Differences in initial NSE levels in malignant and benign diseases of the thoracic wall

BACKGROUND

Neuron-specific enolase (NSE) is widely used to follow-up patients with small cell lung cancer (SCLC). Since the NSE level can be influenced by a broad range of diseases and disorders a large study should be done to assess its level in various lung and non-lung tumors and benign diseases.

METHODS

This research included 328 SCLC patients, 717 non-small cell lung cancer (NSCLC), 50 other thoracic cancers such as tumors of the mediastinum and mesothelioma, 35 non-pulmonary cancers like esophagus, breast and stomach cancer, 205 benign diseases, and 37 healthy individuals. The serum level of NSE was measured at initial diagnosis prior to therapy using electrochemiluminescence immunoassay (ECLIA, Roche Diagnostics).

RESULTS

The high levels of NSE in SCLC differed significantly from all other groups. The results imply very good sensitivity of NSE in SCLC and good discriminatory power of NSE between SCLC and NSCLC.

CONCLUSIONS

The NSE level in SCLC differs significantly from all other tested groups (p < 0.01). The highest values are seen in SCLC extensive disease. ROC curves revealed good discriminatory power of the initial NSE levels separating SCLC from other lung lesions. NSE can be used as a diagnostic tool for the early recognition of the neuroendocrine component of lung tumors and follow-up of SCLC patients.

Elevated serum C-reactive protein as a prognostic marker in small cell lung cancer

PURPOSE

Elevated C-reactive protein (CRP) is associated with poor prognosis in several tumor types. The purpose of this study was to investigate serum CRP as a prognostic marker in small cell lung cancer (SCLC).

MATERIALS AND METHODS

The pretreatment serum CRP level was measured in 157 newly diagnosed SCLC patients, and correlation between serum CRP level and other clinical parameters was analyzed. Multivariate analyses were performed to find prognostic markers using Cox's proportional hazards model.

RESULTS

The initial CRP concentration was within the normal range in 72 (45.9%) patients and elevated in 85 (54.1%) patients. There was a significant correlation between serum CRP level and the extent of disease (p<0.001), weight loss (p=0.029) and chest radiation (p=0.001). Median overall survival (OS) in the normal CRP group was significantly longer than with the high CRP group (22.5 months vs. 11.2 months, p<0.001). Extent of disease (p<0.001), age (p=0.025), and performance status (p<0.001) were additional prognostic factors on univariate analysis. On multivariate analysis, elevated serum CRP level was an independent prognostic factor for poor survival (HR=1.8; p=0.014), regardless of the extent of disease (HR=3.7; p<0.001) and performance status (HR=2.2; p<0.001).

CONCLUSION

High level of CRP was an independent poor prognostic serum marker in addition to previously well-known prognosticators in patients with SCLC.

Comparison of C-reactive protein levels in patients with lung cancer and chronic obstructive pulmonary disease

OBJECTIVE

The aim of this study was to establish C-reactive protein (CRP) levels in serum of patients with lung cancer and chronic obstructive pulmonary disease (COPD) and evaluate the associations of CRP levels with clinicopathological characteristics.

MATERIALS AND METHODS

In total, 140 persons were included in the study: 43 patients with lung cancer, 34 patients with lung cancer and COPD, 42 patients with COPD, and 21 healthy subjects. CRP analysis was performed with a serum protein analyzer using commercially available high-sensitivity reagent kits.

RESULTS

The C-reactive protein levels were significantly higher in the lung cancer patients with or without COPD compared with the COPD patients or the control group (20.42±1.95 and 22.49±2.31 vs. 8.37±0.91 and 2.49±0.47 mg/L, respectively; P<0.01). The patients with advanced lung cancer had higher CRP levels compared with the patients suffering from early stage lung cancer (23.11±1.72 vs. 14.59±2.23 mg/L, P<0.01). The CRP levels were significantly higher in the patients with early stage lung cancer compared with the COPD patients (14.59±2.23 mg/L vs. 8.37±0.91 mg/L, P<0.05). No association was found between CRP and histology, lung function, and smoking status in the patients with lung cancer.

CONCLUSIONS

Chronic inflammation plays an important role in both diseases: lung cancer and COPD. However, it seems that inflammation is more pronounced in patients with lung cancer, as the CRP levels were significantly higher in these patients than other groups.

[Detection and diagnostic value of serum carcinoembryonic antigen and cytokeratin 19 fragment in lung cancer patients]

OBJECTIVE

To explore the diagnostic value of carcinoembryonic antigen (CEA) and cytokeratin-19-fragment (CYFRA21-1) in lung cancer patients.

METHODS

The levels of serum CEA and CYFRA21-1 were measured in 102 patients with lung cancer, 45 patients with benign lung disease and 36 health controls by electrochemiluminescence.

