Biochemical markers of bone turnover and clinical outcome in patients with renal cell and bladder carcinoma with bone metastases following treatment with zoledronic acid: The TUGAMO study
Alcaraz A, González-López R, Morote J, de la Piedra C, Meseguer C, Esteban E, Climent M, González-Gragera B, Alvarez-Ossorio JL, Chirivella I, Mellado B, Lara PC, Vázquez F, Contreras JA, Carles J, Murias A, Calderero V, Comet-Batlle J, González-Del Alba A, León-Mateos L, Mañas A, Segarra J, Lassa A, González-Enguita C, Méndez MJ, Samper P, Unda M, Mahillo-Fernández I, Bellmunt J; TUGAMO GROUP. Br J Cancer. 2013 Jul 9;109(1):121-30. doi: 10.1038/bjc.2013.272. Epub 2013 Jun 25.


Hospital Clínic i Provincial de Barcelona, Carrer Villaroel, no. 170, 08036 Barcelona, Spain.



Levels of bone turnover markers (BTM) might be correlated with outcome in terms of skeletal-related events (SRE), disease progression, and death in patients with bladder cancer (BC) and renal cell carcinoma (RCC) with bone metastases (BM). We try to evaluate this possible correlation in patients who receive treatment with zoledronic acid (ZOL).


This observational, prospective, and multicenter study analysed BTM and clinical outcome in these patients. Serum levels of bone alkaline phosphatase (BALP), procollagen type I amino-terminal propeptide (PINP), and beta-isomer of carboxy-terminal telopeptide of type I collagen (β-CTX) were analysed.


Patients with RCC who died or progressed had higher baseline β-CTX levels and those who experienced SRE during follow-up showed high baseline BALP levels. In BC, a poor rate of survival was related with high baseline β-CTX and BALP levels, and new SRE with increased PINP levels. Cox univariate analysis showed that β-CTX levels were associated with higher mortality and disease progression in RCC and higher mortality in BC. Bone alkaline phosphatase was associated with increased risk of premature SRE appearance in RCC and death in BC.


Beta-isomer of carboxy-terminal telopeptide of type I collagen and BALP can be considered a complementary tool for prediction of clinical outcomes in patients with BC and RCC with BM treated with ZOL.