Summary:Recently CYFRA 21-1, a new tumour marker measuring a fragment of cytokeratin 19, was introduced (1,2) and proved to be suitable for the follow-up care and monitoring of the therapy of non-small cell lung carcinomas, especially squamous cell carcinomas of the lung (3, 4). Besides CYFRA 21-1, there are two other tumour markers available, called tissue polypeptide antigen (TPA) and tissue polypeptide specific antigen (TPS), which also measure different cytokeratins in serum. In a retrospective study we investigated the clinical significance of these 3 cytokeratin markers in lung cancer compared with carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and neuron-specific enolase (NSE). We investigated the sera of 50 healthy persons, 273 patients with various benign diseases and 218 patients with histologically proven lung cancer. In a first step the specificity versus benign diseases of the lung was established for all the markers, and was fixed at 95%. Then the single and combined sensitivities were calculated. CYFRA 21-1 proved to possess the highest sensitivity in lung cancer in general (61%), in non-small cell lung carcinomas (64%), in squamous cell carcinomas (79%), in adenocarcinomas (54%) and in large cell carcinomas (65%). In small cell lung carcinomas, neuron-specific enolase proved again to be the marker of first choice (55%). Combined determinations proved clearly increased sensitivity only for large cell carcinomas (CYFRA 21-1 + TPA: 77%) and for small cell lung carcinomas (CYFRA 21-1 + NSE: 62%). From our investigations it was evident that TPA detects at least partly the same substance as CYFRA 21-1 (the sensitivities compared with the markers TPS, CEA, SCC and NSE were rather high, but not as high as for CYFRA 21-1), whereas the TPS assay measures a completely different clinical chemical analyte (lowest number of true positive test results over the whole investigation). These findings correspond cleary to the very recent results of the comparison of CYFRA 21-1, TPA and TPS by immunoblotting (5).
Introduction_ ,, , ^.r-r-,^ * ~ * Recently a new tumour marker, called CYFRA 21-1, In many industrialized countries, lung cancer is the was described for the detection of cytokeratin 19-inost common cancer in men and is climbing quickly fragments in serum (1, 2). Cytokeratins and other toward the same incidence in women. Clinical chem-intermediate filaments of the cell like vimentin and ical methods for the support of adequate follow up desmin have become well known since the developcare and the control of efficiency of therapy are avail-ment of monoclonal antibodies in histopathology for able only for small cell lung carcinomas, and they the differentiation and classification of physiological consist of the determination of neuron specific enolase and pathological tissues (8, 9). The expression of a (6, 7).single cytokeratin or a combination of certain cyto-