RESULTS

The level of serum CEA and positive rate [(25.77 ± 15.34) ng/ml, 47.1%] were significantly higher in the lung cancer group than that in the benign lung disease group [(4.67 ± 2.21) ml, 7.7%; P < 0.05] and controls [(3.98 ± 3.00) ng/ml, 3.8%; P < 0.05], The level of serum CYFRA21-1 and positive rate [(14.08 ± 8.34) ng/ml, 62.7%] were also significantly higher in the lung cancer group than that in the benign lung disease group [(3.27 ± 2.87) ml, 7.7%; P < 0.05] and controls [(2.69 ± 2.02 ng/ml, 3.8%; P < 0.05]. The difference of level of CEA and CYFRA21-1 between the benign lung disease group and controls was statistically not significant (P > 0.05). Both tumor markers were increased to a different degree in the lung cancer patients at various TNM stages [(CEA: stage II (17.78 ± 8.71) ng/ml, stage III (25.84 ± 7.34) ng/ml, stage IV (34.85 ± 6.99) ng/ml; and CYFRA21-1: stage II (10.05 ± 6.76) ng/ml, stage III (15.93 ± 6.66) ng/ml, stage IV (22.78 ± 4.12) ng/ml]. Combined use of both makers showed a significant higher sensitivity (77.5% vs. 47.1%, 62.8%), but reduced specificity (86.8% vs. 94.0%, 95.6%), and not significantly changed accuracy (83.5% vs. 77.1%, 83.8%) in the diagnosis of lung cancer.

CONCLUSIONS

CEA and CYFRA21-1 employed separately are helpful in the diagnosis of lung cancer. Combined detection of these two tumor markers can improve the positivity for diagnosis of lung cancer.

[The value of plasma pro-gastrin-releasing peptide, cytokeratin 19-fragments and carcinoembryonic antigen in patients with lung cancer]

OBJECTIVE

To evaluate the value of plasma ProGRP, CYFRA 21-1 and CEA in patients with lung cancer.

METHODS

The levels of plasma ProGRP, CYFRA 21-1 and CEA were detected in 85 healthy control, 49 benign lung diseases and 143 lung neoplasms. The levels of ProGRP in the patients with SCLC was monitored.

RESULTS

The level of plasma ProGRP in SCLC (M 179.1 ng/ml) was significantly higher than adenocarcinoma (M 35.3 ng/ml), squamous-cell carcinoma (M 33.3 ng/ml), healthy control (M 35.6 ng/m) and benign lung diseases (M 33.3 ng/m), P < 0.001. The sensitivity and specificity for diagnosing SCLC by ProGRP were 60.6% and 95.0% respectively. In the effective treatment group, ProGRP reduced 45.9%, in the progression group, ProGRP increased 103.1%, P < 0.05. The level of CEA in the metastatic adenocarcinoma (M 10.22 ng/ml) was significantly higher than non-metastatic adenocarcinoma (M 3.85 ng/ml) and squamous cell carcinoma (M 2.56 ng/ml) (P < 0.01).

CONCLUSION

The plasma ProGRP is a good indicator for diagnosing and evaluating cure effect in SCLC; the high expression of CEA is related to the metastatic adenocarcinoma.

Phenotypes and serum level of alpha-1-antitrypsin in lung cancer

PURPOSE

Alpha-1-antitrypsin (AAT) as the major circulating inhibitor of proteases has important role in protease-antiprotease homeostasis. Recent studies have confirmed its antiapoptotic role. AAT is a highly polymorphic protein. Individuals with normal variants have normal serum levels and functional activity of ATT. However, individuals with hereditary AAT deficiency (AATD) have low circulating levels of AAT. Severe AATD was identified as genetic risk factor for early onset of pulmonary emphysema. Association between AAT phenotypes and lung cancer (LC) is not clear, and different studies show contradictory results. The aim of this case-control study was to investigate phenotypes and serum level of AAT in LC.

METHODS

The study group included 147 patients with LC, classified as small cell lung cancer (SCLC, n=42) and non-small cell lung cancer (NSCLC, n=105). The control group consisted of 273 healthy blood donors. AAT phenotyping was performed by isoelectric-focusing and AAT concentration was measured using nephelometry.

RESULTS

There were no differences in the frequencies of AAT phenotypes and alleles between the control group and LC patients, as well as between NSCLC and SCLC groups. An elevated level of AAT was obtained in LC patients. PiMZ and PiMS phenotypes in LC patients were not deficient in the classical sense. AAT levels were 90 and 134%, respectively, when compared to PiMM phenotype in the control group.

CONCLUSION

Our findings revealed that moderate deficiency of AAT is not risk factor for LC development. Although polymorphism of AAT was not associated with risk of LC, further research of this antiprotease and antiapoptotic protein could clarify its role in carcinogenesis, given its high concentration in LC patients, even in AATD patients.

