Baudin E, Gigliotti A, Ducreux M, Ropers J, Comoy E, Sabourin J C, Bidart J M, Cailleux A F, Bonacci R, Ruffié P, Schlumberger M
Service de Médecine Nucléaire, Institut Gustave-Roussy, Villejuif, France.
Br J Cancer. 1998 Oct;78(8):1102-7. doi: 10.1038/bjc.1998.635.
Circulating neuron-specific enolase (NSE) and chromogranin A (CgA) were measured in 128 patients with neuroendocrine tumours (NET) to compare their sensitivity and specificity, to investigate factors associated with elevated serum levels and to determine the usefulness of these markers in the follow-up of NET patients. NSE (Cispack NSE, Cis Bio International, Gif-sur-Yvette, France; normal <12.5 microg l(-1)), and chromogranin A (CgA-Riact, Cis Bio International, normal <100 microg l(-1)) were measured in 128 patients without renal insufficiency. There were 99 patients with gastroenteropancreatic (GEP) NET, 19 with medullary thyroid carcinoma and ten with phaeochromocytoma. Fifty-three patients with non-NET were studied as controls. Serum NSE and CgA levels were elevated in 48 (38%) and 76 (59%) of the 128 NET patients respectively. In all groups of NET patients, CgA proved to be more sensitive than NSE. NSE and CgA had a specificity of 73% and 68% respectively. Immunostaining for NSE was positive in three out of eight controls with elevated CgA levels, whereas immunostaining for CgA and synaptophysin was negative in all cases. Elevated CgA levels were significantly associated with two independent parameters, namely the presence of other secretions (P = 0.0001) and a heavy tumour burden (P = 0.001). Elevated NSE levels were exclusively associated with poor tumour differentiation (P = 0.01). Among six patients with NET followed for 11-37 months, CgA appeared to be a better marker of tumour evolution than NSE. We suggest that CgA ought to be the only general marker screened in NET patients.
对128例神经内分泌肿瘤（NET）患者检测循环神经元特异性烯醇化酶（NSE）和嗜铬粒蛋白A（CgA），以比较其敏感性和特异性，研究与血清水平升高相关的因素，并确定这些标志物在NET患者随访中的有用性。在128例无肾功能不全的患者中检测NSE（Cispack NSE，Cis Bio International，法国吉夫-叙尔-伊夫特；正常<12.5μg l⁻¹）和嗜铬粒蛋白A（CgA-Riact，Cis Bio International，正常<100μg l⁻¹）。其中99例为胃肠胰（GEP）NET患者，19例为甲状腺髓样癌患者，10例为嗜铬细胞瘤患者。53例非NET患者作为对照进行研究。128例NET患者中，血清NSE和CgA水平升高的分别有48例（38%）和76例（59%）。在所有NET患者组中，CgA被证明比NSE更敏感。NSE和CgA的特异性分别为73%和68%。8例CgA水平升高的对照中有3例NSE免疫染色呈阳性，而所有病例中CgA和突触素的免疫染色均为阴性。CgA水平升高与两个独立参数显著相关，即存在其他分泌物（P = 0.0001）和肿瘤负荷重（P = 0.001）。NSE水平升高仅与肿瘤分化差相关（P = 0.01）。在6例随访11 - 37个月的NET患者中，CgA似乎比NSE更能反映肿瘤进展。我们建议CgA应该是NET患者唯一常规筛查的标志物。
