• Prognosis
• Alkaline phosphatase
• Prealbumin
• Evaluating efficiency

• Alkaline Phosphatase
• Humans
• Neutrophils
• Prealbumin
• Prognosis
• Retrospective Studies
• Stomach Neoplasms

•

Plasma ALP could be used as a discriminating marker in presence of bone lesions in solid tumor or MM.

Bone involvement in Multiple Myeloma results from increased osteoclast formation and activity that occurs in proximity to myeloma cells. The role of Alkaline Phosphatse (ALP) in this process and the diagnostic significance of plasma levels in patients with MM are unclear.

To compare plasma ALP levels in patients with MM and solid cancers and metastatic lesions to the bone.

In this observational retrospective study we enrolled 901 patients were enrolled: 440 patients (49%) with Multiple Myeloma, 461 (51%) with solid cancers. All 901 patients had bone lesions. Among patients with Multiple Myeloma, ALP values were mainly in the range of normality than those observed in patients with solid cancers and bone lesions. This difference is independent of stage, number and type of bone lesions.

This study suggests that plasma ALP has a different clinical significance in MM than in other neoplasms and could be used as a discriminating marker in presence of bone lesions. In particular, lower or normal values, should suggest further investigations such as urinary and serum electrophoresis, associated with bone marrow aspirate in case of the presence of a monoclonal component, in order to confirm or exclude a MM diagnosis.

• ALP
• Lytic lesions
• MM
• Osteoblastic lesions

• Cell proliferation
• Dietary phosphate
• Osteopontin
• Phosphate addiction
• Phosphate transport
• Tumor progression

• Bone metastasis
• Diagnosis
• Multiple myeloma
• Osteolytic lesion
• Prediction

• Humans
• Multiple Myeloma/diagnosis
• Prognosis
• Prospective Studies
• Retrospective Studies

• P-18-51991 National Science and Technology Development Agency

Small-cell lung cancer (SCLC) is known as the characteristics of high invasion, rapid progression, and poor prognosis. Therefore, identification of patients with high risk of progression and death is critical to improve the survival of patients with extensive-stage SCLC (ES-SCLC). This study was designed to determine the prognostic importance of the albumin-to-alkaline phosphatase ratio (AAPR) in the survival of patients with ES-SCLC and to develop a nomogram based on AAPR dynamics for ES-SCLC prognosis.

Characteristics were reviewed from 300 patients with ES-SCLC. Training and validation cohorts included 200 and 100 patients, respectively. We applied univariate and multivariate Cox models to assess the prognostic value of AAPR for ES-SCLC. The nomogram for progression-free survival (PFS) and overall survival (OS) of ES-SCLC patients was developed based on the multivariate survival analysis of the training cohort. External validation of the established nomogram was performed using the validation cohort.

N3 stage, thoracic radiotherapy, and post-AAPR were the independent factors identified for PFS. T stage, thoracic radiotherapy, and high post-AAPR were the independent risk factors identified for death. The prognostic nomogram was established by integrating the independent significant factors for PFS and OS in the training cohort with the c-indices of 0.675 and 0.662, respectively, and validated in the validation cohort. The nomogram had superior prognosis prediction ability than did TNM stage. Decision curve analysis (DCA) also indicated clinical net benefits from the nomogram.

AAPR was valuable for prognosis prediction in patients with ES-SCLC and was recommended to be dynamically evaluated to guide patient treatment. Additionally, the nomogram covering post-AAPR accurately predicted individual survival probability.

• albumin-to-alkaline phosphatase ratio; AAPR
• dynamic
• extensive-stage small-cell lung cancer; ES-SCLC
• nomogram
• prognosis prediction

• gastric cancer
• gastrointestinal surgery
• gastrointestinal system
• orthopaedics
• stomach and duodenum

The number of studies on bone metastasis (BM) from gastric cancer (GC) is currently limited. Therefore, the aim of the present study was to investigate the characteristics, skeletal-related events (SREs) and prognosis of GC in patients with BMs. Data from 60 patients with BMs from GC were retrospectively retrieved and patient-, tumor- and BM-related characteristics were analyzed. Kaplan-Meier survival curves were analyzed using the univariate log-rank test. Multivariate analyses were conducted using the Cox proportional hazards model. The median patient age was 63.5 years (range, 26-83 years). Visceral or brain metastases were observed at BM diagnosis in 61.7% of the patients. Multiple BMs were detected in 83.3% and SREs occurred in 76.7% of the patients. The median overall survival (OS) after BM diagnosis and SRE occurrence was 9 months (range, 0-43 months) and 5 months (range, 0-36 months), respectively. On multivariate analysis, poor Eastern Cooperative Oncology Group performance status (P=0.030), the administration of chemotherapy prior to BM diagnosis (P<0.001) and no chemotherapy after BM diagnosis (P=0.002) were significant prognostic factors for unfavorable OS, whereas the non-use of bone-modifying agents (BMAs) was the only independent prognostic factor for poor SRE-free survival (SRS; P=0.022). Among patients without SREs at BM diagnosis, the median SRS duration was 7 months (range, 0-43 months). In conclusion, chemotherapy may confer a survival benefit in GC patients with BMs. In addition, the prognosis for GC patients with BMs presenting with SREs is poor, but treatment with BMAs may prevent or delay the development of SREs.