Lung cancer signatures in plasma based on proteome profiling of mouse tumor models

We investigated the potential of in-depth quantitative proteomics to reveal plasma protein signatures that reflect lung tumor biology. We compared plasma protein profiles of four mouse models of lung cancer with profiles of models of pancreatic, ovarian, colon, prostate, and breast cancer and two models of inflammation. A protein signature for Titf1/Nkx2-1, a known lineage-survival oncogene in lung cancer, was found in plasmas of mouse models of lung adenocarcinoma. An EGFR signature was found in plasma of an EGFR mutant model, and a distinct plasma signature related to neuroendocrine development was uncovered in the small-cell lung cancer model. We demonstrate relevance to human lung cancer of the protein signatures identified on the basis of mouse models.

[CPT-11 chemotherapy for a hemodialysis patient with small-cell lung cancer]

We report a hemodialysis patient with extensive small-cell lung cancer who was administered CPT-11(50mg/m2)chemotherapy and achieved a partial response after four courses of chemotherapy. Hemodialysis was performed 24 hours after the first course of CPT-11 was completed. Because the patient developed thrombocytopenia and pneumonia, hemodialysis was performed 4 hours following the second course of chemotherapy, after which grade III bone marrow suppression was observed. The plasma concentrations of CPT-11 and its metabolic products(SN-38 and SN-38G)were measured during both courses. A pharmacokinetic study showed that the plasma concentration of CPT-11 after the first course was relatively high, and that the kinetics was similar to that in a non-dialysis case. However, 4 hours after hemodialysis, the concentrations of CPT-11 and SN-38G were re-elevated, and showed a sustained level higher than that obtained 24 hours after hemodialysis. Further study is needed to determine the optimal dosages of CPT-11, and the best time to conduct hemodialysis for chronic cancer patients requiring it.

Diagnostic value of tumor marker pro-gastrin-releasing peptide in patients with small cell lung cancer: a systematic review

BACKGROUND

Lung cancer is one of the most common malignancies in the world and one of the leading cancers that result in death. The aim of this study was to evaluate and compare the diagnostic value of the serum tumor marker pro-gastrin-releasing peptide 31-98 (ProGRP31-98) to pathological diagnosis as reference standard in patients with suspected small cell lung cancer (SCLC).

METHODS

Literature searches covering 1978 through to 2009 were performed in Pubmed, OVID, MEDLINE, EMbase, Cancerlit, China National Knowledge Infrastructure (CNKI), and CBM using the key search words; 'small cell lung cancer', 'tumor marker', 'ProGRP31-98' and 'diagnostic tests', 'ELISA', 'EIA' and 'diagnostic accuracy'. Studies were collected and data analyzed to evaluate the diagnostic value of serum ProGRP31-98 levels for the diagnosis of SCLC compared with pathology. Eligibility criteria for inclusion in the analysis were based on criteria for diagnostic research published by the Cochrane Screening and Diagnostic Tests

METHODS

Group (SDTMG). The characteristics of the included articles were appraised and the data were extracted from the original articles for further statistical analysis of study heterogeneity using Review Manager 4.2 software. Based on study heterogeneity analysis, a suitable 'effect' model was selected to calculate pooled sensitivity and specificity by meta-analysis. A Summary Receiver Operating Characteristic (SROC) curve and the area under the curve (AUC) were generated and sensitivity analysis conducted.

RESULTS

A total of 22 articles were entered into this meta-review, including 11 English articles with a quality at level C. In total, the studies involved 6759 subjects, of which 1470 were diagnosed with SCLC by pathology, and 5289 subjects diagnosed with non-SCLC (NSCLC). The meta-analysis showed that heterogeneity among studies was high (P = 0.00001, I(2) = 86.8%). With ELISA, the pooled sensitivity was 0.72 (0.70 to 0.75 at 95%CI) and the pooled specificity was 0.93 (0.92 to 0.94 at 95%CI); the SROC and the AUC were 0.8817. These data suggest that ProGRP31-98 has a relatively high rate of missed diagnosis (28%), but a relatively low rate of misdiagnosis (7%).

CONCLUSION

From meta-analysis, we concluded that serum ProGRP31-98 is a valuable marker with a high specificity for diagnosis of SCLC with a similar diagnostic accuracy to pathology.

Plasma proGRP concentration is sensitive and specific for discriminating small cell lung cancer from nonmalignant conditions or non-small cell lung cancer

To date, most clinical data on pro-gastrin-releasing peptide (proGRP) have been based on serum concentrations. This study evaluated the agreement between proGRP levels in fresh serum and plasma in patients with various lung diseases. Pairs of serum and EDTA plasma were collected from 49 healthy individuals. At the same time, EDTA plasma of 118 lung cancer patients and 23 patients with benign pulmonary diseases were prospectively collected. Compared to serum, plasma proGRP concentrations were higher by an average of 103.3%. Plasma proGRP was higher in malignancy (336.4 ± 925.4 pg/mL) than in benign conditions (40.1 ± 11.5 pg/mL). Small cell lung cancer (SCLC) patients showed higher levels of proGRP (1,256.3 ± 1,605.6 pg/mL) compared to other types of lung cancer. Based on the ROC curve analyses at a specificity of 95%, the diagnostic sensitivity of plasma proGRP was estimated to be 83.8% in distinguishing SCLC from all the other conditions, and 86.5% for discriminating SCLC from the nonmalignant cases. Among the SCLC cases, limited stage disease had lower levels of plasma proGRP than extensive disease. When measuring circulating levels of proGRP, the use of plasma is preferred over serum. Plasma proGRP has a potential marker for discriminating SCLC from nonmalignant conditions or non-small cell lung cancer.

