Comparative analysis of serum levels of CA-50, CA-125, CA-19.9, enolase and CEA in bronchopulmonary cancer

A serum assay of CA-50, CA-125, CA-19.9, ENOLASE (NSE) and CEA was performed in 65 patients with primary lung cancer, 63% of whom had visceral metastases, with the following histological distribution: squamous carcinoma (40), adenocarcinoma (9), large cell carcinoma (4), oat cell carcinoma (12). A raised CEA level was detected in 37% of cases, compared with 40.6% for CA-50, 44.6% for CA-19.9 and 40.6% for CA-125 and only 26.6% for NSE. Overall, at least one marker was positive in 83% of cases. Statistical analysis of the different markers (correlation analysis and principal component analysis) demonstrated the existence of a strict correlation between the levels of CA-50, CEA and CA-19.9 (p less than 0.01). ENOLASE was more frequently elevated in oat cell carcinomas (42%) than in non-oat cell carcinomas (30%), but the difference was not significant. In contrast, CA-125 appears to be a good marker for non-oat cell carcinomas (51%) (p less than 0.05). The authors also found a correlation between the presence of a raised level of CA-50 (p less than 0.05), CA-125 (p less than 0.02) and especially CEA (p less than 0.001) and the presence of visceral metastases. The initial survey of disseminated lung cancers should include the assay of at least 4 of these markers in order to obtain a reliable serum tracer in more than 2/3 of cases.     

CA50、CEA、Cyfra21-1和SCC在肺癌患者中的表达及其临床意义

目的探讨血清肿瘤标志物CA50、CEA、Cyfra21-1和SCC在肺癌诊断中的价值。方法采用电化学发光法检测260例肺癌患者、65例肺良性病变患者及117例健康体检者血清CA50、CEA、Cyfra21-1和SCC的含量。结果肺癌患者CA50、CEA、Cyfra21-1和SCC在肺癌患者中的阳性率分别为46.9%、66.5%、57.7%和58.1%,显著高于肺部良性病变患者和健康对照组(P0.05)。CA50、CEA、Cyfra21-1和SCC小细胞肺癌患者较非小细胞肺癌患者表达水平低。CA50和CEA在肺腺癌高表达;而Cyfra21-1在肺鳞癌高表达。结论血清CA50、CEA、Cyfra21-1和SCC检测对于肺癌诊断敏感性和特异性强,并有助于判断病理类型。     

Sialyl Lewis X-i (SLX) in the bronchoalveolar lavage fluid from patients with lung cancer]

The measurement of serum SLX is thought to be a useful aid in the diagnosis of malignant diseases, particularly adenocarcinoma of the lung. In the present investigation, we measured and compared SLX values in BALF from affected and normal bronchi, obtained from 83 patients. They consisted of 64 males and 19 females, with mean age of 60 years, consisting of 8 normal controls, 19 cases of benign lung disease, and 56 cases of primary lung cancer. SLX value in BALF from normal bronchi was significantly higher in patients with lung cancer than in normal controls, but there was no significant difference in SLX value between lung cancer and benign lung disease. On the other hand, SLX value from affected bronchi was significantly higher in patients with lung cancer than in normal controls and patients with benign lung disease. The rate of elevated SLX in BALF from affected bronchi was significantly higher in patients with lung cancer than in those with benign lung disease. These results suggest that measurement of SLX levels in BALF from affected bronchi may be a useful method for differential diagnosis of primary lung cancer.     

A statistical analysis of serum sialyl Lewis X-1 (SLX), CEA, SCC and NSE levels in patients with lung cancer]

Serum SLX, CEA, SCC and NSE levels were serially measured in 266 patients with lung cancer and compared with those in 345 patients with benign respiratory disorders (BRD). The positive rate for CEA in lung cancer (44.4%) and the false-positive rate in BRD (15.3%) were the highest among the 4 markers. The positive rate for SLX in lung cancer (32.0%) was lower than that of CEA, while the false-positive rate for SLX in BRD (7.2%) was lower than that of CEA. The positive rate for SLX was highest in adenocarcinoma and correlated better with the clinical stages than did CEA. SCC and NSE were specifically elevated in squamous cell carcinoma and small cell carcinoma, respectively. Using these 4 markers, only 70.2% of patients were correctly diagnosed as having lung cancer or BRD. In monitoring treatment effect, only SLX showed a statistically significant correlation with regression and progression in adenocarcinoma, while NSE and SLX showed such a correlation in small cell carcinoma. Serum tumor markers seem to be less sensitive for the diagnosis of lung cancer than chest X-ray and sputum cytology, indicating that a search for more specific markers is still required. However, in monitoring treatment effect, SLX appeared to be suitable for adenocarcinoma, while NSE and SLX seemed to be useful in small cell carcinoma.     

