Japanese journal of clinical oncology · 2026
Clinical utility of tumour markers in skeletal metastasis of unknown primary at the initial visit.
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Yamaga Kensaku, Akahori Keiichi, Osaki Mari, Nagashima Hideki
Аннотация
BACKGROUND: Skeletal metastasis of unknown primary at the initial visit represents a clinically important subset of metastatic bone tumours, accounting for ~7.8%-21.7% of all skeletal metastases. This condition differs from cancer of unknown primary (CUP), in which the primary site remains unidentified after comprehensive evaluation. At this diagnostic entry point, before completion of a full work-up, early stratification is essential; however, the clinical utility of serum tumour markers at this stage remains unclear.
METHODS: We retrospectively reviewed 79 patients who presented with skeletal metastasis of unknown primary at the initial visit before diagnostic work-up between January 2010 and October 2023. Clinical characteristics, final primary diagnoses, types of tumour markers measured, positivity rates, and diagnostic performance were analysed.
RESULTS: Haematologic malignancies were the most frequent final diagnoses (40.5%), followed by lung (22.8%) and prostate cancer (10.1%). A total of 17 tumour markers were measured (mean, 6.3 per patient; range, 0-12). Prostate-specific antigen (PSA), immunoelectrophoresis (IEP), soluble interleukin-2 receptor (sIL-2R), and thyroglobulin (Tg) showed high sensitivity and specificity for prostate cancer, multiple myeloma, malignant lymphoma, and thyroid cancer, respectively. Carcinoembryonic antigen (CEA) and cytokeratin 19 (CK19, CYFRA 21-1), although not organ-specific, were frequently positive in carcinomas and served as indicators of epithelial malignancy.
CONCLUSIONS: Serum tumour markers can assist early diagnostic stratification at the initial presentation of skeletal metastasis before primary-site identification. A selective testing strategy focusing on sIL-2R, IEP, CEA, and CK19, with PSA added in men and Tg when clinically indicated, may improve diagnostic efficiency and provide a basis for considering a bone-metastasis-oriented diagnostic approach.
METHODS: We retrospectively reviewed 79 patients who presented with skeletal metastasis of unknown primary at the initial visit before diagnostic work-up between January 2010 and October 2023. Clinical characteristics, final primary diagnoses, types of tumour markers measured, positivity rates, and diagnostic performance were analysed.
RESULTS: Haematologic malignancies were the most frequent final diagnoses (40.5%), followed by lung (22.8%) and prostate cancer (10.1%). A total of 17 tumour markers were measured (mean, 6.3 per patient; range, 0-12). Prostate-specific antigen (PSA), immunoelectrophoresis (IEP), soluble interleukin-2 receptor (sIL-2R), and thyroglobulin (Tg) showed high sensitivity and specificity for prostate cancer, multiple myeloma, malignant lymphoma, and thyroid cancer, respectively. Carcinoembryonic antigen (CEA) and cytokeratin 19 (CK19, CYFRA 21-1), although not organ-specific, were frequently positive in carcinomas and served as indicators of epithelial malignancy.
CONCLUSIONS: Serum tumour markers can assist early diagnostic stratification at the initial presentation of skeletal metastasis before primary-site identification. A selective testing strategy focusing on sIL-2R, IEP, CEA, and CK19, with PSA added in men and Tg when clinically indicated, may improve diagnostic efficiency and provide a basis for considering a bone-metastasis-oriented diagnostic approach.