Glutathione S-transferase P1 polymorphisms are associated with time to tumor progression in small cell lung cancer patients

PURPOSE

Many of commonly used chemotherapeutics in lung cancer treatment are metabolized by glutathione-S transferases (GSTs). The placental isoform of GST (GSTP1) is the most abundant isoform in the lung. Polymorphisms within the GSTP1 may result in alterations in enzyme activity and change sensitivity to platinum-based chemotherapy. We investigated whether the polymorphism within the exons 5 and 6 of GSTP1 gene may change response to therapy, time to tumor progression (TTP) and overall survival in small cell lung cancer (SCLC) patients.

METHODS

Ninety-four histologically confirmed patients with SCLC were enrolled in this study during 1995-2006. GSTP1 Ile105Val polymorphism in exon 5 and GSTP1 Ala- 114Val polymorphism in exon 6 were determined by using PCR-RFLP techniques. Associations between the GSTP1 polymorphisms and treatment response were evaluated using the chi-square test. Associations between the GSTP1 polymorphisms and TTP and overall survival were compared using Kaplan-Meier survival curves.

RESULTS

We found no significant associations between exon 5 and exon 6 GSTP1 gene polymorphisms and response to therapy or overall survival. Patients carrying both variant exon 5 (Ile/Val or Val/Val) and variant exon 6 (Ala/Val) genotypes had significantly shorter TTP (5 vs. 8 months, p = 0.04). Moreover, patients with heterozygote exon 6 variant had presented with extensive-stage disease.

CONCLUSION

No individual effect of variant alleles was found in relation to chemotherapy response, median TTP and overall survival. The carriage of both types of variant alleles may predict worse outcome.

Increased microcirculation in subepithelial invasion of lung cancer

BACKGROUND AND OBJECTIVE

Mucosal irregularity and hypervascularity associated with primary lung cancer in large airways are observed by bronchoscopy. The aim of this study was to evaluate microcirculation at subepithelial invasion sites of lung cancer.

METHODS AND PATIENTS

Between July 2001 and June 2007, 12 patients who had subepithelial invasion sites of lung cancer in the large airways (aged 52 to 74 years, 12 males) were enrolled into this study. They were 6 patients with adenocarcinoma, 4 patients with squamous cell carcinoma, and 2 patients with small cell carcinoma. We compared 12 control subjects without endobronchial abnormality (aged 51 to 83 years, 9 males and 3 females). The patients underwent conventional bronchoscopy and subsequent high magnification bronchovideoscopy with the conventional imaging and the narrow band imaging (NBI). For evaluating microcirculation of subepithelial invasion, hemoglobin index was calculated.

RESULTS

In high magnification view, aberrant microvessels and/or irregular mucosal thickening were observed at subepithelial invasion sites of lung cancer. Irregularly enlarged microvessels were increased and formed an aberrant microvessel network on the surface of irregular mucosa. The diameter of aberrant microvessels was significantly increased compared to normal microvessels. By switching to NBI, the aberrant microvessels were more clearly visualized. The levels of hemoglobin index were significantly higher in subepithelial invasion sites of lung cancer compared to normal mucosa.

CONCLUSION

In subepithelial invasion of lung cancer, aberrant microvessels are thought to be characteristic and subepithelial microcirculation may be increased.

Effects of ABO and FUT2 genetic transcription absence on ABH histo-blood group antigen expression in lung cancer patients

PURPOSE

To investigate the effect of alterations in mRNAs of ABO and FUT2 genes on the expression of ABH histo-blood group antigens in lung cancer patients.

METHODS

Totals of 18 patients with blood group A, 14 with group B, 8 with group AB and 9 with group O, were assessed for blood group A/B/H antigens by immunohistochemical staining. Expression of A/B enzyme and FUT2 mRNA was detected in tumor tissues and corresponding lung tissues adjacent to tumors from lung cancer patients using RT-PCR.

RESULTS

Expression of FUT2 and A/B enzyme mRNA in lung tissue adjacent to tumors was statistically greater than that in tumor tissues (χ2=14.118, P<0.001). Expression of FUT2 mRNA was statistically lower than that of A/B enzyme in tumor tissues from lung cancer patients whose blood group was A/B/AB (χ2=7.813, P=0.005). Only tumor tissues from 9 patients with mRNA expression of A/B enzyme and FUT2 gene lacked blood group antigens. In particular, expression of A/B antigens was not detected in five cases with A/B mRNA expression, a significant association being observed between the expression of enzyme and antigens (Pearson's R=0.867;kappa's coefficient =0.858, P<0.001).

