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Differences of osteoblastic bone metastases and osteolytic bone metastases in clinical features and molecular characteristics

Abstract

Several cancers tend to metastasize to bone, leading to osteolytic or osteoblastic bone lesions. The respective phenotypes of bone destruction and bone formation vary in clinical features, including incidence, prognosis, skeletal-related events and bone biomarkers. In addition, different molecular mechanisms explain the difference in phenotype. For example, molecules involved in osteolytic bone metastases (represented with breast cancer) include parathyroid hormone-related protein, transforming growth factor-β, while in osteoblastic lesions (represented with prostate cancer), endothelin-1 and morphogenetic proteins, etc. play a more important role in bone formation. It is important for us to understand the differences of bone metastases between two phenotypes to help clinicians to understand the underlying mechanisms, behaviors and therapies in development and currently available for bone metastases.

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References

  1. Roodman GD. Mechanisms of bone metastasis. N Engl J Med. 2004;350:1655–64.

    Article  CAS  PubMed  Google Scholar 

  2. Mundy GR. Metastasis to bone: causes, consequences, and therapeutic opportunities. Nat Rev Cancer. 2002;2:584–93.

    Article  CAS  PubMed  Google Scholar 

  3. Guise T. Examining the metastatic niche: targeting the microenvironment. Semin Oncol. 2010;37(2):S2–14.

    Article  CAS  PubMed  Google Scholar 

  4. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res. 2006;12(20):6243s–9s.

    Article  PubMed  Google Scholar 

  5. Kataoka M, Kunisada T, Tanaka M, Takeda K, Itani S, Sugimoto Y, et al. Statistical analysis of prognostic factors for survival in patients with spinal metastases. Acta Med Okayama. 2012;66(3):213–9.

    PubMed  Google Scholar 

  6. Kingsley LA, Fournier PG, Chirgwin JM, Guise TA. Molecular biology of bone metastases. Mol Cancer Ther. 2007;6:2609–17.

    Article  CAS  PubMed  Google Scholar 

  7. Lipton A, Cook R, Saad F, Major P, Garnero P, Terpos E, et al. Normalization of bone markers is associated with improved survival in patients with bone metastases from solid tumors and elevated bone resorption receiving zoledronic acid. Cancer. 2008;113(1):193–201.

    Article  CAS  PubMed  Google Scholar 

  8. Sugiura H, Yamada K, Sugiura T, Hida T, Mitsudomi T. Predictors of survival in patients with bone metastasis of lung cancer. Clin Orthop Relat Res. 2008;466(3):729–36.

    PubMed Central  Article  PubMed  Google Scholar 

  9. Drzymalski DM, Oh WK, Werner L, Regan MM, Kantoff P, Tuli S. Predictors of survival in patients with prostate cancer and spinal metastases. J Neurosurg Spine. 2010;13(6):789–94.

    Article  PubMed  Google Scholar 

  10. Yavas O, Hayran M, Ozisik Y. Factors affecting survival in breast cancer patients following bone metastases. Tumori. 2007;93(6):580–6.

    PubMed  Google Scholar 

  11. Coleman RE. Bisphosphonates: clinical experience. Oncologist. 2004;9:14–27.

    Article  CAS  PubMed  Google Scholar 

  12. Coleman R, Brown J, Terpos E, Lipton A, Smith MR, Cook R, et al. Bone markers and their prognostic value in metastatic bone disease: clinical evidence and future directions. Cancer Treat Rev. 2008;34(7):629–39.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  13. Coleman RE, Major P, Lipton A, Brown JE, Lee KA, Smith M, et al. Predictive value of bone resorption and formation markers in cancer patients with bone metastases receiving the bisphosphonate zoledronic acid. J Clin Oncol. 2005;23(22):4925–35.

    Article  CAS  PubMed  Google Scholar 

  14. Saad F, Lipton A. Bone-marker levels in patients with prostate cancer: potential correlations with outcomes. Curr Opin Support Palliat Care. 2010;4(3):127–34.

