Tumor Markers (CEA, CA 125, CYFRA 21-1, SCC and NSE) in Patients with Non-Small Cell Lung Cancer as an Aid in Histological Diagnosis and Prognosis

Abstract

CEA, CA 125, SCC, CYFRA 21-1 and NSE were prospectively studied in 211 patients with non-small cell lung cancer and compared with clinical parameters (age, sex, Karnofsky Index, symptoms and smoking status), histopathological parameters (stage, histology, tumor size and nodal involvement), biological parameters (LDH and albumin) and the therapy used (surgery, chemotherapy or radiotherapy). Tumor marker sensitivity was CYFRA 21-1: 76%, CA 125: 55%, CEA: 52%, SCC: 33% and NSE: 22%. One of the tumor markers was abnormally high in 87% of the patients with locoregional disease and in 100% of the patients with metastases. Except for NSE, all tumor markers showed a clear relationship with tumor stage and histology and therefore enabled a better histological diagnosis. Abnormal CEA serum levels were mainly found in adenocarcinomas, CA 125 in large-cell lung cancers (LCLC) and adenocarcinomas and SCC in squamous tumors. Eighty-five percent of the patients with SCC levels >2 ng/ml had squamous tumors. Likewise, CA 125 levels <60 U/ml or CEA <10 ng/ml excluded adenocarcinoma or LCLC with a probability of 82 and 91%, respectively.

Serum-based protein biomarkers for detection of lung cancer

“…CYFRA 21-1 is a fragment of cytokeratin (CK) 19 expressed in many normal and malignant epithelial cells [78]. Early clinical studies have shown that elevated levels of serum CYFRA 21-1 were detected in patients with lung cancer [79][80][81]. Kosacka and Jankowska [82] concluded that in NSCLC patients with strong CK19 expression (+++) in tumor cells, there is a tendency to have lower CYFRA 21-1 levels in serum.…”

Prognostic and predictive value of CEA and CYFRA 21-1 levels in advanced non-small cell lung cancer patients treated with gefitinib or erlotinib

“…Patients with h-CYFRA 21-1 levels were more likely to have a history of smoking; however, this association was not significant (P=0.072). Previous studies have also reported that smoking has no effect on serum CYFRA 21-1 levels (31,32). Univariate and multivariate analyses demonstrated that CYFRA 21-1 levels higher than 3.3 ng/ ml had an independent negative impact on PFS (HR=1.93, 95% CI 1.09-3.44; P=0.025) and OS (HR=2.76, 95% CI 1.38-5.53; P=0.0004).…”

Biomarkers for the lung cancer diagnosis and their advances in proteomics

“…An oncofetal protein, carcinoembryonic antigen (CEA) concentration is elevated in lung cancer patients especially in adenocarcinoma and large cell lung cancer (LCLC) (46)(47)(48). CEA alone has limit to diagnosis and is preferably used in combination with CYFRA.…”