CONCLUSION

Expression of A/B/H blood group antigens was not detected in lung cancer tissues, which may have resulted from down-regulation of ABO/FUT2 gene transcription. Furthermore, the FUT2 gene may indirectly regulate expression of A/B blood group antigens by influencing H antigen expression.

Evaluation of chromogranin A determined by three different procedures in patients with benign diseases, neuroendocrine tumors and other malignancies

CgA is a tumor marker in NET's (neuroendocrine tumors) but different ranges of sensitivity and specificity according to the commercial assay kits used have been reported. Our aim was to compare three commercial available assay kits that use three different methodologies (IRMA, RIA and ELISA) to determine CgA, in a clinical setting: 52 healthy people, 98 patients with benign diseases, 94 patients with non-NET´s malignancies, 20 SCLC and in 79 patients with NET's.

RESULTS

Using a cut-off with a 100% specificity in healthy people (6 nmol/L, 60 ng/ml, and 90 ng/ml, for RIA, ELISA and IRMA, respectively), abnormal serum concentrations of CgA were found in a high proportion of patients with renal failure (76.7% ,86,7% and 93.3% with ELISA; IRMA and RIA, respectively) other benign diseases (excluding patients with creatinine concentrations > 1.5 mg/dl)(40,3%, 50% and 53,2% with ELISA, IRMA and RIA, respectively) or in patients with non-NET´s malignancies (excluding SCLC and patients with renal failure) (59,8% ELISA, 55,4%% IRMA, 37% RIA). The highest CgA sensitivity in SCLC was obtained with ELISA (100%) and in NET´s with ELISA (83.3%) and IRMA (80.3%) (RIA 65.2%). ROC curves comparing healthy people and NET´s or NET´s- benigns showed a significantly higher area under the curve (AUC) with ELISA (0.964 and 0.774), or IRMA (0.955 and 0.785), and smaller with RIA (0,806 and 0.691).

CONCLUSIONS

CgA is not a specific tumormarker and abnormal concentrations may be found in non-NET´s. The higher AUC, sensitivity and specificity obtained with the ELISA and IRMA indicates that these are the best techniques to determine CgA.

[Severe hypercortisolaemia associated with progression of small cell lung cancer]

Small cell lung cancer accounts for about 15% of all cases of lung cancer and is a highly chemo-sensitive disease, but with a high rate of relapse following induction chemotherapy. Small cell lung cancer is often associated with various paraneoplastic syndromes, and we present a case where progression was dominated by a severe endocrine disorder, and present how treatment with the correct chemotherapy improved the patients clinical and biochemical condition.

IL-6 and VEGF in small cell lung cancer patients

Recent data suggest a link between chronic inflammation, angiogenesis, and the development of cancer. The aim of this study was the evaluation of serum IL-6 and VEGF in comparison with the tumor markers NSE and ProGRP, with respect to the prognosis of small cell lung cancer patients. The study of IL-6, VEGF, NSE, ProGRP and platelet count was performed in a group of 72 patients with previously untreated small cell lung cancer at different stages of disease: 40 with limited and 32 with extensive disease. Significantly higher IL-6 and VEGF concentrations and platelet count, as well as NSE and ProGRP levels, were found in patients with small cell lung cancer in comparison with the reference group. Patients with extensive cancer had significantly higher levels of IL-6, VEGF, NSE and ProGRP than those with limited cancer. Elevated VEGF levels, with no significant differences in frequency of elevated NSE and ProGRP concentrations, were often observed in patients with IL-6 levels higher than 5.1 ng/l. Univariate analysis confirmed a significant relationship not only between overall survival and stage of disease or gender, but also with VEGF, IL-6, NSE and ProGRP levels. Moreover, multivariate analysis revealed that only the extent of the disease and IL-6 may be independent prognostic factors in the group of small cell lung cancer patients under investigation. However, simultaneous determinations of ProGRP and IL-6, as well as ProGRP and VEGF, in addition to the extent of the disease, may serve as additional, independent prognostic factors in small cell lung cancer.

[Association between the erythrocyte sedimentation rate, serum C-reactive protein and risk of lung cancer]

OBJECTIVE

To explore the association between the erythrocyte sedimentation rate, serum C-reactive protein (CRP) and the risk of lung cancer.

METHODS

One hundred and three patients with newly diagnosed lung cancer and 85 homochronous hospitalized patients with chronic respiratory diseases (including chronic obstructive pulmonary disease, asthma, bronchiectasis and pulmonary fibrosis) were included in this study. ESR, serum levels of CRP, CEA, CA19-9 and CA125 were analyzed in the two groups before the initiation of any therapy after hospitalization. The association with clinicopathological characteristics of lung cancer and the risk of lung cancer were estimated by logistic regression.

