ASSOCIATION OF RADIONUCLIDE BONE-SCAN AND SERUM ALKALINE-PHOSPHATASE IN PATIENTS WITH METASTATIC RENAL-CELL CARCINOMA

Objectives. We assessed the frequency of bone metastases, their associ ation with serum alkaline phosphatase (AP), and prognostic capabilitie s of AP in patients with renal cell carcinoma (RCC), using bone scan a s the reference standard for diagnosis. Methods. We conducted a retros pective review of patients with metastatic RCC treated with either aut ologous ex vivo activated T-lymphocytes and cimetidine (ALT) or cimeti dine alone. Results. Twenty-eight of 90 patients (31%) had evidence of bone metastases by bone scan. With 100 mg/dL as the upper limit of no rmal, 11 of 28 (39%) patients with bone metastases had normal AP level s. Of these 11 patients, 8 had bone pain. Of the 3 asymptomatic patien ts with bone metastasis and normal AP levels, only 1 had bone as the o nly site of metastasis and would have been incorrectly staged without the scan. Patients with bone metastases had a significantly shorter me dian survival than those without bone metastases (13.8 versus 25.3 mon ths; P < 0.05). Among patients without bone metastases who had elevate d AP levels, those treated with ALT had significantly longer median su rvivals than those treated with cimetidine alone (27.6 versus 14.5 mon ths; P < 0.05). Overall, patients treated with ALT had a significantly longer median survival than the ones treated only with cimetidine (21 versus 8.5 months; P < 0.05). Overall, the median survival for patien ts with elevated AP levels (10 months) was not significantly different from that of those with normal AP levels (13 months).Conclusions, In a high-risk group of patients with metastatic RCC, 31% had bone metast ases. Elevated AP levels, the presence of bone pain, or the presence o f other metastases correctly predicted bone metastasis in all but I pa tient. A bone scan may safely be omitted in patients with RCC, normal AP levels, and no bone pain. However, AP elevation itself had little p rognostic capability in these patients. Copyright 1996 by Elsevier Sci ence Inc.