Shah T, Srirajaskanthan R, Bhogal M, Toubanakis C, Meyer T, Noonan A, Witney-Smith C, Amin T, Bhogal P, Sivathasan N, Warner B, Hochhauser D, Caplin M E
Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
Br J Cancer. 2008 Jul 8;99(1):72-7. doi: 10.1038/sj.bjc.6604428. Epub 2008 Jun 24.
Serum chromogranin A is the most useful general and prognostic tumour marker available for neuroendocrine tumour (NET) patients. The role of other tumour markers is less clear. In order to determine the diagnostic and prognostic value of serum alpha-fetoprotein (AFP) and human chorionic gonadotrophin-beta (hCGbeta) in NETs, a database containing biochemical, histological, and survival data on 360 NET patients was constructed. This data was statistically assessed, using Statistical Package for the Social Sciences, to determine the utility of commonly measured tumour markers with particular emphasis on AFP and hCGbeta. Alpha-fetoprotein and hCGbeta were raised in 9.5 and 12.3% of patients respectively and jointly raised in 9.1% of patients in whom it was measured. Alpha-fetoprotein levels associated strongly and positively with tumour grade, serum CgA and hCGbeta levels, and worse survival. Human chorionic gonadotrophin-beta levels also associated strongly and positively with serum CgA and AFP levels, and worsening survival. Alpha-fetoprotein and hCGbeta are elevated in high-grade NETs, with a rapidly progressive course and poorer survival. They also correlate with chromogranin-A, which is known to be a marker of tumour burden and to have prognostic value. Thus AFP and hCGbeta are clinically important in NETs and when elevated are poor prognostic markers.
血清嗜铬粒蛋白A是神经内分泌肿瘤（NET）患者最有用的通用和预后肿瘤标志物。其他肿瘤标志物的作用尚不清楚。为了确定血清甲胎蛋白（AFP）和人绒毛膜促性腺激素β（hCGβ）在NET中的诊断和预后价值，构建了一个包含360例NET患者生化、组织学和生存数据的数据库。使用社会科学统计软件包对这些数据进行统计评估，以确定常用测量肿瘤标志物的效用，特别强调AFP和hCGβ。分别有9.5%和12.3%的患者甲胎蛋白和hCGβ升高，在检测的患者中，9.1%的患者两者同时升高。甲胎蛋白水平与肿瘤分级、血清嗜铬粒蛋白A（CgA）和hCGβ水平呈强正相关，且与较差的生存率相关。人绒毛膜促性腺激素β水平也与血清CgA和AFP水平呈强正相关，且生存率恶化。甲胎蛋白和hCGβ在高级别NET中升高，病程进展迅速，生存率较差。它们还与嗜铬粒蛋白A相关，已知嗜铬粒蛋白A是肿瘤负荷的标志物且具有预后价值。因此，AFP和hCGβ在NET中具有临床重要性，升高时是不良预后标志物。