    Article  PubMed  Google Scholar 

  15. Brown JE, Cook RJ, Major P, Lipton A, Saad F, Smith M, et al. Bone turnover markers as predictors of skeletal complications in prostate cancer, lung cancer, and other solid tumors. J Natl Cancer Inst. 2005;97(1):59–69.

    Article  CAS  PubMed  Google Scholar 

  16. Ortiz A, Lin SH. Osteolytic and osteoblastic bone metastases: two extremes of the same spectrum? Recent Results Cancer Res. 2012;192:225–33.

    Article  CAS  PubMed  Google Scholar 

  17. Mohammad KS, Guise TA. Mechanisms of osteoblastic metastases: role of endothelin-1. Clin Orthop Relat Res. 2003;415:S67–74.

    Article  PubMed  Google Scholar 

  18. Granchi S, Brocchi S, Bonaccorsi L, Baldi E, Vinci MC, Forti G, et al. Endothelin-1 production by prostate cancer cell lines is up-regulated by factors involved in cancer progression and down-regulated by androgens. Prostate. 2001;49:267–77.

    Article  CAS  PubMed  Google Scholar 

  19. Clines GA, Guise TA. Molecular mechanisms and treatment of bone metastases. Expert Rev Mol Med. 2008;10:e7.

    Article  PubMed  Google Scholar 

  20. Clines GA, Mohammad KS, Bao Y, Stephens OW, Suva LJ, Shaughnessy JD Jr, et al. Dickkopf homolog 1 mediates endothelin-1-stimulated new bone formation. Mol Endocrinol. 2007;21:486–98.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  21. Nelson JB, Chan-Tack K, Hedican SP, Magnuson SR, Opgenorth TJ, Bova GS, et al. Endothelin-1 production and decreased endothelin B receptor expression in advanced prostate cancer. Cancer Res. 1996;56:663–8.

    CAS  PubMed  Google Scholar 

  22. Nelson J, Bagnato A, Battistini B, Nisen P. The endothelin axis: emerging role in cancer. Nat Rev Cancer. 2003;3:110–6.

    Article  CAS  PubMed  Google Scholar 

  23. Yin JJ, Mohammad KS, Käkönen SM, Harris S, Wu-Wong JR, Wessale JL, et al. A causal role for endothelin-1 in the pathogenesis of osteoblastic bone metastases. Proc Natl Acad Sci USA. 2003;100:10954–9.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  24. Nelson JB, Love W, Chin JL, Saad F, Schulman CC, Sleep DJ, et al. Phase 3, randomized, controlled trial of atrasentan in patients with nonmetastatic, hormone-refractory prostate cancer. Cancer. 2008;113:2478–87.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  25. James ND, Caty A, Payne H, Borre M, Zonnenberg BA, Beuzeboc P, et al. Final safety and efficacy analysis of the specific endothelin A receptor antagonist zibotentan (ZD4054) in patients with metastatic castration-resistant prostate cancer and bone metastases who were pain-free or mildly symptomatic for pain: a double-blind, placebo-controlled, randomized Phase II trial. BJU Int. 2010;106(7):966–73.

    Article  CAS  PubMed  Google Scholar 

  26. Nelson JB, Fizazi K, Miller K, Higano C, Moul JW, Akaza H, et al. Phase 3, randomized, placebo-controlled study of zibotentan (ZD4054) in patients with castration-resistant prostate cancer metastatic to bone. Cancer. 2012;118(22):5709–18.

    Article  CAS  PubMed  Google Scholar 

  27. Fizazi KS, Higano CS, Nelson JB, Gleave M, Miller K, Morris T, et al. Phase III, randomized, placebo-controlled study of docetaxel in combination with zibotentan in patients with metastatic castration-resistant prostate cancer. J Clin Oncol. 2013;31(14):1740–7.

