Hamad Wasim, Grigore Bogdan, Walford Hugo, Peters Jaime, Alexandris Panos, Bonfield Stefanie, Standen Laura, Boscott Rachel, Behiyat Dawnya, Kuhn Isla, Neal Richard D, Walter Fiona M, Calanzani Natalia
Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
Exeter Test Group, Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
Cancer Epidemiol Biomarkers Prev. 2025 Jan 9;34(1):19-34. doi: 10.1158/1055-9965.EPI-24-0713.
Intrathoracic cancers, including lung cancer, mesothelioma, and thymoma, present diagnostic challenges in primary care. Biomarkers could resolve some challenges. We synthesized evidence on biomarker performance for intrathoracic cancer detection in low-prevalence settings. A search in Embase and MEDLINE included studies that recruited participants with suspected intrathoracic cancer and reported on at least one diagnostic measure for a validated, noninvasive biomarker. Studies were excluded if participants were recruited based on a preestablished diagnosis. A total of 52 studies were included, reporting on 108 individual biomarkers and panels. Carcinoembryonic antigen, CYFRA 21-1, and VEGF were evaluated for lung cancer and mesothelioma. For lung cancer, carcinoembryonic antigen and CYFRA 21-1 were the most studied, with AUCs of 0.48 to -0.90 and 0.48 to -0.83, respectively. Pro-gastrin-releasing peptide (Pro-GRP) and neuron-specific enolase (NSE) had the highest negative predictive values (NPV) (98.2% and 96.9%, respectively), whereas Early Cancer Detection Test - Lung (Early CDT) and miRNA signature classifier panels showed NPVs of 99.3% and 99.0%, respectively, in smokers. For mesothelioma, fibrillin-3 and mesothelin plus osteopontin had AUCs of 0.93 and 0.91, respectively. Thymoma panels (binding AcHR + StrAb and binding AcHR + modulating AcHR + StrAb) had 100% NPVs in patients with myasthenia gravis. The review highlights the performance of some biomarkers. However, few were evaluated in low-prevalence settings. Further evaluation is necessary before implementing these biomarkers for intrathoracic cancers in primary care.
包括肺癌、间皮瘤和胸腺瘤在内的胸内癌症在初级保健中存在诊断挑战。生物标志物可以解决一些挑战。我们综合了在低患病率环境中用于胸内癌症检测的生物标志物性能的证据。在Embase和MEDLINE数据库中进行的检索纳入了招募疑似胸内癌症参与者并报告至少一项经过验证的非侵入性生物标志物诊断指标的研究。如果参与者是基于预先确定的诊断招募的，则排除这些研究。总共纳入了52项研究，报告了108种个体生物标志物和检测组。癌胚抗原、细胞角蛋白19片段（CYFRA 21-1）和血管内皮生长因子（VEGF）用于肺癌和间皮瘤的评估。对于肺癌，癌胚抗原和CYFRA 21-1研究最多，其受试者工作特征曲线下面积（AUC）分别为0.48至0.90和0.48至0.83。胃泌素释放肽前体（Pro-GRP）和神经元特异性烯醇化酶（NSE）具有最高的阴性预测值（分别为98.2%和96.9%），而早期癌症检测试验-肺癌（Early CDT）和微小RNA特征分类检测组在吸烟者中的阴性预测值分别为99.3%和99.0%。对于间皮瘤，原纤维蛋白-3以及间皮素加骨桥蛋白的AUC分别为0.93和0.91。胸腺瘤检测组（抗乙酰胆碱受体抗体结合试验+抗突触前膜抗体试验和抗乙酰胆碱受体抗体结合试验+调节性抗乙酰胆碱受体抗体试验+抗突触前膜抗体试验）在重症肌无力患者中的阴性预测值为100%。该综述突出了一些生物标志物的性能。然而，在低患病率环境中对其进行评估的很少。在初级保健中对这些用于胸内癌症的生物标志物进行应用之前，有必要进行进一步评估。