• bone metastasis
• gastric cancer
• skeletal-related event

• BTM
• Bone-specific alkaline phosphatase
• Osteocalcin
• Reference intervals

To assess the prognostic value of alkaline phosphatase in patients with hormone-sensitive prostate cancer.

A systematic review and meta-analysis was performed using the PUBMED, Web of Science, Cochrane Library, and Scopus in April 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared hormone-sensitive prostate cancer patients with high vs. low alkaline phosphatase to determine its predictive value for overall survival, cancer-specific survival, and progression-free survival. We performed a formal meta-analysis of these outcomes.

42 articles with 7938 patients were included in the systematic review and 28 studies with 5849 patients for the qualitative assessment. High alkaline phosphatase was associated with worse overall survival (pooled HR 1.72; 95% CI 1.37−2.14) and progression-free survival (pooled HR 1.30; 95% CI 1.10−1.54). In subgroup analyses of patients with “high-volume” and “low-volume”, alkaline phosphatase was associated with the overall survival (pooled HR 1.41; 95% CI 1.21−1.64 and pooled HR 1.64; 95% CI, 1.06−2.52, respectively).

In this meta-analysis, elevated serum levels of alkaline phosphatase were associated with an increased risk of overall mortality and disease progression in patients with hormone-sensitive prostate cancer. In contrast, those were not associated with an increased risk of cancer-specific mortality. Alkaline phosphatase was independently associated with overall survival in both patients with “high-volume” and “low-volume” hormone-sensitive prostate cancer. Alkaline phosphatase may be useful for being integrated into prognostic tools that help guide treatment strategy, thereby facilitating the shared decision making process.

• Alkaline phosphatase (ALP)
• Hormone-sensitive prostate cancer (HSPC)
• Meta-analysis

This study investigated the effects and mechanism of Heshouwu (Polygonum multiflorum Thunb.) water extract (HSW) on diabetes-related bone loss in mice. HSW was orally administered (300 mg/kg body weight) to high-fat diet and streptozotocin-induced diabetic mice for 10 weeks. HSW significantly alleviated mouse body weight loss and hyperglycemia compared with the control group, and elevated serum levels of insulin, osteocalcin, and bone-alkaline phosphatase. HSW supplementation also significantly increased the bone volume/tissue volume ratio and trabecular thickness and number, and decreased the bone surface/bone volume ratio and trabecular structure model index in the femur and tibia. Moreover, HSW significantly increased femoral bone mineral density. In addition, HSW down-regulated osteoclastogenic genes, such as nuclear factor of activated T-cells, cytoplasmic 1 and tartrate-resistant acid phosphatase 5 (TRAP), in both the femur and tibia tissue, and reduced serum TRAP level compare to those of control mice. These results indicate that HSW might relieve diabetes-related bone disorders through regulating osteoclast-related genes, suggesting HSW may be used as a preventive agent for diabetes-induced bone loss.

• Heshouwu
• Polygonum multiflorum Thunb.
• bone microarchitecture
• diabetes
• osteoporosis

• bone metastasis
• gastric cancer
• incidence

Operative fixation for femoral metastatic bone disease is based on the principles of reducing pain and restoring function. Recent literature has proposed a number of prognostic models for appendicular metastatic bone disease. The aim of this study was to compare the accuracy of proposed soring systems in the setting of femoral metastatic bone disease in order to provide surgeons with information to determine the most appropriate scoring system in this setting.

A retrospective cohort analysis of patients who underwent surgical management of femoral metastatic bone disease at a single institution were included. A pre-operative predicted survival for all 114 patients was retrospectively calculated utilising the revised Katagiri model, PathFx model, SSG score, Janssen nomogram, OPTModel and SPRING 13 nomogram. Univariate and multivariate Cox regression proportional hazard models were constructed to assess the role of prognostic variables in the patient group. Area under the receiver characteristics and Brier scores were calculated for each prognostic model from comparison of predicted survival and actual survival of patients to quantify the accuracy of each model.

For the femoral metastatic bone disease patients treated with surgical fixation, multivariate analysis demonstrated a number of pre-operative factors associated with survival in femoral metastatic bone disease, consistent with established literature. The OPTIModel demonstrated the highest accuracy at predicting 12-month (Area Under the Curve [AUC] = 0.79) and 24-month (AUC = 0.77) survival after surgical management. PathFx model was the most accurate at predicting 3-month survival (AUC = 0.70) and 6-month (AUC = 0.70) survival. The PathFx model was successfully externally validated in the femoral patient dataset for all time periods.

Among six prognostic models assessed in the setting of femoral metastatic bone disease, the present study observed the most accurate model for 3-month, 6-month, 12-month and 24-month survival. The results of this study may be utilised by the treating surgical team to determine the most accurate model for the required time period and therefore improve decision-making in the care of patients with femoral metastatic bone disease.