RESULTS

Both the ESR and CRP levels were significantly higher in the lung cancer group, as compared with that in the chronic respiratory diseases group (P < 0.001). There was no significant association of ESR and CRP with lung cancer stage and type. Spearman correlation analysis showed a positive correlation between ESR and CRP (r = 0.56, P < 0.001), ESR and CA125 (r = 0.33, P < 0.001), and CRP and CA125 (r = 0.32, P < 0.001). The results of multivariate logistic analysis showed that the level of CRP was associated with an increased risk of lung cancer. Adjusting the confounding factors such as age, gender and smoking condition, the risk increased along with the elevation of CRP. Compared with the first quantile patients, the risk of the second quantile patients increased twice (OR: 2.46, 95%CI: 1.16 - 5.20), the risk of the third quantile patients increased ten-fold (OR: 10.52, 95%CI: 4.40 - 25.18).

CONCLUSION

The level of CRP is associated with an increased risk of lung cancer. The results of this study suggest that early detection of CRP may have a potential predicting value for high risk group of lung cancer.

Phase II study of cisplatin plus etoposide and bevacizumab for previously untreated, extensive-stage small-cell lung cancer: Eastern Cooperative Oncology Group Study E3501

PURPOSE

To investigate the efficacy and safety of bevacizumab plus cisplatin and etoposide in patients with extensive-stage disease, small-cell lung cancer (ED-SCLC).

PATIENTS AND METHODS

In this phase II trial, 63 patients were treated with bevacizumab 15 mg/kg plus cisplatin 60 mg/m(2) and etoposide 120 mg/m(2), which was followed by bevacizumab alone until death or disease progression occurred. The primary end point was the proportion of patients alive at 6 months without disease progression (ie, progression-free survival [PFS]). Secondary end points included overall survival (OS), objective response rate, and toxicity. Correlative studies were performed to explore the relationship between baseline and changes in plasma vascular endothelial growth factor (VEGF), soluble cell adhesion molecules (ie, vascular cell adhesion molecule [VCAM], intercellular cell adhesion molecule [ICAM], and E-selectin) and basic fibroblast growth factor and outcome.

RESULTS

The 6-month PFS was 30.2%, the median PFS was 4.7 months, and OS was 10.9 months. The response rate was 63.5%. The most common adverse event was neutropenia (57.8%). Only one patient had grade 3 pulmonary hemorrhage. Patients who had high baseline VCAM had a higher risk of progression or death compared with those who had low baseline VCAM levels. No relationships between outcome and any other biomarkers were seen.

CONCLUSION

The addition of bevacizumab to cisplatin and etoposide in patients with ED-SCLC results in improved PFS and OS relative to historical controls who received this chemotherapy regimen without bevacizumab. This regimen appears to be well tolerated and has minimal increase in toxicities compared with chemotherapy alone. Baseline VCAM levels predicted survival, but no other relationships among treatment, biomarkers, and outcome were identified.

[Assessment of total bilirubin or SN-38/SN-38G ratio as a predictor of severe irinotecan toxicity]

SN-38, an active metabolite of irinotecan (CPT-11), is glucuronidated into SN-38G mainly by UGT1A1, during detoxification. However, significant interindividual pharmacokinetic variability in SN-38 is caused by factors, including inherited predispositions that may affect the function and expression of UGT1A1. Moreover, these individual differences can contribute to the development of clinical conditions, such as severe leucopenia and diarrhea. Similar to SN-38, bilirubin is excreted into bile after being glucuronidated by UGT1A1. Thus, bilirubin is metabolized by a mechanism similar to that of SN-38. This suggests that the bilirubin level may be an indicator of the adverse effects caused by CPT- 11. On the other hand, the ratio between the AUC of SN-38 and the AUC of SN-38G (AUCSN-38/AUCSN-38G) indicates the ability of SN-38 to be glucuronidated, and is known to correlate with leucopenia and diarrhea. However, many blood sampling points are required to calculate these AUCs. Therefore, the daily estimation of the AUCSN-38/AUCSN-38G values of individual patients is not practical at the clinical level. Thus, the objectives of this study were as follows: (1) to establish whether or not the total bilirubin level is a useful indicator in predicting the development of CPT-11 toxicity. (2) to investigate the correlation of SN-38/SN-38G (the ratio of the serum concentrations of SN-38 and SN-38G) with AUCSN-38/AUCSN-38G. Based on the result of this investigation, it will be discussed whether or not SN-38/SN-38G may be used as an alternative to AUCSN-38/AUCSN-38G. This study included 14 patients with small cell lung cancer or non-small-cell lung cancer, in whom serum concentrations of CPT-11, SN-38, and SN-38G were measured by HPLC. The results demonstrated a significant correlation between the total bilirubin levels prior to chemotherapy and the logarithmic values for AUCSN-38/AUCSN-38G (r2=0.852). Among the cases with high values for both the total bilirubin level and the AUCSN-38/AUCSN-38G ratio, none of the patients had grade-3 diarrhea, while many cases tended to have grade-3 to -4 neutropenia. Additionally, the results of regression analysis suggest that SN-38/SN-38G (2 hr) and SN-38/SN-38G (4 hr) might be preferable as a predictive index for AUCSN-38/AUCSN-38G. These findings suggest that the total bilirubin level and SN-38/SN-38G, 2 to 4 hours after administration might be used as indicators to predict CPT-11-induced neutropenia. These indicators are likely to contribute to the pharmacogenetic analysis of UGT1A1 genes, as well as individualized therapy, in future, and further studies on this subject are expected.

