Ebert W, Dienemann H, Fateh-Moghadam A, Scheulen M, Konietzko N, Schleich T, Bombardieri E
Thoraxklinik Heidelberg-Rohrbach.
Eur J Clin Chem Clin Biochem. 1994 Mar;32(3):189-99.
The diagnostic value of the water-soluble cytokeratin 19 fragment CYFRA 21-1 in lung cancer was assessed in comparison with carcinoembryonic antigen, squamous cell carcinoma antigen, and neuron-specific enolase. The cut-off value, defined as 95% specificity versus a group of 526 patients suffering from benign chest diseases, was set at 3.3 micrograms/l for cytokeratin 19 fragment CYFRA 21-1 (carcinoembryonic antigen: 7.8 micrograms/l, squamous cell carcinoma antigen: 1.9 micrograms/l, neuron-specific enolase: 13.7 micrograms/l). Elevated pretreatment cytokeratin 19 fragment CYFRA 21-1 concentrations were recorded: in 112 of 244 (46%) patients with all histological types of lung cancer (carcinoembryonic antigen: 32%, squamous cell carcinoma antigen: 25%, neuron-specific enolase: 28%), in 89 of 177 (50%) patients with non-small cell lung cancer (carcinoembryonic antigen: 33%, squamous cell carcinoma antigen: 24%, neuron-specific enolase: 12%), in 47 of 81 (58%) patients with squamous cell carcinoma (carcinoembryonic antigen: 23%, squamous cell carcinoma antigen: 32%, neuron-specific enolase: 14%), in 27 of 63 (42%) patients with adenocarcinoma (carcinoembryonic antigen: 44%, squamous cell carcinoma antigen: 14%, neuron-specific enolase: 9%), in 15 of 33 (45%) patients with other non-small cell lung cancer (carcinoembryonic antigen: 36%, squamous cell carcinoma antigen: 24%, neuron-specific enolase: 14%), and in 20 of 55 (36%) patients with small cell lung cancer (carcinoembryonic antigen: 32%, neuron-specific enolase: 77%). Three of 12 patients with undefined histological type showed cytokeratin 19 fragment CYFRA 21-1 elevations. The best performance in terms of sensitivity and diagnostic accuracy was attained with the cytokeratin 19 fragment CYFRA 21-1 test in squamous cell carcinoma. In small cell lung cancer neuron-specific enolase was confirmed to be superior to the other markers. Cytokeratin 19 fragment CYFRA 21-1 concentrations increased with the extent of the malignant disease in non-small cell lung cancer. The positivity rate of cytokeratin 19 fragment CYFRA 21-1 in tumour stage TNM I was only 23% (carcinoembryonic antigen: 23%, squamous cell carcinoma antigen: 14%), i.e. the markers under study cannot be used for the diagnosis of early stage disease. Cytokeratin 19 fragment CYFRA 21-1 differentiated significantly between squamous cell carcinoma and the other histological types (p < 0.01). In addition, cytokeratin 19 fragment CYFRA 21-1 distinguished significantly the operable group TNM I-IIIa from inoperable TNM IIIb-IV (p < 0.05), but not TNM IIIa from IIIb. Out of 177 patients with non-small cell lung cancer, 90 individuals were monitored after surgery.(ABSTRACT TRUNCATED AT 400 WORDS)
将水溶性细胞角蛋白19片段CYFRA 21-1与癌胚抗原、鳞状细胞癌抗原和神经元特异性烯醇化酶相比较，评估其在肺癌中的诊断价值。以526例患有良性胸部疾病的患者为一组，将95%特异性对应的临界值设定为：细胞角蛋白19片段CYFRA 21-1为3.3微克/升（癌胚抗原：7.8微克/升，鳞状细胞癌抗原：1.9微克/升，神经元特异性烯醇化酶：13.7微克/升）。记录到治疗前细胞角蛋白19片段CYFRA 21-1浓度升高的情况如下：在244例所有组织学类型肺癌患者中有112例（46%）（癌胚抗原：32%，鳞状细胞癌抗原：25%，神经元特异性烯醇化酶：28%）；在177例非小细胞肺癌患者中有89例（50%）（癌胚抗原：33%，鳞状细胞癌抗原：24%，神经元特异性烯醇化酶：12%）；在81例鳞状细胞癌患者中有47例（58%）（癌胚抗原：23%，鳞状细胞癌抗原：32%，神经元特异性烯醇化酶：14%）；在63例腺癌患者中有27例（42%）（癌胚抗原：44%，鳞状细胞癌抗原：14%，神经元特异性烯醇化酶：9%）；在33例其他非小细胞肺癌患者中有15例（45%）（癌胚抗原：36%，鳞状细胞癌抗原：24%，神经元特异性烯醇化酶：14%）；在55例小细胞肺癌患者中有20例（36%）（癌胚抗原：32%，神经元特异性烯醇化酶：77%）。12例组织学类型未明确的患者中有3例细胞角蛋白19片段CYFRA 21-1升高。在鳞状细胞癌中，细胞角蛋白19片段CYFRA 21-1检测在敏感性和诊断准确性方面表现最佳。在小细胞肺癌中，证实神经元特异性烯醇化酶优于其他标志物。在非小细胞肺癌中，细胞角蛋白19片段CYFRA 21-1浓度随恶性疾病范围增加而升高。肿瘤分期为TNM I期时，细胞角蛋白19片段CYFRA 21-1的阳性率仅为23%（癌胚抗原：23%，鳞状细胞癌抗原：14%），即所研究的标志物不能用于早期疾病的诊断。细胞角蛋白19片段CYFRA 21-1在鳞状细胞癌与其他组织学类型之间有显著差异（p<0.01）。此外，细胞角蛋白19片段CYFRA 21-1能显著区分可手术的TNM I - IIIa期组与不可手术的TNM IIIb - IV期组（p<0.05），但不能区分TNM IIIa期与IIIb期。在177例非小细胞肺癌患者中，90例患者术后接受了监测。（摘要截选至400字）