Clinical significance of oncogene product expression in human lung cancer]

The clinical importance of ras oncogene product p21 was evaluated in surgically treated non-small cell lung cancer patients. Paraffin sections of tumors were analysed immunohistochemically using anti-ras p21 monoclonal antibody rp35. The ras p21 expression was correlated with clinicopathological parameters and survival. Survival analysis demonstrated significantly longer survival times in patients with p21-negative tumors than those with p21-positive tumors. In Cox's multivariate analysis, ras p21 expression was a major and independent prognostic determinant of survival. On the other hand, in small cell lung cancer, L-myc gene is known to be frequently amplified and overexpressed. Immunoprecipitation analysis of two small cell lung cancer cell lines (classic type) revealed three major L-myc proteins (p60, p66 and p68), all of which were derived from extensive phosphorylation of a p59 protein. Expression and phosphorylation of L-myc protein, as well as the autocrine growth mechanism of gastrin-releasing peptide (GRP), is thought to be involved in the malignant behavior of small cell lung cancer.     

Clinical significance of sialyl SSEA-1 (SLX) in patients with idiopathic interstitial pneumonia]

Serum SLX levels were measured in 29 patients with idiopathic interstitial pneumonia (IIP) to evaluate its clinical significance. Serum SLX had positive correlations with the BALF neutrophil ratio but not with the severity or the disease activity in patients with IIP, and bronchoalveolar lavage fluid (BALF) SLX had positive correlations with the BALF neutrophil count. Epithelial lining fluid (ELF) SLX levels showed positive correlations with serum SLX, but were much higher. These results suggest that increases of serum SLX may reflect increases of SLX in the lung tissues. Thus, we speculate that increases of the serum SLX level may represent increases of the BALF neutrophil count. Patients with higher SLX showed poor therapeutic responses and poor prognoses in comparison with those with normal SLX for the reason that serum SLX level represents BALF neutrophil level.     

Clinical significance of respiratory infections associated with lung cancer patients]

An attempt was made to interpret the clinical significance of secondary infections associated with lung cancer. The incidence of secondary infections was 51.4% in 214 in-patients with lung cancer in our institution in 1988 and 1989, and almost all of them had respiratory infections caused by commonly encountered bacteria. The incidence of infection was high in lung cancer of cell types other than adenocarcinoma, and in those with hypoalbuminemia, impaired cellular immunity and obstruction of the airway. The prognosis in patients with infection was much poorer than that in patients without infection. Major pathogens responsible for infection were Staphylococcus aureus including methicillin-resistant S. aureus (MRSA), Haemophilus influenzae, Klebsiella spp. and Pseudomonas aeruginosa. These pathogens, except for H. influenzae, were isolated in the terminal stage in cases with airway obstruction and post cancer chemotherapy. The efficacy rate of 194 therapeutic regimens against infection was 57.7%. It was thus found that the efficacy rate in 1988 and 1989 exceeded that in the 1970s. The effectiveness was very poor for infections caused by S. aureus and P. aeruginosa, and for cases with airway obstruction and marked impairment of pulmonary blood flow. The efficacy rate of single-drug regimens was 57.1% (80/140) and that of combined regimens was 59.3% (32/54). The above results indicate that a new combined therapy which includes a beta-lactam antibiotic as well as measures to improve the general health of compromised hosts are required in the treatment of secondary infections in these patients.     

PTEN蛋白及CD44V6在中老年NSCLC中的表达及意义

目的研究抑癌基因10q丢失的与张力蛋白同源的磷酸酶(PTEN)基因及CD44V6蛋白在中老年非小细胞肺癌(NSCLC)组织中的表达及意义。方法应用免疫组化染色方法分别检测50例中老年NSCLC组织和18例癌旁组织及20例正常肺组织中PTEN及CD44V6的表达水平。结果正常肺组织及癌旁组织PTEN蛋白阳性表达率明显高于NSCLC组织;高、中分化组明显高于低分化组;临床Ⅰ、Ⅱ期PTEN蛋白阳性率显著高于Ⅲ期;PTEN蛋白表达阳性患者生存率显著高于阴性患者。CD44V6蛋白在正常肺组织中不表达,肺鳞癌和肺腺癌中表达阳性率显著高于癌旁组织。CD44V6在临床Ⅲ期NTCLC中表达显著高于Ⅰ、Ⅱ期;CD44V6表达阳性者患者生存率低。结论PTEN/CD44V6的表达可能在中老年NSCLC的发生、发展和转移过程中扮演着重要的角色。PTEN蛋白表达降低与NSCLC的病理类型、临床分期、预后密切相关。     

Clinical significance of serum carcinoembryonic antigen in small cell lung cancer patients]

