Skip to main content
British Journal of Cancer logoLink to British Journal of Cancer
. 1993 Apr;67(4):760–766. doi: 10.1038/bjc.1993.138

Tumour markers for prediction of survival and monitoring of remission in small cell lung cancer.

P W Johnson 1, S P Joel 1, S Love 1, M Butcher 1, M R Pandian 1, L Squires 1, P F Wrigley 1, M L Slevin 1
PMCID: PMC1968374  PMID: 8385978

Abstract

Levels of the tumour markers neurone specific enolase (NSE), lactate dehydrogenase (LDH), chromogranin A (ChrA) and carcinoembryonic antigen (CEA) were measured in serum taken at presentation and during treatment, remission and relapse from 154 patients who received chemotherapy for small cell lung cancer at a single centre over a 6 year period. At presentation NSE was the most frequently elevated marker, being raised in 81% of patients and significantly higher in extensive as opposed to limited disease, as were LDH and ChrA. The response rate to therapy was best correlated with presentation level of ChrA, being 79% for those whose levels were within twice the upper limit of normal and 51% above (P < 0.01). Multivariate regression analysis showed NSE, performance status and albumin at presentation to be the best independent predictors of survival. Patients with NSE below twice the upper limit of normal, Karnofsky performance status of 80 or above and albumin 35 g l-1 or above had a median survival of 15 months with 25% alive at 2 years, whilst those with NSE above twice normal, Karnofsky below 80 and albumin less that 35 g l-1 had all died by 8 months. Changes in marker levels during therapy were of low predictive value for outcome although the finding of rising NSE during chemotherapy after an initial fall correlated with significantly reduced duration of remission. There was a strong inverse correlation between the NSE level at the time of response and duration of remission (P < 0.0001). Prediction of relapse was most reliable with ChrA, 52% of patients having rising levels before clinical evidence of disease recurrence.

