McGinley Peter J, Kilpatrick Eric S
Department of Clinical Biochemistry, Hull Royal Infirmary, Hull HU3 2JZ, UK.
Ann Clin Biochem. 2003 Nov;40(Pt 6):643-7. doi: 10.1258/000456303770367234.
Several guidelines exist on the appropriate use of serum tumour markers in the management of patients with cancer. This study audited tumour marker requesting against these guidelines in a busy teaching hospital over a 12-month period.
All marker requests from 1 April 2001 to 31 March 2002 were collected using the laboratory computer. From one 24-h period, the case notes from all hospital requests [excluding prostate-specific antigen (PSA)] were examined.
Tumour marker workload increased by 125% from 1997-98 to 2001-02. Of 27 323 tumour marker requests, 7166 were from general practice, 2312 were requested on hospital admission before further investigation, 612/3636 of CA125 and 98/374 of CA15.3 requests were on men and 12/11585 PSA requests on women. Of 34 case notes examined, 18 had tumour markers measured before biopsy and only nine after. Of 19 patients with 'normal' markers, one had malignancy on biopsy and, of 15 with one or more raised markers, four had normal biopsies.
Tumour marker workload is rapidly increasing. Tumour markers are frequently and inappropriately requested, either because they are on patients of the wrong sex, or because they are taken before a cancer diagnosis is reached. Results from these tests can be falsely reassuring or unduly alarming.
关于血清肿瘤标志物在癌症患者管理中的合理应用，已有多项指南。本研究在一家繁忙的教学医院对12个月期间肿瘤标志物的申请情况对照这些指南进行了审核。
利用实验室计算机收集了2001年4月1日至2002年3月31日期间所有的标志物申请。从一个24小时时间段内，检查了所有医院申请（不包括前列腺特异性抗原（PSA））的病历。
从1997 - 98年到2001 - 02年，肿瘤标志物的工作量增加了125%。在27323项肿瘤标志物申请中，7166项来自全科医疗，2312项是在住院进一步检查前申请的，CA125申请中有612/3636项是针对男性的，CA15.3申请中有98/374项是针对男性的，PSA申请中有12/11585项是针对女性的。在检查的34份病历中，18份在活检前检测了肿瘤标志物，只有9份在活检后检测。在19名标志物“正常”的患者中，1名活检显示为恶性肿瘤，在15名有一项或多项标志物升高的患者中，4名活检结果正常。
肿瘤标志物的工作量正在迅速增加。肿瘤标志物的申请频繁且不恰当，要么是因为申请对象性别错误，要么是因为在癌症诊断达成之前就进行了检测。这些检测结果可能会提供错误的安慰或过度警示。