In this study, the clinical significance of serum carcinoembryonic antigen (CEA) level in small cell lung cancer patients was investigated. The relationship between serum CEA level before treatment and the effect of chemotherapy was analyzed. In 97 evaluable patients with small cell lung cancer, the 26 who had elevated CEA values of 10.0 ng/ml or greater at diagnosis tended to be resistant to intravenous systemic chemotherapy. In patients with limited disease (LD), survival time of 13 patients whose CEA levels were 10.0 ng/ml or greater was shorter than that of the other LD patients. These findings suggest that small cell lung cancer patients with high serum CEA levels are less responsive to standard chemotherapy, and serum CEA level may be able to identify biologically different tumors from common small cell cancer.     

Evaluation of CEA, CA 19-9, CA-50, CA-195, and TATI with special reference to pancreatic disorders.

The tumor markers CEA, CA 19-9, CA-50, CA-195, and TATI were analyzed in patients with pancreatic diseases as well as disorders in the upper quadrant of the abdomen. Two different methods for CA-50, namely CA-50 IRMA and CA-50 DELFIA, which are based on the same monoclonal antibody, were used. The sensitivities, specificities, and predictive values of positive and negative results were calculated at one, three, and ten multiples of the upper reference value ("cutoff") for each method. All the tumor markers except TATI had sensitivities exceeding 90% at one cutoff level, but CEA had low specificity. Poor sensitivities were observed for CEA and TATI at three cutoff levels, whereas CA 19-9, CA-50, and CA-195 had sensitivities and specificities greater than 80%. The sensitivities of these tumor markers decreased at 10 cutoff levels, although the specificities exceeded 95%. The predictive values of positive and negative results were also evaluated at these three cutoff levels. High scores were observed at three cutoff levels. Examined together with the sensitivity and specificity, the evaluation at three cutoff levels indicated that CA 19-9, CA-50, and CA-195 can be used in the diagnostic arsenal for the detection of cancer of the exocrine pancreas in symptomatic patients, and in the differential diagnosis between pancreatic cancer and chronic pancreatitis. Although CA-50 IRMA and CA-50 DELFIA are based on the same monoclonal antibody, there were substantial differences in the levels of CA-50 in a lot of the patients when samples were analyzed by the two methods. These differences were shown to be methodological, and they affected the test evaluations to some extent.     

The significance of the heparin precipitable fraction in lung diseases]

The authors recently experienced a case of idiopathic interstitial pneumonia (IIP) that exhibited skin ulcers due to increased heparin precipitable fraction (HPF) in plasma. This case prompted us to investigate the occurrence and significance of HPF in interstitial pneumonia (IP). The subjects included patients with IIP (acute exacerbation 6 cases, chronic active stage 12 cases), IP associated with collagen vascular disease (CVD) (9 cases) and granulomatous lung diseases (7 cases). The data indicated that all of the cases with acute exacerbation of IIP exhibited increased plasma HPF values (218-951 mg/dl) compared to those of normal controls (less than 180 mg/dl). In contrast, the values ranged within normal limits in all of the cases with IP associated with CVD. In a companion study, we measured plasma HPF values in patients with lung cancer, bacterial pneumonia and diffuse panbronchiolitis. It was found that 22% of the subjects showed increased plasma HPF values. We also investigated whether there were correlations between plasma HPF and various inflammatory parameters. The data revealed that there were correlations between HPF and ESR, CRP, alpha 1-globulin, alpha 2-globulin, complement (C3) or fibrinogen. However, there was no correlation between HPF and fibronection. These results suggest that plasma HPF is valuable to evaluate the acute exacerbation of IIP, although the elevation of plasma HPF levels is not specific.     

GST Caspase-3在非小细胞肺癌（NSCLC）中的表达及意义

目的探讨非小细胞肺癌（non-small-cell lung cancer）中谷胱甘肽S-转移酶-Л（glutathione transferase-ЛGST-Л）与半胱氨酸蛋白（Caspase-3）之问的关系以及他们的表达与意义。方法采用免疫组织化学法检测117例NSCLC中GST-Л的表达水平,流式细胞技术检测Caspase-3的表达;根据肿瘤耐药机制的不同,选择一个耐药元素与一个凋亡促进元素对肿瘤的耐药进行分析评估。结果GST-Л的阳性率明显高于对照组（P〈0．01）,GST-Л与肿瘤的分型、分期、转移均无关（P〉0．05）;在分化表达中随其恶性程度的增高而产生统计学意义。Caspase-3定量分析中,癌组与对照组、鳞癌与腺癌组、高中低分化组、淋巴转移与无淋巴转移组均有不同程度的统计学意义。结论GST-Л构成的肿瘤耐药与细胞凋亡不直接互为因果,结合Caspase-3定量分析,凋亡指数均有不同程度的衰减。     

