Use of serum gamma-enolase and aldolase A in combination as markers for renal cell carcinoma.

To clarify whether measurement of serum gamma-enolase and aldolase A in combination is useful for diagnosis and prediction of prognosis in cases of renal cell carcinoma (RCC), levels of both markers were evaluated by enzyme immunoassay in 132 patients with RCC. Serum gamma-enolase was elevated in 53 of the cases (40%) whereas serum aldolase A was elevated in 45 (34%). At least one of the two markers was elevated in 54% of the patients (71/132), this value being significantly higher than the positive rates for either gamma-enolase (40%) or aldolase A (34%) evaluated singly. Expression of the two markers assessed in combination became more positive with stage progression, values being 37% in stage I, 59% in stage II, 72% in stage III, and 74% in stage IV. In contrast, patients with benign urological diseases demonstrated positive rates for gamma-enolase and aldolase A as low as 3% and 6%, respectively. Increase in serum gamma-enolase was correlated with stage, tumor size, and histological grade, whereas elevated levels of serum aldolase A were associated only with advancing stage. In 15 patients with recurrent diseases, 11 (73%) had elevated levels of gamma-enolase and 5 (33%) had elevated levels of aldolase A, indicating that gamma-enolase is the more sensitive of the two for detection of recurrence. Patients with elevated levels of both gamma-enolase and aldolase A had less favorable survival than those expressing no or only one of the markers, indicating that simultaneous measurement of the two markers provides information directly relevant to prognosis in cases of RCC.