Alkaline phosphatase (ALP), calcium, and hemoglobin levels are independent risk factors for bone metastasis in patients with renal cell carcinoma (RCC), according to a recent report.

In a study of 372 patients with RCC, Zhi-Li Liu, MD, Zhi-Hong Zhang, MD, and colleagues at the First Affiliated Hospital of Nanchang University in Nanchang, China, found significantly higher levels of these clinical factors in the patients with versus without bone metastasis. An ALP level above 105.5 U/L, a calcium level above 2.615 mmol/L, and a hemoglobin level below 11.15 g/dL had a sensitivity of 57.9%, 36.8%, and 71.1%, respectively, and a specificity of 83.5%, 95.2%, and 65.3%, respectively, for predicting bone metastasis, the investigators reported in the Journal of Bone Oncology (2017;9:29-33). According to the investigators, intensive monitoring and bone scans are warranted for patients with newly diagnosed RCC who have these levels of ALP, calcium, and hemoglobin.

The investigators stated that a combination of these risk factors appeared to be more useful for predicting bone metastasis than each risk factor individually. ALP plus hemoglobin, hemoglobin plus calcium, ALP plus calcium, and a combination of all 3 had a specificity of 91%, 97.6%, 97.9%, and 98.2%, respectively.

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Of the 372 patients (62.6% male, 37.4% female), 111 had metastatic disease; 38 of these patients had bone metastases. The overall cohort had a median age of 56 years. The most common histologic subtype was clear cell carcinoma (75.3% of cases).

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Chen XY, Lan M, Zhou Y, et al. Risk factors for bone metastasis from renal cell cancer. J Bone Oncol 2017;9:29-33).