Occurrence of neuron specific enolase in tumour tissue and serum in small cell lung cancer

Evaluation of the clinical application of multiple tumor marker protein chip in the diagnostic of lung cancer

BACKGROUND

The early diagnostic of lung cancer plays an important role in the prognosis of surgical treatment among lung cancer patients. To evaluate the clinical application of multi-tumor markers protein biochip in the diagnosis of lung cancer, 12 tumor markers were detected in patients with different stages of lung cancer.

METHODS

Serum CA125, CA19-9, Ferritin, CA15-3, CA242, CEA, AFP, NSE, PSA, f-PSA, HGH, and β-HGH were assessed in 506 patients, with 224 patients with lung cancer (including 123 cases of adenocarcinoma, 30 squamous cell carcinoma, 54 small-cell carcinoma, and 17 non classification), 159 patients with benign lung disease and 90 healthy people control by the C-12 multiple tumor protein-chip detective system.

RESULTS

The positive rate of C-12 (77.23%) in lung cancer was significantly higher than that of benign lung disease (13.84%) and healthy people (9.76%) (P < .01). In lung cancer, the positive rate of CA199, NSE, CEA, CA242, Ferritin, f-PSA, and CA125 were significantly higher than that of benign lung disease and healthy people. In adenocarcinoma, the positive rate of CA125 (73.53%) was significantly higher than that of squamous cell carcinoma (36.67%) and small-cell carcinoma (56.62%).

CONCLUSION

The C-12 multiple tumor protein-chip detective system has acceptable sensitivity in the diagnostic of lung cancer.

Reevaluation of the Usefulness of Systematic Bone Scanning in Initial Staging and follow-up of Small Cell Lung Carcinoma, Taking into Account the Serum Levels of Neuron-Specific Enolase

The prescription of bone scans (BS) in the initial staging and follow-up of small cell lung carcinoma (SCLC) is a traditional attitude. The availability of the serum neuron-specific enolase (NSE) assay and budget limitations led us to evaluate retrospectively, in 57 patients, the consequences of a more selective attitude, namely to perform BS only in those patients with abnormal serum NSE levels. Both BS and NSE assays were performed in 47 patients referred for initial staging of SCLC; NSE levels were normal in 8 but in 2 of these cases (25%) secondary bone localizations with great clinical significance were discovered at BS. During follow-up, 59 BS were performed in conjunction with NSE assays; 45 NSE levels were in the normal range whereas 17 (38%) corresponding BS were suggestive of bone metastases. In conclusion, due to the frequent occurrence of false-negative results in patients with bone metastases, serum NSE levels proved to be useless in the selection for BS of patients suffering from SCLC.

Tumour markers: An overview

Tumor Markers comprise a wide spectrum of biomacromolecules synthesized in excess concentration by a wide variety of neoplastic cells. The markers could be endogenous products of highly active metabolic malignant cells or the products of newly switched on genes, which remained unexprssed in early life or newly acquired antigens at cellular and sub-cellular levels. The appearance of tumor marker and their concentration are related to the genesis and growth of malignant tumors in patients. An ideal tumor marker should be highly sensitive, specific, reliable with high prognostic value, organ specificity and it should correlate with tumor stages. However, none of the tumor markers reported to date has all these characteristics. Inspite of these limitations, many tumor markers have shown excellent clinical relevance in monitoring efficacy of different modes of therapies during entire course of illness in cancer patients. Additionally, determination of markers also helps in early detection of cancer recurrence and in prognostication.

Prognostic factors in non-small cell lung cancer: a decade of progress

STUDY OBJECTIVES

To provide a systematic overview of the literature investigating patient and tumor factors that are predictive of survival for patients with non-small cell lung cancer (NSCLC), and to analyze patterns in the design of these studies in order to highlight problematic aspects of their design and to advocate for appropriate directions of future studies.

DESIGN

A systematic search of the MEDLINE database and a synthesis of the identified literature.

MEASUREMENTS AND RESULTS

The database search (January 1990 to July 2001) was carried out combining the MeSH terms prognosis and carcinoma, nonsmall cell lung. Eight hundred eighty-seven articles met the search criteria. These studies identified 169 prognostic factors relating either to the tumor or the host. One hundred seventy-six studies reported multivariate analyses. Concerning 153 studies reporting a multivariate analysis of prognostic factors in patients with early-stage NSCLC, the median number of patients enrolled per study was 120 (range, 31 to 1,281 patients). The median number of factors reported to be significant in univariate analyses was 4 (range, 2 to 14 factors). The median number of factors reported to be significant in multivariate analyses per study was 2 (range, 0 to 6 factors). The median number of studies examining each prognostic factor was 1 (range, 1 to 105 studies). Only 6% of studies addressed clinical outcomes other than patient survival.

