Plebani M, Basso D, Navaglia F, De Paoli M, Tommasini A, Cipriani A
Department of Laboratory Medicine, University of Padova, Italy.
Br J Cancer. 1995 Jul;72(1):170-3. doi: 10.1038/bjc.1995.296.
In this study we compared the diagnostic utility of: (1) neuron-specific enolase (NSE); (2) squamous cell carcinoma antigen (SCC); (3) carcinoembryonic antigen (CEA); and (4) cytokeratin markers (CYFRA 21-1, TPA, TPM, TPS) in patients with small-cell lung cancer (SCLC) (21 cases) and non-small-cell lung cancer (94 cases). For comparison we also studied 66 patients with benign lung diseases and nine with pleural mesothelioma. NSE levels in SCLC patients were significantly higher than those in all the other groups studied. No significant variations were found among the SCC levels in all groups. CEA levels in patients with adenocarcinoma were significantly higher than those in all other groups studied. CYFRA 21-1 serum levels significantly increased in patients with squamous cell carcinoma and mesothelioma, while TPA, TPS and TPM increased in patients with lung cancer irrespective of the histological type. In patients with SCLC, high levels of all markers except SCC were found when the disease was extensive. In patients with non-SCLC, the highest levels of all tumour markers were usually found in those with advanced disease, although CYFRA 21-1 gave a sensitivity of 44% when a specificity of 95% was fixed in stage I non-SCLC patients. An analysis of receiver operating characteristic curves revealed that the highest diagnostic accuracies in distinguishing benign from malignant lung diseases were achieved with TPM (81%), CYFRA 21-1 (72%), CEA (78%) or TPA (78%) when using cut-off values of 46 Ul-1, 3.0 micrograms l-1, 2.0 micrograms l-1 and 75 Ul-1 respectively. When all patients were considered, the combined evaluation of more than one marker did not significantly improve the results obtained with TPM alone. However, taking into consideration the fact that CYFRA 21-1 is the most sensitive index of early lung tumours and that its combined determination with TPM did not worsen the overall sensitivity and specificity of the latter, the combined use of these two markers may be suggested as a useful took for the diagnosis of lung tumours.
在本研究中，我们比较了以下指标在小细胞肺癌（SCLC，21例）和非小细胞肺癌（94例）患者中的诊断效用：（1）神经元特异性烯醇化酶（NSE）；（2）鳞状细胞癌抗原（SCC）；（3）癌胚抗原（CEA）；以及（4）细胞角蛋白标志物（CYFRA 21-1、TPA、TPM、TPS）。为作比较，我们还研究了66例良性肺病患者和9例胸膜间皮瘤患者。SCLC患者的NSE水平显著高于所研究的所有其他组。所有组的SCC水平未发现显著差异。腺癌患者的CEA水平显著高于所研究的所有其他组。鳞状细胞癌和间皮瘤患者的CYFRA 21-1血清水平显著升高，而TPA、TPS和TPM在肺癌患者中升高，与组织学类型无关。在SCLC患者中，当疾病广泛时，除SCC外的所有标志物水平均较高。在非SCLC患者中，所有肿瘤标志物的最高水平通常见于疾病晚期患者，尽管在I期非SCLC患者中，当设定特异性为95%时，CYFRA 21-1的敏感性为44%。对受试者工作特征曲线的分析显示，当分别使用46 Ul-1、3.0微克/升、2.0微克/升和75 Ul-1的临界值时，TPM（81%）、CYFRA 21-1（72%）、CEA（78%）或TPA（78%）在区分良性和恶性肺病方面具有最高的诊断准确性。当考虑所有患者时，多种标志物的联合评估并未显著改善单独使用TPM所获得的结果。然而，考虑到CYFRA 21-1是早期肺肿瘤最敏感的指标，并且其与TPM的联合测定并未降低后者的总体敏感性和特异性，建议联合使用这两种标志物作为诊断肺肿瘤的有用工具。
