RESUMO
Bone sialoprotein (BSP) is a noncoflagenous bone matrix protein that is important for both mineralization and cell-cell interactions. Tissue studies in primary breast cancers have shown that immunohistochemical expression of BSP is associated with a high incidence of bone metastases in the course of the disease. We used a RIA to investigate the importance of serum BSP as a marker for subsequent bone metastases. Between 1994 and 1996, preoperative blood samples were collected from 388 consecutive patients with nonmetastatic breast cancer and from 30 control patients with benign breast disease. Serum BSP concentrations were measured in a blinded fashion by RIA. The cutoff for elevated serum BSP values was 24 ng/ml, ie., two SDs above the normal mean value. Serum BSP was correlated with the risk of metastasis and analyzed with regard to its prognostic value. After a median follow-up period of only 20 months, 28 patients had developed metastases. Fourteen patients had bone metastases only, 9 visceral metastases only, and 5 a combination of osseous and visceral metastases. Of the 19 women with skeletal metastases, 17 had preoperative serum BSP values in excess of 24 ng/ml (median BSP values: 48.3 ng/ml for isolated metastatic bone disease, 30.6 ng/ml for combined metastases), whereas none of the women with visceral metastases only had elevated serum BSP concentrations (median BSP value: 12.3 ng/ml). The median serum BSP value in the control group (benign breast disease) was 8.8 ng/ml serum BSP; levels correlated with the size of the primary tumor, but not with any other prognostic factors. Using a multivariate regression analysis, serum BSP was found to be the most important independent prognostic factor for the development of skeletal metastasis (P < 0.001; relative risk, 94); its specificity was 96.7%, and its sensitivity was 89.5%. Our study shows that patients with preoperatively elevated serum BSP levels are at high risk of subsequent bone metastases in the first years after primary surgery. The mechanism of BSP in the pathogenesis of skeletal metastases is unclear. Because BSP contains an integrin recognition sequence, its expression in tumor cells may facilitate their adhesion to the bone surface. However, it is possible that a proportion of circulation BSP is derived from normal or tumor-induced bone turnover. Breast cancer patients with elevated serum BSP levels may benefit from osteoprotective adjuvant therapy with bisphosphonates.
Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Ósseas/sangue , Neoplasias Ósseas/secundário , Neoplasias da Mama/sangue , Sialoglicoproteínas/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antineoplásicos Hormonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Sialoproteína de Ligação à Integrina , Pessoa de Meia-Idade , PrognósticoRESUMO
Treatment of the (C6F5)2BF x OEt2 (3) complex with N-pyrrolyl lithium gives bis(pentafluorophenyl)(N-pyrrolyl)borane (2), a strong organometallic Lewis acid, which was characterized by X-ray diffraction (B-N bond length: 1.401(5) A). It exhibits a columnar superstructure in the crystal and contains pi-stacks of pyrrolyl units. Compound 2 readily abstracts alkyl anions from a variety of alkyl Group 4 metallocene-type complexes and leads to the clean formation of the respective metallocene ions or ion pairs. For example, the treatment of Cp3ZrCH3 (9) with 2 transfers a methyl anion to yield the ion pair [Cp3Zr]+[(C4H4N)B(CH3)(C6F5)2]- (12). The X-ray crystal structure analysis of 12 shows a close contact between zirconium and the pyrrolyl-beta-carbon (2.641(2) A). The borane 2 adds to (butadiene)zirconocene (13) to yield the betaine system [Cp2Zr]+[(C4H6)B- (NC4H4)(C6F)2]- (15). Complex 15 contains a distorted eta3-allyl moiety inside the metallacyclic framework and it features an internal Zr+...(pyrrolyl)B- ion pair interaction with a Zr...pyrrolyl-alphacarbon separation of 2.723(3) A (determined by X-ray diffraction). From the dynamic NMR spectra of 15 the bond strength of the internal ion pair interaction was estimated to be deltaGdiss (223 K) approximately = to15 kcalmol(-1). Treatment of dimethylzirconocene (16) with 2 yields the metallocene borate salt [Cp2ZrCH3]+[(C4H4N)B(CH3)(C6F5)2]- (17), which is an active catalyst for the polymerization of ethene.