    Article  CAS  PubMed  Google Scholar 

  28. Day TF, Guo X, Garrett-Beal L, Yang Y. Wnt/β-catenin signaling in mesenchymal progenitors controls osteoblast and chondrocyte differentiation during vertebrate skeletogenesis. Dev Cell. 2005;8:739–50.

    Article  CAS  PubMed  Google Scholar 

  29. Zi X, Guo Y, Simoneau AR, Hope C, Xie J, Holcombe RF, et al. Expression of Frzb/secreted Frizzled-related protein 3, a secreted Wnt antagonist, in human androgen-independent prostate cancer PC-3 cells suppresses tumor growth and cellular invasiveness. Cancer Res. 2005;65(21):9762–70.

    Article  CAS  PubMed  Google Scholar 

  30. Qiang YW, Chen Y, Stephens O, Brown N, Chen B, Epstein J, et al. Myeloma-derived Dickkopf-1 disrupts Wnt-regulated osteoprotegerin and RANKL production by osteoblasts: a potential mechanism underlying osteolytic bone lesions in multiple myeloma. Blood. 2008;112:196–207.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  31. Hall CL, Bafico A, Dai J, Aaronson SA, Keller ET. Prostate cancer cells promote osteoblastic bone metastases through Wnts. Cancer Res. 2005;65:7554–60.

    CAS  PubMed  Google Scholar 

  32. Menezes ME, Devine DJ, Shevde LA, Samant RS. Dickkopf1: a tumor suppressor or metastases promoter? Int J Cancer. 2012;130(7):1477–83.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  33. Thudi NK, Martin CK, Murahari S, Shu ST, Lanigan LG, Werbeck JL, et al. Dickkopf-1 (DKK-1) stimulated prostate cancer growth and metastases and inhibited bone formation in osteoblastic bone metastases. Prostate. 2011;71(6):615–25.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  34. Voorzanger-Rousselot N, Goehrig D, Journe F, Doriath V, Body JJ, Clézardin P, et al. Increased Dickkopf-1 expression in breast cancer bone metastases. Br J Cancer. 2007;97:964–70.

    PubMed Central  CAS  PubMed  Google Scholar 

  35. Schluter KD, Katzer C, Piper HM. An N-terminal PTHrP peptide fragment void of a PTH/PTHrP-receptor binding domain activates cardiac ET(A) receptors. Br J Pharmacol. 2001;132:427–32.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  36. Guise TA, Mohammad KS, Clines G, Stebbins EG, Wong DH, Higgins LS, et al. Basic mechanisms responsible for osteolytic and osteoblastic bone metastases. Clin Cancer Res. 2006;12(Suppl 20):6213s–6s.

    Article  CAS  PubMed  Google Scholar 

  37. Baylink DJ, Finkelman RD, Mohan S. Growth factors to stimulate bone formation. J Bone Miner Res. 1993;8(Suppl 2):S565–72.

  38. Autzen P, Robson CN, Bjartell A, Malcolm AJ, Johnson MI, Neal DE, et al. Bone morphogenetic protein 6 in skeletal metastases from prostate cancer and other common human malignancies. Br J Cancer. 1998;78:1219–23.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  39. Feeley BT, Krenek L, Liu N, Hsu WK, Gamradt SC, Schwarz EM, et al. Overexpression of noggin inhibits BMP-mediated growth of osteolytic prostate cancer lesions. Bone. 2006;38:154–66.

    Article  CAS  PubMed  Google Scholar 

  40. Dai J, Kitagawa Y, Zhang J, Yao Z, Mizokami A, Cheng S, et al. Vascular endothelial growth factor contributes to the prostate cancer-induced osteoblast differentiation mediated by bone morphogenetic protein. Cancer Res. 2004;64:994–9.

    Article  CAS  PubMed  Google Scholar 

  41. Lee YC, Cheng CJ, Bilen MA, Lu JF, Satcher RL, Yu-Lee LY, et al. BMP4 promotes prostate tumor growth in bone through osteogenesis. Cancer Res. 2011;71(15):5194–203.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  42. Haudenschild DR, Palmer SM, Moseley TA, You Z, Reddi AH. Bone morphogenetic protein (BMP)-6 signaling and BMP antagonist noggin in prostate cancer. Cancer Res. 2004;64(22):8276–84.

