Neven P, Iles R K, Lee C L, Hudson C N, Shepherd J H, Chard T
Gynaecological Oncology Unit, Saint Bartholomew's Hospital, West Smithfield, London.
Cancer. 1993 Jun 15;71(12):4124-30. doi: 10.1002/1097-0142(19930615)71:12<4124::aid-cncr2820711252>3.0.co;2-p.
The presence of urinary excretion products of human chorionic gonadotropin (hCG) has been proposed as a tumor marker. To ascertain the clinical value in gynecologic cancers, the authors studied 612 nonpregnant women.
Three different assays in four clinical groups were compared: no disease, benign disease, malignant disease, and complete remission of previously treated malignant disease. The assays were for the urinary beta-core, "total" beta-hCG, and free alpha-subunit.
Measurement of the alpha-subunit was of no obvious clinical value. In some patients with benign disease, hCG metabolites were elevated. In the 141 patients with active gynecologic malignancy the sensitivity of the total beta-hCG assay was 47% and that of the beta-core assay was 36%. The specificities were 80.3% and 90.4%, respectively. Advanced cancers generally had higher levels of total beta-hCG and beta-core. Squamous cell and poorly differentiated cervical tumors had higher levels of total beta-hCG than did adenocarcinomas and well-differentiated cervical tumors. Invasive, serous, endometrioid, and germ cell ovarian tumors had higher total beta-hCG, beta-core, and alpha-subunit levels than did borderline, mucinous, and clear cell ovarian tumors. Six of 16 patients with disease in complete remission had elevated levels.
The excretion of hCG and its metabolic fragments is a common event in gynecologic cancer, but sensitivity and specificity are low, and there is little consistent relationship between tumor stage and histologic type.
人绒毛膜促性腺激素（hCG）的尿排泄产物已被提议作为一种肿瘤标志物。为确定其在妇科癌症中的临床价值，作者对612名未怀孕女性进行了研究。
比较了四个临床组中的三种不同检测方法：无疾病组、良性疾病组、恶性疾病组以及先前治疗的恶性疾病完全缓解组。检测项目为尿β-核心片段、“总”β-hCG和游离α亚基。
α亚基的检测无明显临床价值。在一些良性疾病患者中，hCG代谢产物升高。在141例活动性妇科恶性肿瘤患者中，总β-hCG检测的敏感性为47%，β-核心片段检测的敏感性为36%。特异性分别为80.3%和90.4%。晚期癌症患者的总β-hCG和β-核心片段水平通常较高。鳞状细胞癌和低分化宫颈癌的总β-hCG水平高于腺癌和高分化宫颈癌。浸润性、浆液性、子宫内膜样和生殖细胞性卵巢肿瘤的总β-hCG、β-核心片段和α亚基水平高于交界性、黏液性和透明细胞性卵巢肿瘤。16例疾病完全缓解的患者中有6例水平升高。
hCG及其代谢片段的排泄在妇科癌症中很常见，但敏感性和特异性较低，且肿瘤分期与组织学类型之间几乎没有一致的关系。
