早期癌症筛查中肿瘤标志物的前瞻性研究及风险评估

Prospective investigation of tumor markers and risk assessment in early cancer screening.

作者信息

Kobayashi T, Kawakubo T

机构信息

Asia Medical Center, Saitama, Japan.

出版信息

Cancer. 1994 Apr 1;73(7):1946-53. doi: 10.1002/1097-0142(19940401)73:7<1946::aid-cncr2820730728>3.0.co;2-f.

DOI:10.1002/1097-0142(19940401)73:7<1946::aid-cncr2820730728>3.0.co;2-f

PMID:8137222

Abstract

BACKGROUND

Many researchers have reported that tumor marker diagnosis may not be useful in the early detection of cancer. However, the authors proposed a new diagnostic system using a tumor marker combination assay.

METHODS

The authors screened an asymptomatic population (2126 subjects) in Japan for early cancer over a 2-year period (1984-1986) using this tumor marker combination assay. The serum tumor marker combination assay data were analyzed: tumor-specific tumor markers (carcinoembryonic antigen, carbohydrate 19-9, heat-stable alkaline phosphatase, and tissue polypeptide antigen), tumor-associated tumor markers (ferritin, the ratio of ferritin to serum iron, immunosuppressive acidic protein, sialic acid), and growth-related tumor markers (alkaline phosphatase isoenzymes, ribonuclease). The tumor growth levels of the subjects were assessed by the tumor marker combination assay and classified into five tumor stages (Stage I, tumorfree; Stages II-III, precancer; Stage IV, preclinical cancer; Stage V, suggestive of cancer weighing over 1 g). The follow-up period was 5-7 years.

RESULTS

The percentage of subjects in tumor stages IV and V increased with age, whereas the percentage in tumor stages II and III decreased. The distribution of screenees within each tumor stage was as follows: I, 0.1%; II, 11.8%; III, 58.8%; IV, 24.8%; V, 4.6%. The rate of incidence of cancer for Stages V, VI, III, II and I was 29.5% (28 of 95), 2.7% (14 of 528), 0.7% (9 of 1251), 0.4% (1 of 250), and 0 (0 of 2), respectively.

CONCLUSIONS

Our tumor stage classification can adequately assess the risk of cancer developing in apparently healthy persons.

摘要

背景

许多研究人员报告称，肿瘤标志物诊断在癌症早期检测中可能并无用处。然而，作者提出了一种使用肿瘤标志物联合检测的新诊断系统。

方法

作者在1984年至1986年的两年时间里，使用这种肿瘤标志物联合检测方法对日本的无症状人群（2126名受试者）进行了早期癌症筛查。对血清肿瘤标志物联合检测数据进行了分析：肿瘤特异性肿瘤标志物（癌胚抗原、糖类抗原19-9、热稳定碱性磷酸酶和组织多肽抗原）、肿瘤相关肿瘤标志物（铁蛋白、铁蛋白与血清铁的比值、免疫抑制酸性蛋白、唾液酸）以及生长相关肿瘤标志物（碱性磷酸酶同工酶、核糖核酸酶）。通过肿瘤标志物联合检测评估受试者的肿瘤生长水平，并将其分为五个肿瘤阶段（I期，无肿瘤；II - III期，癌前病变；IV期，临床前癌症；V期，提示癌症重量超过1克）。随访期为5至7年。

结果

IV期和V期受试者的百分比随年龄增加，而II期和III期受试者的百分比下降。各肿瘤阶段筛查对象的分布如下：I期，0.1%；II期，11.8%；III期，58.8%；IV期，24.8%；V期，4.6%。V期、VI期、III期、II期和I期的癌症发病率分别为29.5%（95例中的28例）, 2.7%（528例中的14例）, 0.7%（1251例中的9例）, 0.4%（250例中的1例）和0（2例中的0例）。