Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1995 Jul;72(1):170–173. doi: 10.1038/bjc.1995.296

Clinical evaluation of seven tumour markers in lung cancer diagnosis: can any combination improve the results?

M Plebani 1, D Basso 1, F Navaglia 1, M De Paoli 1, A Tommasini 1, A Cipriani 1
PMCID: PMC2034156  PMID: 7541234

Abstract

In this study we compared the diagnostic utility of: (1) neuron-specific enolase (NSE); (2) squamous cell carcinoma antigen (SCC); (3) carcinoembryonic antigen (CEA); and (4) cytokeratin markers (CYFRA 21-1, TPA, TPM, TPS) in patients with small-cell lung cancer (SCLC) (21 cases) and non-small-cell lung cancer (94 cases). For comparison we also studied 66 patients with benign lung diseases and nine with pleural mesothelioma. NSE levels in SCLC patients were significantly higher than those in all the other groups studied. No significant variations were found among the SCC levels in all groups. CEA levels in patients with adenocarcinoma were significantly higher than those in all other groups studied. CYFRA 21-1 serum levels significantly increased in patients with squamous cell carcinoma and mesothelioma, while TPA, TPS and TPM increased in patients with lung cancer irrespective of the histological type. In patients with SCLC, high levels of all markers except SCC were found when the disease was extensive. In patients with non-SCLC, the highest levels of all tumour markers were usually found in those with advanced disease, although CYFRA 21-1 gave a sensitivity of 44% when a specificity of 95% was fixed in stage I non-SCLC patients. An analysis of receiver operating characteristic curves revealed that the highest diagnostic accuracies in distinguishing benign from malignant lung diseases were achieved with TPM (81%), CYFRA 21-1 (72%), CEA (78%) or TPA (78%) when using cut-off values of 46 Ul-1, 3.0 micrograms l-1, 2.0 micrograms l-1 and 75 Ul-1 respectively. When all patients were considered, the combined evaluation of more than one marker did not significantly improve the results obtained with TPM alone. However, taking into consideration the fact that CYFRA 21-1 is the most sensitive index of early lung tumours and that its combined determination with TPM did not worsen the overall sensitivity and specificity of the latter, the combined use of these two markers may be suggested as a useful took for the diagnosis of lung tumours.

Full text

PDF
170

Selected References

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

  1. Bergman B., Brezicka F. T., Engström C. P., Larsson S. Clinical usefulness of serum assays of neuron-specific enolase, carcinoembryonic antigen and CA-50 antigen in the diagnosis of lung cancer. Eur J Cancer. 1993;29A(2):198–202. doi: 10.1016/0959-8049(93)90174-e. [DOI] [PubMed] [Google Scholar]
  2. Broers J. L., Ramaekers F. C., Rot M. K., Oostendorp T., Huysmans A., van Muijen G. N., Wagenaar S. S., Vooijs G. P. Cytokeratins in different types of human lung cancer as monitored by chain-specific monoclonal antibodies. Cancer Res. 1988 Jun 1;48(11):3221–3229. [PubMed] [Google Scholar]
  3. Carney D. N., De Leij L. Lung cancer biology. Semin Oncol. 1988 Jun;15(3):199–214. [PubMed] [Google Scholar]
  4. Ebert W., Dienemann H., Fateh-Moghadam A., Scheulen M., Konietzko N., Schleich T., Bombardieri E. Cytokeratin 19 fragment CYFRA 21-1 compared with carcinoembryonic antigen, squamous cell carcinoma antigen and neuron-specific enolase in lung cancer. Results of an international multicentre study. Eur J Clin Chem Clin Biochem. 1994 Mar;32(3):189–199. [PubMed] [Google Scholar]
  5. Gion M., Mione R., Barioli P., Sartorello P., Capitanio G. Tissue polypeptide antigen and tissue polypeptide specific antigen in primary breast cancer. Evaluation in serum and tumour tissue. Eur J Clin Chem Clin Biochem. 1994 Oct;32(10):779–787. doi: 10.1515/cclm.1994.32.10.779. [DOI] [PubMed] [Google Scholar]
  6. Harding M., McAllister J., Hulks G., Vernon D., Monie R., Paul J., Kaye S. B. Neurone specific enolase (NSE) in small cell lung cancer: a tumour marker of prognostic significance? Br J Cancer. 1990 Apr;61(4):605–607. doi: 10.1038/bjc.1990.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Järvisalo J., Hakama M., Knekt P., Stenman U. H., Leino A., Teppo L., Maatela J., Aromaa A. Serum tumor markers CEA, CA 50, TATI, and NSE in lung cancer screening. Cancer. 1993 Mar 15;71(6):1982–1988. doi: 10.1002/1097-0142(19930315)71:6<1982::aid-cncr2820710610>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  8. Jørgensen L. G., Osterlind K., Hansen H. H., Cooper E. H. Serum neuron specific enolase (NSE) is a determinant of response duration in small cell lung cancer (SCLC). Br J Cancer. 1992 Sep;66(3):594–598. doi: 10.1038/bjc.1992.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lazarides E. Intermediate filaments as mechanical integrators of cellular space. Nature. 1980 Jan 17;283(5744):249–256. doi: 10.1038/283249a0. [DOI] [PubMed] [Google Scholar]
  10. Moll R., Franke W. W., Schiller D. L., Geiger B., Krepler R. The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells. Cell. 1982 Nov;31(1):11–24. doi: 10.1016/0092-8674(82)90400-7. [DOI] [PubMed] [Google Scholar]
  11. Pujol J. L., Grenier J., Daurès J. P., Daver A., Pujol H., Michel F. B. Serum fragment of cytokeratin subunit 19 measured by CYFRA 21-1 immunoradiometric assay as a marker of lung cancer. Cancer Res. 1993 Jan 1;53(1):61–66. [PubMed] [Google Scholar]
  12. Stieber P., Dienemann H., Hasholzner U., Müller C., Poley S., Hofmann K., Fateh-Moghadam A. Comparison of cytokeratin fragment 19 (CYFRA 21-1), tissue polypeptide antigen (TPA) and tissue polypeptide specific antigen (TPS) as tumour markers in lung cancer. Eur J Clin Chem Clin Biochem. 1993 Oct;31(10):689–694. doi: 10.1515/cclm.1993.31.10.689. [DOI] [PubMed] [Google Scholar]
  13. Stieber P., Hasholzner U., Bodenmüller H., Nagel D., Sunder-Plassmann L., Dienemann H., Meier W., Fateh-Moghadam A. CYFRA 21-1. A new marker in lung cancer. Cancer. 1993 Aug 1;72(3):707–713. doi: 10.1002/1097-0142(19930801)72:3<707::aid-cncr2820720313>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  14. van der Gaast A., Schoenmakers C. H., Kok T. C., Blijenberg B. G., Cornillie F., Splinter T. A. Evaluation of a new tumour marker in patients with non-small-cell lung cancer: Cyfra 21.1. Br J Cancer. 1994 Mar;69(3):525–528. doi: 10.1038/bjc.1994.95. [DOI] [PMC free article] [PubMed] [Google Scholar]

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

RESOURCES