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Diagnostic value of alkaline phosphatase and bone-specific alkaline phosphatase for metastases in breast cancer: a systematic review and meta-analysis

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Abstract

Purpose

Numerous studies had reported the diagnostic value of alkaline phosphatase (ALP) and its bone-specific isoforms (BAP) in the metastases of breast cancer (BC). The purpose of this meta-analysis was to summarize the diagnostic value of serum ALP and BAP in metastatic BC, especially focused on bone metastases.

Methods

We searched comprehensively in the PubMed, Cochrane Library, and EMBASE for studies to explore the diagnostic accuracy of serum ALP/BAP level for metastatic BC. Qualities of including studies were assessed and pooled sensitivity, specificity, and summary receiver operating characteristic curve were calculated. Publication bias was assessed and meta-regression was conducted.

Results

We finally included 25 studies with a total of 12,155 BC patients (1681 metastatic cases and 10,474 controls). According to the QUADAS-2 tool to assessment the methodological quality, most of the included studies were judged as high risk of patient selection bias. High serum levels of ALP/BAP in bone metastatic BC patients could be found compared with non-metastatic BC patients. The pooled sensitivity and specificity of ALP for BC bone metastases were 0.62 and 0.86, and the area under the curve (AUC) was 0.80. The pooled sensitivity and specificity of ALP for all site metastases (mainly bone and liver) were 0.56 and 0.91, and the AUC was 0.90. The pooled sensitivity and specificity of BAP for BC bone metastases were 0.66 and 0.92, and the AUC was 0.89.

Conclusion

Although not promising, serum ALP and BAP could bring useful information for the early detection of BC metastases especially for the bone metastases.

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Data availability

No online data sharing is applicable to this article as all new data were presented in the manuscript. The raw data could be provided under further requst.

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Acknowledgements

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Funding

The work was funded by the National Natural Science Foundation of China (Grant No. 81772840) and Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-012A).

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Author notes

  1. Chengying Jiang and Fangke Hu have contributed equally to this work.

Authors and Affiliations

  1. Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, China

    Chengying Jiang, Jiazhen Li, Guangshen Gao & Xiaojing Guo

  2. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China

    Chengying Jiang, Jiazhen Li, Guangshen Gao & Xiaojing Guo

  3. Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University, Ministry of Education, Tianjin, China

    Chengying Jiang, Jiazhen Li, Guangshen Gao & Xiaojing Guo

  4. Tianjin’s Clinical Research Center for Cancer, Tianjin, China

    Chengying Jiang, Jiazhen Li, Guangshen Gao & Xiaojing Guo

  5. Orthopedic Department, Tianjin Hospital, Tianjin, China

    Fangke Hu

  6. Department of Breast Cancer Pathology and Research Laboratory, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China

    Xiaojing Guo

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  1. Chengying Jiang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CJ, FH, JL, and GG. The draft of the manuscript was written by CJ, FH, and XG. The manuscript was revised by CJ, FH, and JL. All authors read and approved the final manuscript.

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Correspondence to Xiaojing Guo.

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Jiang, C., Hu, F., Li, J. et al. Diagnostic value of alkaline phosphatase and bone-specific alkaline phosphatase for metastases in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 202, 233–244 (2023). https://doi.org/10.1007/s10549-023-07066-z

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