Jørgensen L G, Hansen H H, Cooper E H
Department of Oncology ONB, Finsen Institute, Rigshospitalet, Copenhagen, Denmark.
Eur J Cancer Clin Oncol. 1989 Jan;25(1):123-8. doi: 10.1016/0277-5379(89)90059-x.
The clinical value of the three serum biomarkers neuron specific enolase (NSE), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) were evaluated prospectively in 86 patients with small cell lung cancer (SCLC) entered into randomized clinical trials. The patients were monitored clinically very closely and biomarkers were measured before each course of chemotherapy. The correlation between disease extent and biomarker was significant for both NSE (2P: 0.001) and LDH (2P:0.05). Of those two biomarkers NSE was the most sensitive and was raised in 75% of all patients at diagnosis, in 67% of patients with limited disease, and in 86% of patients with extensive disease. All patients with three or more sites involved presented raised serum NSE levels but there was no significant correlation between definite number or specific sites known to have metastatic disease. There was a tendency towards a higher serum CEA level in extensive disease than in local disease. Only half the patients with metastatic disease had elevated (greater than 5.0 ng/ml) levels of CEA, and values above 50.0 ng/ml were unusual. In patients initially seropositive for NSE a close correlation was found during follow up between serum NSE and response (98%) or progressive systemic disease (100%). During a major response, either complete or partial, serum NSE showed minor fluctuations (mean 8 ng/ml, S.D. 1.79, range 4.6-12.1). At present serum NSE seem to be the most sensitive and valuable biomarker in the management of SCLC, while the gain by adding CEA is small. Furthermore, NSE may be a useful tool in the estimation of disease extent and response to treatment in patients in whom clinical or radiological evaluation is difficult.
对86例参加随机临床试验的小细胞肺癌（SCLC）患者前瞻性评估了三种血清生物标志物神经元特异性烯醇化酶（NSE）、癌胚抗原（CEA）和乳酸脱氢酶（LDH）的临床价值。对患者进行密切的临床监测，并在每个化疗疗程前检测生物标志物。疾病范围与生物标志物之间的相关性在NSE（P：0.001）和LDH（P：0.05）方面均具有显著性。在这两种生物标志物中，NSE最敏感，在所有患者诊断时75%升高，局限期患者中67%升高，广泛期患者中86%升高。所有有三个或更多部位受累的患者血清NSE水平升高，但已知有转移疾病的确切部位数量或特定部位之间无显著相关性。广泛期疾病患者血清CEA水平有高于局部疾病患者的趋势。只有一半的转移疾病患者CEA水平升高（大于5.0 ng/ml），高于50.0 ng/ml的值不常见。在最初NSE血清学阳性的患者中，随访期间发现血清NSE与缓解（98%）或进行性全身疾病（100%）密切相关。在完全或部分主要缓解期间，血清NSE显示轻微波动（平均8 ng/ml，标准差1.79，范围4.6 - 12.1）。目前，血清NSE似乎是SCLC管理中最敏感和有价值的生物标志物，而添加CEA的获益较小。此外，NSE可能是在临床或影像学评估困难的患者中估计疾病范围和治疗反应的有用工具。