    Article  CAS  PubMed  Google Scholar 

  43. Virk MS, Alaee F, Petrigliano FA, Sugiyama O, Chatziioannou AF, Stout D, et al. Combined inhibition of the BMP pathway and the RANK-RANKL axis in a mixed lytic/blastic prostate cancer lesion. Bone. 2011;48(3):578–87.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  44. Mehrotra M, Krane SM, Walters K, Pilbeam C. Differential regulation of platelet-derived growth factor stimulated migration and proliferation in osteoblastic cells. J Cell Biochem. 2004;93:741–52.

    Article  CAS  PubMed  Google Scholar 

  45. Bendre MS, Margulies AG, Walser B, Akel NS, Bhattacharrya S, Skinner RA, et al. Tumor derived interleukin-8 stimulates osteolysis independent of the receptor activator of nuclear factor-κB ligand pathway. Cancer Res. 2005;65:11001–9.

    Article  CAS  PubMed  Google Scholar 

  46. Kang Y, Siegel PM, Shu W, Drobnjak M, Kakonen SM, Cordón-Cardo C, et al. A multigenic program mediating breast cancer metastases to bone. Cancer Cell. 2003;3:537–49.

    Article  CAS  PubMed  Google Scholar 

  47. Guise TA. Parathyroid hormone-related protein and bone metastases. Cancer. 1997;80(8 Suppl):1572–80.

    Article  CAS  PubMed  Google Scholar 

  48. Guise TA, Yin JJ, Taylor SD, Kumagai Y, Dallas M, Boyce BF, et al. Evidence for causal role of parathyroid hormone-related protein in the pathogenesis of human breast cancer-mediated osteolysis. J Clin Invest. 1996;98:1544–9.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  49. Falzon M, Du P. Enhanced growth of MCF-7 breast cancer cells overexpressing parathyroid hormone-related peptide. Endocrinology. 2000;141:1882–92.

    CAS  PubMed  Google Scholar 

  50. Isowa S, Shimo T, Ibaragi S, Kurio N, Okui T, Matsubara K, et al. PTHrP regulates angiogenesis and bone resorption via VEGF expression. Anticancer Res. 2010;30(7):2755–67.

    CAS  PubMed  Google Scholar 

  51. Linforth R, Anderson N, Hoey R, Nolan T, Downey S, Brady G, et al. Coexpression of parathyroid hormone related protein and its receptor in early breast cancer predicts poor patient survival. Clin Cancer Res. 2002;8:3172–7.

    CAS  PubMed  Google Scholar 

  52. Henderson MA, Danks JA, Slavin JL, Byrnes GB, Choong PF, Spillane JB, et al. Parathyroid hormone-related protein localization in breast cancers predict improved prognosis. Cancer Res. 2006;66:2250–6.

    Article  CAS  PubMed  Google Scholar 

  53. Saito H, Tsunenari T, Onuma E, Sato K, Ogata E, Yamada-Okabe H. Humanized monoclonal antibody against parathyroid hormone-related protein suppresses osteolytic bone metastases of human breast cancer cells derived from MDA-MB-231. Anticancer Res. 2005;25(6B):3817–23.

    CAS  PubMed  Google Scholar 

  54. Kakonen SM, Selander KS, Chirgwin JM, Yin JJ, Burns S, Rankin WA, et al. Transforming growth factor-beta stimulates parathyroid hormone-related protein and osteolytic metastases via Smad and mitogen-activated protein kinase signaling pathways. J Biol Chem. 2002;277:24571–8.

    Article  CAS  PubMed  Google Scholar 

  55. Mourskaia AA, Dong Z, Ng S, Banville M, Zwaagstra JC, O’Connor-McCourt MD, et al. Transforming growth factor-β1 is the predominant isoform required for breast cancer cell outgrowth in bone. Oncogene. 2008;28(7):1005–15.