CONCLUSIONS

While the breadth of prognostic factors studied in the literature is extensive, the scope of factors evaluated in individual studies is inappropriately narrow. Individual studies are typically statistically underpowered and are remarkably heterogeneous with regard to their conclusions. Larger studies with clinically relevant modeling are required to address the usefulness of newly available prognostic factors in defining the management of patients with NSCLC.

Entendendo o papel de marcadores biológicos no câncer de pulmão

Marcadores biológicos são componentes celulares, estruturais e bioquímicos, que podem definir alterações celulares e moleculares tanto em células normais quanto aquelas associadas a transformação maligna. Podem ser de dois tipos: 1) marcadores intermediários, que medem alterações celulares e moleculares antes do aparecimento da malignidade; 2) marcadores diagnósticos, presentes em associação com a malignidade. O processo de identificação e validação para uso clínico do marcador tem diversas etapas: identificação inicial feita em linhagens celulares do tumor em questão; teste do marcador em tecido proveniente de biópsias de pacientes com diagnóstico estabelecido do tumor em questão; teste em biópsias de tecidos normais e com processo inflamatório; teste em escarro, sangue ou urina para validação como teste não-invasivo que possa ser usado em população de alto risco. Marcadores biológicos diagnósticos sorológicos e histológicos são componentes celulares, estruturais e bioquímicos, presentes não só em células tumorais como também em células normais, que podem ser medidos quantitativamente por métodos bioquímicos, imunológicos e moleculares nos fluidos ou nos tecidos corporais, respectivamente, associados a neoplasias e possivelmente ao órgão de origem da neoplasia. Marcadores biológicos são estudados em diferentes neoplasias primárias, porém poucos tiveram seu valor clínico definido. O papel dos marcadores biológicos em câncer de pulmão ainda é incerto, pois apenas um pequeno número de marcadores foi avaliado de maneira adequada. O objetivo deste trabalho é entender o papel dos marcadores biológicos sorológicos e diagnósticos no prognóstico e sobrevida de pacientes com câncer de pulmão baseado em uma coletânea de trabalhos realizada pela autora. Apresenta-se também uma perspectiva futura para a detecção precoce do câncer de pulmão baseada no papel dos marcadores biológicos intermediários.

Tumour markers in serum, bronchoalveolar lavage and biopsy cytosol in lung carcinoma: what environment lends the optimum diagnostic yield?

BACKGROUND

The aim of this study was to assess the diagnostic yield of the tumour markers carbohydrate antigen (CA 125), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC) and specific tissue polypeptide antigen (TPS) in serum, bronchoalveolar lavage (BAL) and biopsy cytosol in a group of patients with bronchogenic carcinoma.

METHODS

Serum, BAL and biopsy cytosol samples were collected in a group of 85 patients with benign or malignant pulmonary diseases. After appropriate processing, tumour markers were determined by enzyme immunoassay. The diagnostic yields (sensitivity, specificity and accuracy) in each environment (serum, BAL or biopsy) were obtained by using "ROC" curves.

RESULTS

Determined individually, CA 125, NSE and SCC show the greatest diagnostic accuracy in cytosol. CEA and TPS do so in BAL. CEA is the most relevant marker in serum and BAL, and CA 125 in cytosol. When the different tumour markers are associated, they offer better overall yields for all except TPS.

CONCLUSIONS

For the factors evaluated in this study, determination of CEA in BAL was clinically the most useful marker in comparison with serum and cytosol determinations, although the latter may also be helpful in certain situations. Although there is no specific tumour marker for lung cancer, the combination of several can be used to monitor most patients with lung cancer.

Serum biomarkers of non-neuron-endocrine origin in small-cell lung cancer: a 16-year study on carcinoembryonic antigen, tissue polypeptide antigen and lactate dehydrogenase

BACKGROUND

Biomarkers of non-neuron-endocrine origin are measured only occasionally in the sera of patients with small-cell lung cancer (SCLC). An exception to this rule is carcinoembryonic antigen (CEA), for which, however, there is no consistent evidence. Based on such a premise, we decided to review the Cuneo Lung Cancer Study Group 16-year-experience with non-neuron-endocrine markers in SCLC.

METHODS

a total of 619 CEA, 621 tissue polypeptide antigen (TPA), and 616 lactate dehydrogenase (LDH) serum assays were obtained from 160 consecutive SCLC at diagnosis, during, and after treatment. Demographic, clinical, laboratory, and tumoral correlates were also available for another 25 pretreatment and 14 posttreatment variables.

