Piva M G, Navaglia F, Basso D, Fogar P, Roveroni G, Gallo N, Zambon C F, Pedrazzoli S, Plebani M
Department of Laboratory Medicine, University of Padua, Italy.
Oncology. 2000 Nov;59(4):323-8. doi: 10.1159/000012190.
It has been suggested that the molecular identification of cancer cells in the circulation may be useful in predicting the presence of micrometastasis in several cancer types. The aim of the present study was therefore to assess the feasibility of CEA mRNA identification in blood for diagnosing and staging colorectal, gastric and pancreatic cancer.
We studied 16 control subjects, 69 patients with colorectal (CRC), 30 with gastric (GC), 27 with pancreatic cancer (PC) and 8 with benign diseases of the pancreatobiliary tree. At diagnosis CEA mRNA was identified in peripheral blood by means of a RT-PCR procedure.
The specificity of this test in control subjects was 94%, and its sensitivity in identifying CRC, GC and PC were 34, 37 and 41%, respectively. False-positive findings were recorded in 25% patients with benign diseases. No association was found between CEA mRNA and stage in patients with GC or PC. In CRC patients, positive CEA mRNA findings were correlated with local spread (chi(2) = 14.6, p<0.01), lymph node (chi(2) = 18.95, p<0.001) and distant metastasis (chi(2) = 11.3, p<0.001). In these cases, CEA mRNA, but not CEA, was entered in stepwise discriminant analysis to classify the presence of lymph node metastasis.
The molecular detection of micrometastasis in the blood by means of CEA mRNA identification is feasible for colorectal, but not for gastric or pancreatic cancer staging. Further studies are needed in order to define the clinical utility of this marker also in follow-up protocols.
有人提出，循环中癌细胞的分子鉴定可能有助于预测多种癌症类型中微转移的存在。因此，本研究的目的是评估血液中癌胚抗原（CEA）mRNA鉴定在诊断和分期结直肠癌、胃癌和胰腺癌方面的可行性。
我们研究了16名对照受试者、69名结直肠癌（CRC）患者、30名胃癌（GC）患者、27名胰腺癌（PC）患者和8名胰胆管良性疾病患者。在诊断时，通过逆转录聚合酶链反应（RT-PCR）程序在外周血中鉴定CEA mRNA。
该检测在对照受试者中的特异性为94%，在鉴定CRC、GC和PC中的敏感性分别为34%、37%和41%。25%的良性疾病患者出现假阳性结果。在GC或PC患者中，未发现CEA mRNA与分期之间存在关联。在CRC患者中，CEA mRNA阳性结果与局部扩散（χ² = 14.6，p<0.01）、淋巴结（χ² = 18.95，p<0.001）和远处转移（χ² = 11.3，p<0.001）相关。在这些病例中，将CEA mRNA而非CEA纳入逐步判别分析以对淋巴结转移的存在进行分类。
通过CEA mRNA鉴定进行血液中微转移的分子检测对于结直肠癌分期是可行的，但对于胃癌或胰腺癌分期不可行。需要进一步研究以确定该标志物在随访方案中的临床应用价值。