    Article  PubMed  Google Scholar 

  56. Chen YC, Sosnoski DM, Mastro AM. Breast cancer metastases to the bone: mechanisms of bone loss. Breast Cancer Res. 2010;12(6):215.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  57. Sethi N, Dai X, Winter CG, Kang Y. Tumor-derived JAGGED1 promotes osteolytic bone metastases of breast cancer by engaging notch signaling in bone cells. Cancer Cell. 2011;19(2):192–205.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  58. Hiraga T, Yoneda T. Stimulation of cyclooxygenase-2 expression by TGF-b enhances bone metastases in breast cancer. J Bone Miner Res. 2004;19:S129.

    Google Scholar 

  59. Ohshiba T, Miyaura C, Ito A. Role of prostaglandin E produced by osteoblasts in osteolysis due to bone metastases. Biochem Biophys Res Commun. 2003;300:957–64.

    Article  CAS  PubMed  Google Scholar 

  60. Buijs JT, Stayrook KR, Guise TA. TGF-β in the bone microenvironment: role in breast cancer metastases. Cancer Microenviron. 2011;4(3):261–81.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  61. Maroni P, Matteucci E, Luzzati A, Perrucchini G, Bendinelli P, Desiderio MA. Nuclear co-localization and functional interaction of COX-2 and HIF-1α characterize bone metastases of human breast carcinoma. Breast Cancer Res Treat. 2011;129(2):433–50.

    Article  CAS  PubMed  Google Scholar 

  62. Hiraga T, Kizaka-Kondoh S, Hirota K, Hiraoka M, Yoneda T. Hypoxia and hypoxia-inducible factor-1 expression enhance osteolytic bone metastases of breast cancer. Cancer Res. 2007;67(9):4157–63.

    Article  CAS  PubMed  Google Scholar 

  63. McMahon S, Charbonneau M, Grandmont S, Richard DE, Dubois CM. Transforming growth factor beta1 induces hypoxia-inducible factor-1 stabilization through selective inhibition of PHD2 expression. J Biol Chem. 2006;281(34):24171–81.

    Article  CAS  PubMed  Google Scholar 

  64. Yin JJ, Selander K, Chirgwin JM, Dallas M, Grubbs BG, Wieser R, et al. TGF-β signaling blockade inhibits PTHrP secretion by breast cancer cells and bone metastases development. J Clin Invest. 1999;103:197–206.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  65. Ganapathy V, Ge R, Grazioli A, Xie W, Banach-Petrosky W, Kang Y, et al. Targeting the transforming growth factor-beta pathway inhibits human basal-like breast cancer metastases. Mol Cancer. 2010;9:122.

    PubMed Central  Article  PubMed  Google Scholar 

  66. Fang Y, Chen Y, Yu L, Zheng C, Qi Y, Li Z, et al. Inhibition of breast cancer metastases by a novel inhibitor of TGFβ receptor 1. J Natl Cancer Inst. 2013;105(1):47–58.

    Article  CAS  PubMed  Google Scholar 

  67. Connolly EC, Freimuth J, Akhurst RJ. Complexities of TGF-β targeted cancer therapy. Int J Biol Sci. 2012;8(7):964.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  68. Drabsch Y, ten Dijke P. TGF-beta signaling in breast cancer cell invasion and bone metastases. J Mammary Gland Biol Neoplasia. 2011;16:97–108.

    PubMed Central  Article  PubMed  Google Scholar 

  69. Kyle RA, Yee GC, Somerfield MR, Flynn PJ, Halabi S, Jagannath S, et al. American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. J Clin Oncol. 2007;25(17):2464–72.

    Article  CAS  PubMed  Google Scholar 

  70. Aapro M, Abrahamsson PA, Body JJ, Coleman RE, Colomer R, Costa L, et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol. 2008;19(3):420–32.

