Noris-García E, Escobar-Pérez X
Instituto Nacional de Oncología y Radiobiología, La Habana, Cuba.
Rev Neurol. 2004;38(3):267-70.
Neurological complications have a notable repercussion on the quality of life of patients with systemic cancer, and can even become the direct cause of death. The complication that causes most concern is undoubtedly brain metastasis, because of its difficult management and because there has been an upward tendency in its incidence in the last few years.
The aim of this study is to provide a review of the literature about brain metastases and, more particularly, about the carcinoembryonic antigen (CEA) as a marker of these pathologies.
In general it is reckoned that 60% of all brain metastases start from the lung and most of them are multiple when they are diagnosed, which suggests a possibly mistaken staging of these patients. The carcinoembryonic antigen is the prototypical tumour marker, and it is usually found in higher concentrations in the cerebrospinal fluid of patients with metastatic tumours in the central nervous system. As the CEA goes through the blood brain barrier, it behaves in a similar way to IgA due to their having homologous molecular weights. This allows us to employ the same hyperbolic distribution curve that is used as a reference for lgA to distinguish between intrathecally synthesized CEA and that which diffuses from the systemic circulation.
In spite of the progress that has been obtained with the new therapies, brain metastases continue to have a poor prognosis. Hence, there is a need to identify new tumour markers that allow a diagnosis to be established before the clinical methods and presentations.
神经并发症对全身性癌症患者的生活质量有显著影响,甚至可能成为直接死因。最令人担忧的并发症无疑是脑转移,这是因为其治疗困难,且在过去几年中发病率呈上升趋势。
本研究的目的是对有关脑转移的文献进行综述,尤其是关于癌胚抗原(CEA)作为这些病症标志物的文献。
一般认为,所有脑转移中60%起源于肺部,并且大多数在诊断时为多发性,这表明这些患者的分期可能有误。癌胚抗原是典型的肿瘤标志物,通常在中枢神经系统有转移瘤的患者脑脊液中浓度较高。由于癌胚抗原穿过血脑屏障,且其分子量与免疫球蛋白A(IgA)同源,所以其行为与IgA相似。这使我们能够采用与IgA相同的双曲线分布曲线作为参考,来区分鞘内合成的CEA和从体循环扩散而来的CEA。
尽管新疗法取得了进展,但脑转移的预后仍然很差。因此,需要识别新的肿瘤标志物,以便在临床方法和症状出现之前就能做出诊断。