[Comparison and analysis of three classifying models for discrimination of lung cancer established by 6 tumor markers]

OBJECTIVE

To distinguish lung cancer by detecting 6 tumor markers in serum and establishing three classifying models of artificial neural networks (ANN), decision tree (CART), Fisher discrimination analysis, and to compare the differences among three models.

METHODS

The levels of serum CEA, gastrin, NSE, sialic acid (SA), Cu/ Zn, Ca in 50 healthy individuals, 40 patients with lung benign disease and 50 patients with lung cancers were detected by means of radioimmunology, spectrophotometry, atomic absorption spectrophotometry, respectively, and then developed ANN, CART and Fisher discrimination analysis models.

RESULTS

The sensitivity of ANN, CART and Fisher discrimination analysis models were 100%, 93.33%, 84.00%, the specificity were 100%, 100%, 98.89%, the accuracy were 91.67%, 86.11%, 85.00%. The areas under receiver operating curve (AUROC) of ANN, CART and Fisher discrimination analysis models were 0.964, 0.953, 0.812, respectively. There was no significantly statistical difference between ANN and CART (P > 0.05), while there were significantly statistical differences not only between Fisher discrimination analysis and ANN, but also Fisher discrimination analysis and CART (P < 0.05).

CONCLUSION

The effects of ANN, CART models established by 6 tumor markers were better than that of Fisher discrimination analysis in discrimination of lung cancer.

[Detection of serum CK19-2G2 and Cyfra21-1 protein and comparison of their diagnostic value for lung cancer]

OBJECTIVE

To evaluate and compare the value of serum CK19-2G2 and Cyfra21-1 in diagnosis of lung cancer.

METHODS

The serum concentration of CK19-2G2 and Cyfra21-1 was detected in 104 patients with lung cancer, 71 with benign lung diseases and 105 healthy volunteers. The value of the two parameters in the diagnosis of lung cancer was evaluated with ROC curve analysis. The mean level of CK19-2G2 in the three groups was compared with that of Cyfra21-1 by Mann-Whitney U test, and the correlation between these two parameters was calculated using Pearson coefficient correlation test.

RESULTS

The mean serum CK19-2G2 concentration in the lung cancer group was 2.87 mU/ml, significantly higher than that in the group with benign lung diseases (1.02 mU/ml) and healthy volunteer group (0.01 mU/ml) (P = 0.000). The serum concentration of CK19-2G2 was positively correlated with that of Cyfra21-1, with a Pearson coefficient correlation of 0.543. Furthermore, the mean serum CK19-2G2 level in squamous cell carcinoma group (8.35 mU/ml) was significantly higher than that in the other pathologic groups (P < 0.05).

CONCLUSION

CK19-2G2, with a higher specificity, may be a better tumor marker than CK19-2G2 in respect of specificity for non-small cell lung cancer (NSCLC), especially for squamous lung carcinoma, and deserves further study.

Determining the cut-off value of pro-gastrin releasing peptide (ProGRP) in lung cancer according to population characteristics

The standardisation process consisted of determining tumour marker levels in all relevant population groups which are connected with the biology of the marker in normal and tumourous cells. This makes clinical application possible. ProGRP serum levels were measured in 273 healthy subjects, 176 patients with benign diseases and tumours, 200 with small cell lung cancer (SCLC), 294 with non-small cell lung cancer (NSCLC), 21 with carcinoid tumour, 93 with undifferentiated lung cancer, 35 with mixed SCLC-NSCLC, and 189 with other malignancies. ProGRP levels in patients with SCLC and SCLC-NSCLC were significantly higher than in all the other groups (p = 5.4 x 10(-3)). Moreover, in SCLC patients ProGRP levels significantly correlate with the extent of the disease and the patients' smoking habit. The cut-off level of ProGRP for SCLC is 65.89 pg/mL in the Croatian population. It is based on 96.8% specificity in benign diseases which cause problems in differential diagnosis. The sensitivity of ProGRP was 85% at the time of SCLC diagnosis.

[Clinical value of combined detection of serum tumor markers in lung cancer diagnosis]

OBJECTIVE

To investigate the clinical significance of a combination of several serum tumor markers in the diagnosis of lung cancer.

