N-telopeptide as a potential diagnostic and prognostic marker for bone metastasis in human cancers: A meta-analysis

PURPOSE: Whether N-telopeptide of type I collagen (NTx) can be applied for diagnosis and prognostic prediction of bone metastasis in human cancers is still conflicting. This study aimed to investigate the diagnostic and prognostic value of NTx for cancer patients with bone metastasis. METHODS: Embase, PubMed, Chinese National Knowledge Infrastructure and Wanfang databases were retrieved to collect related publications. In diagnostic meta-analysis, the sensitivity (SEN) and specificity (SPE) were calculated. Hazard ratio (HR) with 95% confidence interval (95% CI) was used in the prognostic meta-analysis. Sensitivity and publication analyses were conducted for potential heterogeneity sources. RESULTS: The pooled SEN and SPE were 77% (72–81%) and 80% (75–84%) for 45 diagnostic studies. A higher diagnostic efficacy was obtained from NTx combining with other markers (AUC: 0.94 (0.92–0.96)) for bone metastasis of human cancers, especially for lung cancer (AUC: 0.87 (0.84–0.90)), breast cancer (AUC: 0.83 (0.79–0.86)) and prostate cancer (AUC: 0.88 (0.85–0.90)) in Asian people (AUC: 0.86 (0.83–0.89)). For the value of NTx on prognosis of human cancers with bone metastasis, the pooled HR was 2.12 (1.74–2.58) for high versus low NTx level, indicating high NTx level would increase the risk of poor overall survival. CONCLUSION: Our results indicated serum NTx combining with other markers can become a feasible biomarker for the diagnosis and prognosis prediction for bone metastasis of different cancers, including lung cancer, breast cancer and prostate cancer in Asian people.