Amayo A A, Kuria J G
Department of Human Pathology, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
East Afr Med J. 2009 Dec;86(12 Suppl):S76-83. doi: 10.4314/eamj.v86i12.62909.
Tumour markers have made a difference to oncology practice. They can be used in screening, diagnosis, prognostication and assessment of treatment efficacy. Reports on tumour marker usage suggest that many clinicians assume that a biomarker for a particular cancer can be effectively used for all these indications. This assumption is incorrect. Several guidelines have been published to inform clinicians on effective utilisation of these tests.
To outline the recommended uses of the most commonly requested tumours markers in clinical practice.
A hand search of literature on the recommended use of carcinoembryonic antigen (CEA), alphafetoprotein (AFP), prostate specific antigen (PSA), CA-125 and CA-19.9. Systematic reviews and prospective randomised clinical trials of tumour marker applications were also looked at.
Five key journals and reference lists of relevant studies were considered.
Two authors abstracted relevant data independently. Emphasis was given to guidelines from expert panels. The quality of the guidelines was assessed by availability of level of evidence supporting the recommendations.
Several national and international expert groups have developed guidelines for use of markers for most cancers. CEA, AFP, PSA, CA-125 and CA-19.9 are validated for use in treatment monitoring of colorectal, hepatocellular, prostatic, ovarian and pancreatic carcinomas respectively. AFP and PSA are also useful for cancer screening in high risk groups. CA-125 has limited role in screening while CEA and CA 19.9 are not recommended for cancer screening.
Not all currently available tumour markers can be used for screening and diagnosis of malignancies. Adherence to recommendations on tumour marker utilisation will improve the cost-effectiveness of these tests.
肿瘤标志物已改变肿瘤学实践。它们可用于筛查、诊断、预后评估及治疗效果评估。关于肿瘤标志物使用的报告表明，许多临床医生认为特定癌症的生物标志物可有效用于所有这些指征。这种假设是不正确的。已发布多项指南，告知临床医生如何有效利用这些检测。
概述临床实践中最常要求检测的肿瘤标志物的推荐用途。
手工检索关于癌胚抗原（CEA）、甲胎蛋白（AFP）、前列腺特异性抗原（PSA）、CA - 125和CA - 19.9推荐用途的文献。还查阅了肿瘤标志物应用的系统评价和前瞻性随机临床试验。
考虑了五种主要期刊及相关研究的参考文献列表。
两位作者独立提取相关数据。重点关注专家小组的指南。通过支持推荐意见的证据水平的可用性评估指南的质量。
多个国家和国际专家小组已制定大多数癌症标志物使用指南。CEA、AFP、PSA、CA - 125和CA - 19.9分别被证实可用于结直肠癌、肝细胞癌、前列腺癌、卵巢癌和胰腺癌的治疗监测。AFP和PSA在高危人群癌症筛查中也有用。CA - 125在筛查中的作用有限，而CEA和CA 19.9不推荐用于癌症筛查。
并非所有现有的肿瘤标志物都可用于恶性肿瘤的筛查和诊断。遵循肿瘤标志物使用的推荐意见将提高这些检测的成本效益。
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