Full text

PDF
760

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bork E., Hansen M., Urdal P., Paus E., Holst J. J., Schifter S., Fenger M., Engbaek F. Early detection of response in small cell bronchogenic carcinoma by changes in serum concentrations of creatine kinase, neuron specific enolase, calcitonin, ACTH, serotonin and gastrin releasing peptide. Eur J Cancer Clin Oncol. 1988 Jun;24(6):1033–1038. doi: 10.1016/0277-5379(88)90154-x. [DOI] [PubMed] [Google Scholar]
  2. Burghuber O. C., Worofka B., Schernthaner G., Vetter N., Neumann M., Dudczak R., Kuzmits R. Serum neuron-specific enolase is a useful tumor marker for small cell lung cancer. Cancer. 1990 Mar 15;65(6):1386–1390. doi: 10.1002/1097-0142(19900315)65:6<1386::aid-cncr2820650623>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  3. Carney D. N., Marangos P. J., Ihde D. C., Bunn P. A., Jr, Cohen M. H., Minna J. D., Gazdar A. F. Serum neuron-specific enolase: a marker for disease extent and response to therapy of small-cell lung cancer. Lancet. 1982 Mar 13;1(8272):583–585. doi: 10.1016/s0140-6736(82)91748-2. [DOI] [PubMed] [Google Scholar]
  4. Esscher T., Steinholtz L., Bergh J., Nöu E., Nilsson K., Påhlman S. Neurone specific enolase: a useful diagnostic serum marker for small cell carcinoma of the lung. Thorax. 1985 Feb;40(2):85–90. doi: 10.1136/thx.40.2.85. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Goslin R. H., Skarin A. T., Zamcheck N. Carcinoembryonic antigen. A useful monitor of therapy of small cell lung cancer. JAMA. 1981 Nov 13;246(19):2173–2176. doi: 10.1001/jama.246.19.2173. [DOI] [PubMed] [Google Scholar]
  6. Hansen M., Hammer M., Hummer L. ACTH, ADH, and calcitonin concentrations as markers of response and relapse in small-cell carcinoma of the lung. Cancer. 1980 Nov 1;46(9):2062–2067. doi: 10.1002/1097-0142(19801101)46:9<2062::aid-cncr2820460926>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  7. Havemann K., Holle R., Gropp C. Prospective multicenter study of hormone markers in small cell lung cancer. Recent Results Cancer Res. 1985;99:194–208. doi: 10.1007/978-3-642-82533-0_22. [DOI] [PubMed] [Google Scholar]
  8. Jaques G., Bepler G., Holle R., Wolf M., Hannich T., Gropp C., Havemann K. Prognostic value of pretreatment carcinoembryonic antigen, neuron-specific enolase, and creatine kinase-BB levels in sera of patients with small cell lung cancer. Cancer. 1988 Jul 1;62(1):125–134. doi: 10.1002/1097-0142(19880701)62:1<125::aid-cncr2820620122>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  9. Jørgensen L. G., Hansen H. H., Cooper E. H. Neuron specific enolase, carcinoembryonic antigen and lactate dehydrogenase as indicators of disease activity in small cell lung cancer. Eur J Cancer Clin Oncol. 1989 Jan;25(1):123–128. doi: 10.1016/0277-5379(89)90059-x. [DOI] [PubMed] [Google Scholar]
  10. Jørgensen L. G., Osterlind K., Hansen H. H., Cooper E. H. The prognostic influence of serum neuron specific enolase in small cell lung cancer. Br J Cancer. 1988 Dec;58(6):805–807. doi: 10.1038/bjc.1988.313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krischke W., Niederle N., Schütte J., Pfeiffer R., Hirche H. Is there any clinical relevance of serial determinations of serum carcinoembryonic antigen in small cell lung cancer patients? Cancer. 1988 Oct 1;62(7):1348–1354. doi: 10.1002/1097-0142(19881001)62:7<1348::aid-cncr2820620718>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  12. Laberge F., Fritsche H. A., Umsawasdi T., Carr D. T., Welch S., Murphy W. K., Chiuten D. F., Dhingra H. M., Farha P., Spitzer G. Use of carcinoembryonic antigen in small cell lung cancer. Prognostic value and relation to the clinical course 1. Cancer. 1987 Jun 15;59(12):2047–2052. doi: 10.1002/1097-0142(19870615)59:12<2047::aid-cncr2820591214>3.0.co;2-9. [DOI] [PubMed] [Google Scholar]
  13. Lokich J. J. Plasma CEA levels in small cell lung cancer. Correlation with stage, distribution of metastases, and survival. Cancer. 1982 Nov 15;50(10):2154–2156. doi: 10.1002/1097-0142(19821115)50:10<2154::aid-cncr2820501030>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  14. North W. G., Ware J., Maurer L. H., Chahinian A. P., Perry M. Neurophysins as tumor markers for small cell carcinoma of the lung. A cancer and Leukemia Group B evaluation. Cancer. 1988 Oct 1;62(7):1343–1347. doi: 10.1002/1097-0142(19881001)62:7<1343::aid-cncr2820620717>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  15. O'Connor D. T., Deftos L. J. Secretion of chromogranin A by peptide-producing endocrine neoplasms. N Engl J Med. 1986 May 1;314(18):1145–1151. doi: 10.1056/NEJM198605013141803. [DOI] [PubMed] [Google Scholar]
  16. Sculier J. P., Feld R., Evans W. K., Shepherd F. A., DeBoer G., Malkin D. G., Malkin A. Carcinoembryonic antigen: a useful prognostic marker in small-cell lung cancer. J Clin Oncol. 1985 Oct;3(10):1349–1354. doi: 10.1200/JCO.1985.3.10.1349. [DOI] [PubMed] [Google Scholar]
  17. Shinkai T., Saijo N., Tominaga K., Eguchi K., Shimizu E., Sasaki Y., Fujita J., Futami H., Ohkura H., Suemasu K. Serial plasma carcinoembryonic antigen measurement for monitoring patients with advanced lung cancer during chemotherapy. Cancer. 1986 Apr 1;57(7):1318–1323. doi: 10.1002/1097-0142(19860401)57:7<1318::aid-cncr2820570711>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  18. Slevin M. L., Clark P. I., Joel S. P., Malik S., Osborne R. J., Gregory W. M., Lowe D. G., Reznek R. H., Wrigley P. F. A randomized trial to evaluate the effect of schedule on the activity of etoposide in small-cell lung cancer. J Clin Oncol. 1989 Sep;7(9):1333–1340. doi: 10.1200/JCO.1989.7.9.1333. [DOI] [PubMed] [Google Scholar]
  19. Sobol R. E., O'Connor D. T., Addison J., Suchocki K., Royston I., Deftos L. J. Elevated serum chromogranin A concentrations in small-cell lung carcinoma. Ann Intern Med. 1986 Nov;105(5):698–700. doi: 10.7326/0003-4819-105-5-698. [DOI] [PubMed] [Google Scholar]
  20. Souhami R. L., Law K. Longevity in small cell lung cancer. A report to the Lung Cancer Subcommittee of the United Kingdom Coordinating Committee for Cancer Research. Br J Cancer. 1990 Apr;61(4):584–589. doi: 10.1038/bjc.1990.131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Waalkes T. P., Abeloff M. D., Ettinger D. S., Woo K. B., Gehrke C. W., Kuo K. C., Borek E. Biological markers and small cell carcinoma of the lung: a clinical evaluation of urinary ribonucleosides. Cancer. 1982 Dec 1;50(11):2457–2464. doi: 10.1002/1097-0142(19821201)50:11<2457::aid-cncr2820501134>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  22. Woo K. B., Waalkes P., Abeloff M. D., Ettinger D. S., McNitt K. L., Gehrke C. W. Multiple biologic markers in the monitoring of treatment for patients with small cell carcinoma of the lung: the use of serial levels of plasma CEA and serum carbohydrates. Cancer. 1981 Oct 1;48(7):1633–1642. doi: 10.1002/1097-0142(19811001)48:7<1633::aid-cncr2820480727>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES