Brown R W, Campagna L B, Dunn J K, Cagle P T
Department of Pathology, Baylor College of Medicine, Houston, Texas, USA.
Am J Clin Pathol. 1997 Jan;107(1):12-9. doi: 10.1093/ajcp/107.1.12.
Adenocarcinoma that metastasizes from an unknown primary site is a significant oncologic problem. With the exception of prostate-specific antigen and thyroglobulin, no single immunohistochemical marker is entirely site-specific. A retrospective study was undertaken to determine whether a panel of markers could accurately predict the site of origin of common metastatic adenocarcinomas. On the basis of reports of their relatively restricted specificity for carcinomas of colon, breast, lung, ovary, and upper gastrointestinal tract (stomach, pancreas, and bile duct), eight markers were selected for simultaneous evaluation: gross cystic disease fluid protein-15, breast cancer antigen 225 (BCA225), B72.3, DF3 (CA15-3), carcinoembryonic antigen (CEA), CA19-9, CA125, and estrogen receptor. The study population consisted of 128 metastatic nonmucinous adenocarcinomas for which the primary site was known. Staining was performed on formalin-fixed, paraffin-embedded tissue using an enhanced-sensitivity avidin-biotin peroxidase complex detection system. The most informative markers were CEA, CA19-9, CA125, and BCA225. With this four-marker panel, the most predictive multiple-marker phenotypes, as determined by a combination of area under the receiver operating characteristic curve, specificity, and percent correct predictions, were CEA+, BCA225-, and CA125- for colon tumors; BCA225+, CEA-, and CA125- for breast tumors; BCA225+, CEA+, and CA19-9- for lung tumors; CA125+ and CEA- for ovarian tumors; and CEA+, CA19-9+, and CA125+ for upper gastrointestinal tract tumors. Overall, these phenotypes correctly predicted the known primary site in 66% of cases. Until single highly sensitive and specific markers are developed for adenocarcinomas other than prostate and thyroid tumors, the origin of a metastatic adenocarcinoma can best be suggested or excluded with clinicopathologic data combined with a panel of selected immunohistochemical markers.
来自未知原发部位的腺癌转移是一个重大的肿瘤学问题。除前列腺特异性抗原和甲状腺球蛋白外，没有单一的免疫组化标志物是完全位点特异性的。进行了一项回顾性研究，以确定一组标志物是否能准确预测常见转移性腺癌的原发部位。根据它们对结肠、乳腺、肺、卵巢和上消化道（胃、胰腺和胆管）癌相对受限的特异性报告，选择了8种标志物进行同步评估：巨大囊肿病液体蛋白-15、乳腺癌抗原225（BCA225）、B72.3、DF3（CA15-3）、癌胚抗原（CEA）、CA19-9、CA125和雌激素受体。研究人群包括128例已知原发部位的转移性非黏液腺癌。使用增强敏感性抗生物素蛋白-生物素过氧化物酶复合物检测系统对福尔马林固定、石蜡包埋的组织进行染色。最具信息价值的标志物是CEA、CA19-9、CA125和BCA225。使用这个四标志物组合，通过接受者操作特征曲线下面积、特异性和正确预测百分比的组合确定的最具预测性的多标志物表型，对于结肠肿瘤是CEA+、BC A225-和CA125-；对于乳腺肿瘤是BCA225+、CEA-和CA125-；对于肺肿瘤是BCA225+、CEA+和CA19-9-；对于卵巢肿瘤是CA125+和CEA-；对于上消化道肿瘤是CEA+、CA19-9+和CA125+。总体而言，这些表型在66%的病例中正确预测了已知的原发部位。在为前列腺和甲状腺肿瘤以外的腺癌开发出单一的高敏感性和特异性标志物之前，结合临床病理数据和一组选定的免疫组化标志物，最有助于提示或排除转移性腺癌的起源。
