CLINICAL-EVALUATION OF 7 TUMOR-MARKERS IN LUNG-CANCER DIAGNOSIS - CANANY COMBINATION IMPROVE THE RESULTS

In this study we compared the diagnostic utility of: (1) neuron-specif ic enolase (NSE); (2) squamous cell carcinoma antigen (SCC); (3) carci noembryonic antigen (CEA); and (4) cytokeratin markers (CYFRA 21-1, TP A, TPM, TPS) in patients with small-cell lung cancer (SCLC) (21 cases) and non-small-cell lung cancer (94 cases). For comparison we also stu died 66 patients with benign lung diseases and nine with pleural mesot helioma. NSE levels in SCLC patients were significantly higher than th ose in all the other groups studied. No significant variations were fo und among the SCC levels in all groups. CEA levels in patients with ad enocarcinoma were significantly higher than those in all other groups studied. CYFRA 21-1 serum levels significantly increased in patients w ith squamous cell carcinoma and mesothelioma, while TPA, TPS and TPM i ncreased in patients with lung cancer irrespective of the histological type. In patients with SCLC, high levels of all markers except SCC we re found when the disease was extensive. In patients with non-SCLC, th e highest levels of all tumour markers were usually found in those wit h 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 analy sis of receiver operating characteristic curves revealed that the high est 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 U l(-1), 3.0 pg l(-1), 2.0 mu g l(-1) and 75 U l(-1) respectively. When all patients were conside red, the combined evaluation of more than one marker did not significa ntly 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 rumours and that its combined determination with TPM did n ot worsen the overall sensitivity and specificity of the latter, the c ombined use of these two markers may be suggested as a useful took for the diagnosis of lung tumours.