Bates S E, Longo D L
Cancer Treat Rev. 1985 Sep;12(3):163-207. doi: 10.1016/0305-7372(85)90037-4.
Sixteen tumor markers are reviewed, and measured to the ideal: produced by the tumor cell alone absent in health and in benign disease present in all patients with a given malignancy level in the blood representative of tumor mass detectable in occult disease. The only marker that approaches the ideal is human chorionic gonadotropin (HCG) in gestational trophoblastic tumors. In this malignancy, the HCG level suggests the diagnosis and stage, confirms response to therapy, and predicts relapse. The three most widely used and intensely studied tumor markers are carcinoembryonic antigen (CEA), alphafetoprotein (AFP), and HCG. CEA cannot be used in screening for cancer, but in carcinoma of the colon its elevation preoperatively increases the likelihood of advanced disease and postoperative recurrence. Postoperatively, elevated titers are often but not invariably associated with recurrent disease. AFP and HCG are useful in the management of nonseminomatous germ cell testicular tumors. Like CEA, they cannot be used for screening. They are more likely to be increased with advancing stage, and after therapy rising levels almost always mean recurrent disease. Some markers are valuable in specific circumstances, such as calcitonin in screening for familial medullary carcinoma of the thyroid. In multiple myeloma, immunoglobulins are useful in determining the tumor mass and response to therapy. In neuroblastoma, catecholamine metabolites are useful primarily in making the diagnosis. In some malignancies, the absence of effective therapy lowers the value of the marker, as for AFP in hepatoma. The remaining markers are too unreliable or too little studied to be useful in the management of an individual patient with cancer. The purpose of this paper is to provide the clinician with an understanding of the limitations of the present tumor markers that will lead to wiser use of the tests, and to provide standards to which future tumor markers should be measured.
本文对16种肿瘤标志物进行了综述，并按照理想标准进行衡量：由肿瘤细胞单独产生，在健康状态和良性疾病中不存在，在所有患有特定恶性肿瘤程度的患者血液中存在，可代表隐匿性疾病中可检测到的肿瘤块。唯一接近理想标准的标志物是妊娠滋养细胞肿瘤中的人绒毛膜促性腺激素（HCG）。在这种恶性肿瘤中，HCG水平有助于诊断和分期，确认对治疗的反应，并预测复发。三种使用最广泛且研究最深入的肿瘤标志物是癌胚抗原（CEA）、甲胎蛋白（AFP）和HCG。CEA不能用于癌症筛查，但在结肠癌中，术前其升高会增加晚期疾病和术后复发的可能性。术后，滴度升高通常但并非总是与复发性疾病相关。AFP和HCG在非精原细胞性生殖细胞睾丸肿瘤的管理中有用。与CEA一样，它们不能用于筛查。随着分期进展，它们更有可能升高，治疗后水平升高几乎总是意味着复发性疾病。一些标志物在特定情况下有价值，例如降钙素用于筛查家族性甲状腺髓样癌。在多发性骨髓瘤中，免疫球蛋白有助于确定肿瘤块和对治疗的反应。在神经母细胞瘤中，儿茶酚胺代谢产物主要用于诊断。在某些恶性肿瘤中，缺乏有效的治疗会降低标志物的价值，如肝癌中的AFP。其余标志物过于不可靠或研究太少，对癌症个体患者的管理没有用处。本文的目的是让临床医生了解当前肿瘤标志物的局限性，从而更明智地使用这些检测，并提供未来肿瘤标志物应遵循的衡量标准。