    Article  CAS  PubMed  Google Scholar 

  71. Kohno N, Aogi K, Minami H, Nakamura S, Asaga T, Iino Y, et al. Zoledronic acid significantly reduces skeletal complications compared with placebo in Japanese women with bone metastases from breast cancer: a randomized, placebo-controlled trial. J Clin Oncol. 2005;23(15):3314–21.

    Article  CAS  PubMed  Google Scholar 

  72. Winter MC, Coleman RE. Bisphosphonates in the adjuvant treatment of breast cancer. Clin Oncol. 2013;25(2):135–45.

    Article  CAS  Google Scholar 

  73. Nuzzo F, Gallo C, Lastoria S, Di Maio M, Piccirillo MC, Gravina A, et al. Bone effect of adjuvant tamoxifen, letrozole or letrozole plus zoledronic acid in early-stage breast cancer: the randomized phase 3 HOBOE study. Ann Oncol. 2012;23(8):2027–33.

    Article  CAS  PubMed  Google Scholar 

  74. Llombart A, Frassoldati A, Paija O, Sleeboom HP, Jerusalem G, Mebis J, et al. Immediate administration of zoledronic acid reduces aromatase inhibitor–associated bone loss in postmenopausal women with early breast cancer: 12-month analysis of the E-ZO-FAST trial. Clin Breast Cancer. 2012;12(1):40–8.

    Article  CAS  PubMed  Google Scholar 

  75. Paterson AH, Anderson SJ, Lembersky BC, Fehrenbacher L, Falkson CI, King KM, et al. Oral clodronate for adjuvant treatment of operable breast cancer (national surgical adjuvant breast and bowel project protocol B-34): a multicentre, placebo-controlled, randomised trial. Lancet Oncol. 2012;13(7):734–42.

    Article  CAS  PubMed  Google Scholar 

  76. Saad F, Gleason DM, Murray R, Tchekmedyian S, Venner P, Lacombe L, et al. A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma. J Natl Cancer Inst. 2002;94(19):1458–68.

    Article  CAS  PubMed  Google Scholar 

  77. Small EJ, Smith MR, Seaman JJ, Petrone S, Kowalski MO. Combined analysis of two multicenter, randomized, placebo-controlled studies of pamidronate disodium for the palliation of bone pain in men with metastatic prostate cancer. J Clin Oncol. 2003;21(23):4277–84.

    Article  CAS  PubMed  Google Scholar 

  78. Dearnaley DP, Mason MD, Parmar MK, Sanders K, Sydes MR. Adjuvant therapy with oral sodium clodronate in locally advanced and metastatic prostate cancer: long-term overall survival results from the MRC PR04 and PR05 randomised controlled trials. Lancet Oncol. 2009;10(9):872–6.

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  79. Palmieri C, Fullarton JR, Brown J. Comparative efficacy of bisphosphonates in metastatic breast and prostate cancer and multiple myeloma: a mixed-treatment meta-analysis. Clin Cancer Res. 2013;19(24):6863–72.

    Article  CAS  PubMed  Google Scholar 

  80. Henry D, Vadhan-Raj S, Hirsh V, von Moos R, Hungria V, Costa L, et al. Delaying skeletal-related events in a randomized phase 3 study of denosumab versus zoledronic acid in patients with advanced cancer: an analysis of data from patients with solid tumors. Support Care Cancer. 2014;22(3):679–87.

    Article  PubMed  Google Scholar 

  81. Lipton A, Fizazi K, Stopeck AT, Henry DH, Brown JE, Yardley DA, et al. Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer. 2012;48(16):3082–92.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by National Natural Science Foundation of China (Grant Nos. 30872591 and 81372749).

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The authors declare no conflict of interest.

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Fang, J., Xu, Q. Differences of osteoblastic bone metastases and osteolytic bone metastases in clinical features and molecular characteristics. Clin Transl Oncol 17, 173–179 (2015). https://doi.org/10.1007/s12094-014-1247-x

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Keywords

  • Bone metastases
  • Differences
  • Clinical features
  • Molecular characteristics
  • Bone targets