METHODS

Serum CEA, CA125, CA199, CYFRA21-1 and NSE were measured with RIA, chromatometrychemoluminescence, ELISA and biochemoluminescence methods respectively in 340 patients with lung cancers at different TNM stages, 120 patients with benign lung diseases, and 45 healthy people. The sensitivities, specificities and accuracies of different combination of those markers for the diagnosis of lung cancers were compared.

RESULTS

CYFRA21-1 had the highest sensitivity and accuracy (60.0% and 70.3%) and CA199 had the highest specificity (99.4%) for detecting lung cancers. CYFRA21-1 had the highest sensitivity (79.6%) for detecting squamous carcinoma. CEA had the highest sensitivity of (75.7%) for detecting adenocarcinoma. NSE had the highest sensitivity (76.2%) for detecting small cell lung cancers (SCLC). The combination of several serum tumor markers had higher sensitivities than the single marker for the diagnosis of lung cancers. With two markers, the combination of CYFRA21-1 and NSE had the highest sensitivity and accuracy (82.9% and 83.4%), while the combination of CA125 and CA199 had the highest specificity (94.5%). With three markers, the combination of CEA, NSE and CYFRA21-1 had the highest sensitivity and accuracy (89.1% and 85.1%), while the combination of CEA, CA125 and CA199 had the highest specificity (86.7%). The combination of CEA, CA125, CA199, CYFRA21-1 and NSE produced the best value, with a sensitivity of 93.8%, a specificity of 71.5%, and an accuracy of 86.5%.

CONCLUSION

Serum CEA, CA125, CA199, CYFRA21-1 and NSE are helpful markers for the diagnosis of lung cancer. The combination of the markers can improve the sensitivity and accuracy of the diagnosis.

[The evaluation to relationship between serum vascular endothelial growth factor (VEGF) level, metastases and other tumor markers in patients with lung cancer]

Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis. Increased expression of VEGF may be associated with advanced stage and poor prognosis in patients with lung cancer. We investigated the relationship between serum VEGF level and lung cancer stage. We also studied the correlation between serum VEGF level and some other tumor markers. Forty newly diagnosed lung cancer (31 non-small cell, 9 small cell) patients and 25 age-matched controls were enrolled in this study. Serum VEGF levels of lung cancer group (345.16 +/- 159.36 pg/mL) were significantly higher than that of the control group (230.36 +/- 47.87 pg/mL) (p< 0.001). The area under the ROC curve was 0.727 (p< 0.05) for serum VEGF threshold of 249.8 pg/mL predictive sensitivity and specificity, for lung cancer were respectively 70.0% and 76.0%. There were no significant relationship between serum VEGF level and age, gender, histologic type, lung cancer stage, distant metastases and site of metastases. In addition, there were no correlation between serum VEGF level and other tumor markers (NSE, CYFRA 21-1, CEA, CA125, LDH).

[Relation between the level of TPS, NSE, CEA and beta2-mG in the serum and the biological behavior of small cell lung cancer]

AIM

To study the relation between the level of tissue polypeptide specific antigen (TPS), neuron-specific enolase (NSE), carcinoembryonic antigen (CEA) and beta(2)-microglobulin (beta(2)-mG) in serum and the biological behavior of lung cancer for the more scientific diagnosis of lung cancer.

METHODS

To detect the level of TPS, NSE, CEA and beta(2)-mG in the serum of 94 patients with small cell lung cancer (SCLC), 86 patients with benign pulmonary diseases (BPD) and 89 patients in normal control group, the level of serum were examined by ELISA and immunoradiometric assay.

RESULTS

The level of TPS and NSE in the serum of SCLC group [(437.8+/-516.6) U/L, (76.8+/-91.4) microg/L] were much higher than those in BPD group [(143.6+/-78.7) U/L, (13.3+/-10.8) microg/L] and normal group [(98.4+/-58.9) U/L, (10.1+/-5.7) microg/L, P<0.01)], and the level of CEA and beta(2)-mG in the serum of SCLC group were also obviously higher than those in normal group and BPD group (P<0.01). The sensitivity, specificity and accuracy of SCLC'S diagnosis by an indicator of TPS and NSE were 84.4%, 87.8%, 83.6% and 79.3%, 93.7%, 88.3%, respectively, and were much higher than CEA and beta(2)-Mg. In addition, the level of TPS and NSE in the patients' serum with metastatic SCLC were markedly higher than those in the patients with SCLC without metastasis, increased with the number of metastatic focuses. In clinical practice, the possibility of smokers suffering from lung cancer disease is 8 to 10 times higher than that of no-smokers, and 10 to 24 times higher of the people who smoked 30 to 40 cigarettes per day. From this comparison, the amount of smoking was closely related to the occurrence of lung cancer.

CONCLUSION

TPS, NSE, CEA and beta(2)-mG in serum are useful for early diagnosis of lung cancer. There is complementarity in the combined detection of the level of TPS, NSE, CEA and beta(2)-MG. Their levels have close correlation with lung cancer, histological grades and lymphoid nodule metastasis.