RESULTS

bivariate correlation analyses showed that LDH and TPA were significantly related to each other, and both of them were also correlated with disease extent, and treatment response. LDH correlation indexes were higher than that of TPA, especially those regarding the parameters of disease extent. CEA was correlated only with the category of treatment response. Receiver-operating characteristic (ROC) analysis confirmed the correlation between stage disease at diagnosis and both LDH (P = 0.000) and TPA (P = 0.002), while the treatment failure was better recognized by TPA (P = 0.000). In univariate analysis, both LDH and TPA were correlated with survival (P = 0.000 and 0.092, respectively); however, only LDH remained significant in multivariate analysis (P = 0.012).

CONCLUSIONS

the evidence from this study does not suggest a routine CEA test in SCLC. LDH remains particularly useful and it should be kept in use. Finally, data on TPA is insufficient to advocate its systematic use in this type of malignancy.

Pro-gastrin-releasing peptide, neuron specific enolase and chromogranin A as serum markers of small cell lung cancer

BACKGROUND

Small cell lung cancer (SCLC) yields neuroendocrine properties. Pro-gastrin-releasing peptide (ProGRP), neuron specific enolase (NSE) and chromogranin A (CGA) are therefore putative serum markers in this disease.

AIM

To assess any difference in the sensitivity-specificity relationship between these neuroendocrine markers regarding various control populations and disease extent.

METHOD

A total of 146 patients were prospectively assessed clinically and biologically. Serum marker titrations were performed using commercial immunoradiometric assays (NSE, CGA) or ELISA (ProGRP). Areas under receiver operating characteristic curves (AUC-ROC) were calculated in order to assess the sensitivity-specificity relationship of each marker and to compare marker accuracy. Maximum Youden indices were used to determine marker thresholds able to produce the best overall diagnostic information.

RESULTS

Assessing the sensitivity in the SCLC population and the specificity in benign lung disease, ProGRP demonstrated the best sensitivity relationship in as much as its AUC-ROC was significantly greater than the ones calculated using NSE and CGA (respective values, 0.95, 0.89, 0.70; two-tailed Z-test <0.05). The ProGRP threshold value, which offered the best sensitivity-specificity relationship was 53 pg/ml corresponding to a 0.80 sensitivity and a 0.96 specificity. In addition, when specificity was assessed in NSCLC and again the sensitivity in the whole SCLC population, ProGRP continued to demonstrate a greater AUC-ROC in comparison with other markers. Using the 53 pg/ml threshold the specificity of this marker was excellent with no false positives in NSCLC. On the other hand, none of the markers were able to discriminate limited from extensive SCLC as suggested by the fact that AUC-ROC, constructed when sensitivity was defined as a positive test in extensive disease and specificity as a true negative test in limited disease, did not reach the upper left octant (AUC 0.65, 0.71 and 0.63 for ProGRP, NSE and CGA, respectively).

CONCLUSION

ProGRP yields the best sensitivity-specificity feature in SCLC, a result deserving further studies designed to evaluate the clinical applicability of this marker.

Serum neuron-specific enolase and immunohistochemical markers of neuroendocrine differentiation in lung cancer

An enzyme immunoassay for serum neuron-specific enolase (NSE) was evaluated with respect to analytical performance and clinical utility and compared with immunohistochemical evaluation of neuroendocrine differentiation. Values obtained agreed well with values obtained using a radioimmunoassay method giving a correlation coefficient of 0.934. Analytical performance of the enzyme immunoassay was good but the diagnostic sensitivity of 82% in extensive and 67% in limited disease was insufficient for serum NSE to be of value in the diagnosis of small cell lung cancer (SCLC). Serum NSE decreased significantly in 11 of 15 patients with SCLC following institution of chemotherapy. Classification of lung cancers into SCLC and non small cell lung cancer (NSCLC) types is largely based on tumour morphology. Neuroendocrine differentiation may not be morphologically evident. Immunohistochemical staining of tumour tissue with markers of neuroendocrine differentiation, i.e. NSE (both monoclonal and polyclonal antibodies) Leu 7, Chromogranin A and P G P 9.5 was performed in both patients with SCLC and NSCLC. 38 per cent of patients with NSCLC had both raised serum NSE and positive NSE (polyclonal) immunoperoxidase staining of lung tissue. A further 35 per cent of patients showed a raised serum NSE or positive immunohistochemistry but not both. The presence of two positive immunoperoxidase markers in lung tissue has been suggested as an indicator of responsiveness to chemotherapy in NSCLC patients. A number of factors may affect immunohistochemical positivity in tissue sections and the additional use of a serum marker may better define chemotherapy responsive groups.