P-gp和VEGF在肺癌组织中的表达及其预后意义

目的探讨P-糖蛋白(P-gp)、血管内皮生长因子(VEGF)在肺癌的临床意义。方法应用免疫组化检测40例化疗组和44例非化疗组的肺癌中P-gp、VEGF与生存率的关系。结果肺癌P-gp的阳性表达率为40.5%,VEGF的阳性表达率为67.9%;两者的表达呈正相关;化疗组中P-gp、VEGF表达阳性者化疗后其生存时间明显低于阴性表达者(P0.05);与肺癌的预后有明显的关系(P0.05)。结论P-gp与VEGF两者联合检测对肺癌患者化疗及预后的判断具有指导作用。     

第50例--双肺多发阴影

患者女性 ,48岁。 1995年查体时胸片发现“双肺多发阴影” ,无自觉症状 ,曾用青霉素治疗无效。 2 0 0 0年 8月复查胸片 (图 1,2 )及胸部ＣＴ(图 3,4)发现“双肺阴影增多”。以肺部阴影于 2 0 0 0年 9月 2 0日收住入院。查体 :浅表淋巴结无肿大 ,左侧中、下肺可闻及湿音 ,肝肋下触及。实验室检查 :白细胞 1 99× 10 9/Ｌ ,中性粒细胞 0 5 2 ,血红蛋白 136ｇ/Ｌ ,血小板 44× 10 9/Ｌ ,尿、粪常规 (- ) ,红细胞沉降率 78ｍｍ/1ｈ ,血ＩｇＭ 2 3ｇ/Ｌ ,呈单克隆异常增多 ,血轻链κ 2 46× 10 -1μｇ /Ｌ,δ 5 0 3× 10 -2 μｇ/Ｌ ,腹部Ｂ…     

埃兹蛋白和E-钙黏素在肺癌中的表达及意义

目的 通过检测埃兹蛋白(ezrin)和E-钙黏素(E-cadherin)在肺癌中的表达探讨其与肺癌侵袭和转移的关系.方法 采用免疫组织化学法检测52例肺癌组织和15例正常肺组织中埃兹蛋白和E-钙黏素的表达情况.结果 ①埃兹蛋白在52例癌组织中36例异常表达(69.2%)较15例正常肺组织中2例异常表达(13.3%)差异有显著性(P＜0.05),E-钙黏素在癌组织中4t例(78.8%)较正常肺组织中4例异常表达(26.7%),差异有显著性(P＜0.05);②其表达均与分化程度、临床分期、淋巴结转移有显著性差异(P＜0.05);③埃兹蛋白和E-钙黏素在肺癌中的表达呈负相关(r=-0.485,P＜0.01).结论 埃兹蛋白和E-钙黏素与肺癌的浸润和转移密切相关,并可作为肺癌临床判断转移、预后等生物学行为的重要参考指标.     

血清Pro-GRP和NSE检测在小细胞肺癌中的意义

目的探讨血清胃泌素释放肽前体（Pro-GRP）检测在小细胞肺癌诊断中的价值,并与神经元特异性烯醇酶（NSE）进行比较。方法采用电化学发光法检测68例小细胞肺癌,120例非小细胞肺癌,30例肺部良性疾病和150例健康人血清Pro-GRP和NSE的含量。结果小细胞肺癌患者血清Pro-GRP和NSE水平显著高于非小细胞肺癌、良性疾病组和健康人（P〈0.05）。Pro-GRP和NSE对在小细胞肺癌诊断的敏感性分别为80.9%和83.8%,特异性分别为90.2%和58.2%;Pro-GRP和NSE浓度在化疗后均下降;在复发/进展的患者中,Pro-GRP的阳性率显著高于NSE（85%vs50%,P〈0.05）。结论血清Pro-GRP检测对小细胞肺癌诊断敏感性和特异性强;还可以反映疗效,监测复发。     

EGFR在非小细胞肺癌组织中的表达及其初步临床意义

目的探讨表皮生长因子受体（EGFR）在非小细胞肺癌组织和癌旁正常肺组织中表达的临床意义。方法采用免疫组织化学SP三步法检测100例非小细胞肺癌（NSCLC）及与其相对应的100例癌旁正常肺组织中EGFR的表达,并分析其与临床病理特征的关系。结果 EGFR在肺癌组织中明显高于在癌旁正常肺组织中的表达,且差异具有统计学意义（P〈0.05）。EGFR的表达与肺癌组织的分化程度、有/无淋巴结转移及组织类型无关。结论 EGFR的高表达与NSCLC的发生发展有着密切的关系,EGFR的表达与NSCLC患者临床病理特征无关。