• ALP, alkaline phosphatase
• ASA, American Society of Anaesthesiologists score
• AUC, Area Under the Curve
• CCI, Charlson Comorbidity Index
• ECOG, Eastern Cooperation Oncology Group
• Femur
• MBD, metastatic bone disease
• Metastatic bone disease
• Nomogram
• Prognosis
• ROC, Receiver Operating Characteristic
• SSG, Scandinavian Sarcoma Group
• Scoring system
• Surgery

Gastric cancer frequently spreads to the regional lymph nodes, liver and lungs following surgery or late in the clinical course. However, an initial clinical presentation of bone metastasis in gastric cancer patients is relatively rare. The current study presents two cases of gastric cancer diffusely metastasized to the spinal vertebrae and with a single metastasis to the trapezium, respectively. The initial presentations were an increased alkaline phosphatase level without any symptoms associated with bone metastasis in the first case and a swelling in the right carpometacarpal joint of the thumb in the second case. These clinical manifestations are also extremely rare in gastric cancer with bone metastasis. The study emphasizes that a diagnosis of gastric cancer should be considered in patients with increased alkaline phosphatase without clinical symptoms or with a single bone metastasis.

• S-1
• chemotherapy
• cisplatin
• disseminated bone metastasis
• single bone metastasis
• trapezium

• alkaline phosphatase
• meta-analysis
• prognosis
• prostate cancer
• survival

• children
• adolescence
• bone tumor
• prognostic marker

• bone alkaline phosphatase
• bone mineral density
• diabetes
• glycohemoglobin

• Adult
• Age Factors
• Alcohol Drinking/epidemiology
• Alkaline Phosphatase/blood
• Biomarkers
• Bone Density/physiology
• Bone and Bones/metabolism
• Comorbidity
• Diabetes Mellitus/epidemiology
• Diabetes Mellitus/physiopathology
• Exercise
• Female
• Humans
• Male
• Middle Aged
• Racial Groups
• Sex Factors
• Smoking/epidemiology
• Young Adult

The prognosis for renal cell carcinoma (RCC) is related to a high rate of metastasis, including 30% of bone metastasis. In this study, we investigate the correlation between diverse clinical factors and bone metastases secondary from renal cell cancer (RCC), and to identify potential risk factors for bone metastasis in newly diagnosed patients and those who have already received treatment.

The clinical data of 372 patients with RCC were reviewed from January 2000 to August 2016. The correlations between age, gender, histopathologic types, alkaline phosphotase (ALP), CEA, AFP, CA-125, CA-153, CA-199, calcium, hemoglobin (HB) and bone metastases were analyzed. And the risk factors for bone metastases in RCC were identified by multivariate logistic regression analysis. The cutoff value, sensitivity and specificity of the independent correlation factors were calculated by receiver operating characteristic (ROC) curve.

The bone is the second to the lung as a distant metastasis target site in patients with RCC. Thirty eight individuals were identified with bone metastases. Of these patients, significantly higher levels of ALP, calcium, HB were found than those without bone metastasis (P < 0.05, respectively). No significant differences were detected in CEA, AFP, CA-125, CA-153, CA-199, age, gender and histopathologic types between patients with and without bone metastases (P > 0.05, respectively). Multivariate logistic regression analysis indicated that ALP, calcium and HB were independent risk factors correlated with bone metastasis (P < 0.05, respectively). ROC curves demonstrated these factors had comparable accuracy at predicting bone metastasis (AUC were 0.749, 0.633 and 0.665, respectively). The cutoff values of ALP, calcium and HB were 105.5 U/L, 2.615 mmol/L and 111.5 g/L, respectively. The sensitivities of them were 57.9%, 36.8% and 71.1% for predicting bone metastasis, with specificities of 83.5%, 95.2% and 65.3%, respectively.

Based on our study, the concentrations of ALP, calcium and HB were potentially risk factors for bone metastasis in patients with RCC. For newly diagnosed patients, if the values of ALP>105.5 U/L, calcium>2.615 mmol/L and HB<111.5 g/L were detected, intensive monitoring and bone scanning are warranted for them.

• Bone metastases
• Renal cell cancer
• Risk factors

• Anticancer
• Chalcones
• Pharmacokinetics
• Prodrugs
• Sodium phosphate
• Water solubility

• Adult
• Aged
• Aged, 80 and over
• Alkaline Phosphatase/blood
• Biomarkers, Tumor/blood
• Bone Neoplasms/blood
• Bone Neoplasms/diagnosis
• Bone Neoplasms/secondary
• Calcium/blood
• Carcinoma, Transitional Cell/blood
• Carcinoma, Transitional Cell/pathology
• Early Detection of Cancer/methods
• Female
• Hemoglobins/metabolism
• Humans
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Risk Factors
• Urinary Bladder Neoplasms/blood
• Urinary Bladder Neoplasms/pathology
• Young Adult

• Department of Science and Technology Program of Jiangxi Province, China

• High BMD
• bone metastasis
• gastric carcinoma