Molina Rafael, Augé Josep M, Bosch Xavier, Escudero José M, Viñolas Nuria, Marrades Ramón, Ramírez José, Carcereny Enric, Filella Xavier
Laboratory of Biochemistry (Oncobiology Unit), University of Barcelona, ES-08036-Barcelona, Spain.
Tumour Biol. 2009;30(3):121-9. doi: 10.1159/000224628. Epub 2009 Jun 9.
Tumor markers have been extensively studied in lung cancer, reporting some relationship to the histology, but their clinical utility is not clear.
ProGRP, CEA, SCC, CA 125, CYFRA 21-1 and NSE were studied prospectively in 155 patients with unconfirmed suspicion of lung cancer and in 647 patients with lung cancer: 182 squamous, 205 adenocarcinomas, 19 large-cell lung cancer (LCLC), 175 small-cell lung cancer (SCLC) and 66 unspecific non-small-cell lung cancer (NSCLC).
Abnormal tumor marker serum levels were found in less than 5.3% of the patients with benign diseases, excluding CA 125 (21.3%). Tumor markers were related to histological type and tumor extension with significantly higher CEA (p <0.01) and CA 125 (p <0.007) serum levels in adenocarcinomas, SCC (p <0.0001) and CYFRA 21-1 (p <0.008) in squamous tumors and ProGRP (p <0.0001) and NSE (p <0.0001) in SCLC. Tumor markers may be useful in the histological differentiation of NSCLC and SCLC. Patients with SCC serum levels >2 ng/ml were always NSCLC, while those with SCC <2 ng/ml and ProGRP >100 pg/ml and NSE >35 ng/ml were all SCLC patients. The sensitivity was 76.7 and 79.5%, specificity was 97.2 and 99.6%, with a positive predictive value of 98.6 and 98.6% and a negative predictive value of 60.7 and 92.9% in the differentiation of NSCLC and SCLC, respectively.
Tumor marker determination in patients with suspicious signs of lung cancer suggests, in a few hours, the histological diagnosis in the majority of lung cancer patients.
肿瘤标志物已在肺癌中得到广泛研究，报告显示其与组织学存在一定关系，但其临床应用尚不清楚。
对155例未经确诊但疑似肺癌的患者以及647例肺癌患者（其中182例为鳞状细胞癌、205例为腺癌、19例为大细胞肺癌、175例为小细胞肺癌和66例为非特异性非小细胞肺癌）进行了前瞻性研究，检测了胃泌素释放肽前体（ProGRP）、癌胚抗原（CEA）、鳞状细胞癌抗原（SCC）、糖类抗原125（CA 125）、细胞角蛋白19片段（CYFRA 21-1）和神经元特异性烯醇化酶（NSE）。
在良性疾病患者中，除CA 125（21.3%）外，肿瘤标志物血清水平异常的患者不到5.3%。肿瘤标志物与组织学类型和肿瘤分期有关，腺癌中CEA（p<0.01）和CA 125（p<0.007）血清水平显著更高，鳞状肿瘤中SCC（p<0.0001）和CYFRA 21-1（p<0.008）显著更高，小细胞肺癌中ProGRP（p<0.0001）和NSE（p<0.0001）显著更高。肿瘤标志物可能有助于非小细胞肺癌和小细胞肺癌的组织学鉴别。SCC血清水平>2 ng/ml的患者均为非小细胞肺癌，而SCC<2 ng/ml且ProGRP>100 pg/ml以及NSE>35 ng/ml的患者均为小细胞肺癌患者。在非小细胞肺癌和小细胞肺癌的鉴别中，敏感性分别为76.7%和79.5%，特异性分别为97.2%和99.6%，阳性预测值分别为98.6%和98.6%，阴性预测值分别为60.7%和92.9%。
对有肺癌可疑症状的患者进行肿瘤标志物检测，在数小时内可为大多数肺癌患者提供组织学诊断。