Frequency-dependent alterations in enolase activity in Escherichia coli caused by exposure to electric and magnetic fields

Some neurochemical effects of low-intensity electric and magnetic fields have been shown to be nonlinear functions of exposure parameters. These effects occurred within narrow ranges of frequency and intensity. Previous studies on membrane-associated endpoints in cell culture preparations demonstrated changes in calcium efflux and in acetylcholinesterase activity following exposure to radiofrequency radiation, amplitude modulated (AM) at 16 and at 60 Hz, at a specific absorption rate of 0.05 W/kg. In this study, these modulation frequencies were tested for their influence on the activity of a cytoplasmic enzyme, enolase, which is being tested clinically for detection of neoplasia. Escherichia coli cultures containing a plasmid with a mammalian gene for enolase were exposed for 30 min, and cell extracts were assayed for enolase activity by measuring absorbance at 240 nm. The enolase activity in exposed cultures was compared to the activity in paired control cultures. Exposure to 147 MHz carrier waves at 0.05 W/kg, AM at 16 Hz showed enolase activity enhanced by 62%, and AM at 60 Hz showed enolase activity reduced by 28%. Similarly, exposure to 16 Hz fields alone, at 21.2 V/mrms (electric) and 97 nTrms (magnetic), showed enhancement in enolase activity by 59%, whereas exposure to 60 Hz fields alone, at 14.1 V/mrms (electric) and 65 nTrms (magnetic), showed reduction in activity by 24%. Sham exposures as well as exposure to continuous-wave 147 MHz radiation at 0.05 W/kg showed no change in enolase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum gamma-enolase and prognosis of patients with renal cell carcinoma

BACKGROUND

Increased levels of gamma-enolase (gamma-enolase) have been observed in the sera of patients with renal cell carcinoma. To evaluate the prognostic information of gamma-enolase in this disease, 161 consecutive patients were assessed before initiation of therapy.

METHODS

gamma-Enolase was analyzed in serum using an immunoradiometric assay. The patients were clinically staged and followed up for a median time of 36 months (range, 5-104 months). Actuarial survival was calculated using the Kaplan-Meier method.

RESULTS

Elevated levels of gamma-enolase was found in 28 of 61 (46%) patients with distant metastases, compared with 8 of 56 (14%) when the tumor was confined to the kidney. A correlation also was observed between gamma-enolase and tumor grade, with poorly differentiated tumors having the highest levels. In 28 patients with distant metastases and elevated gamma-enolase, the survival time was significantly shorter than that of 31 patients with normal gamma-enolase levels (P < 0.001). The median survival time was 5 and 11 months, respectively. Using Cox proportional hazard model, clinical stage, serum gamma-enolase, and tumor grade were identified as independent prognostic factors.

CONCLUSION

Serum gamma-enolase can be useful as an adjunct in the staging of renal cell carcinoma. It also gives predictive information and might be of value as a marker in adjuvant therapy.

Inability of serum neuron-specific enolase to predict disease extent in small cell lung cancer

Serum neuron-specific enolase (NSE) levels were measured before treatment in 112 patients diagnosed as having small cell lung cancer in our department. All these patients underwent exhaustive staging procedures: 53 had limited disease (LD) and 59 extensive disease (ED). Serum NSE was elevated in 83% of the patients (i.e. 71% of the patients with LD and 93% of the patients with ED). Mean values of NSE differed significantly according to disease extent. A receiver-operating characteristic curve was constructed with different cut-off levels of serum NSE in order to determine the accuracy of NSE for identifying ED. There was no level of NSE capable of predicting with sufficient accuracy the presence of ED. The best compromise was given by a threshold of 35 micrograms/l: 60% of the ED patients had a serum NSE above 35 micrograms/l but 30% of the LD patients also had a serum NSE above 35 micrograms/l.

Prognostic impact of histologic demonstration of chromogranin A and neuron specific enolase in pulmonary adenocarcinoma

One hundred-fourteen patients with inoperable adenocarcinoma of the lung (ACL) were evaluated by immunohistochemistry with monoclonal antibodies against Neuron Specific Enolase (NSE) and Chromogranin A (Chr A) in order to determine the frequency and prognostic impact of such antigen expression. All patients were previously untreated and received chemotherapy according to a prospective randomized trial. The tumors of 18 patients (16%) had more than 10% positive cells stained with anti-NSE, 59 (52%) had 1-10% positive cells and those of 37 patients (32%) contained no NSE-positive cells. The corresponding figures for Chr A were: 22 patients (19%), 51 patients (45%) and 41 patients (36%), respectively. Forty-four per cent of the patients with more than 10% positive NSE cells responded to chemotherapy (either complete or partial remissions) compared to 17% of the patients with fewer than 10% positive cells (p less than 0.025). The corresponding values for Chr A were 30% responders versus 19% responders (not statistically significant). The median survival for patients with more than 10%, 1-10% or no NSE-positive cells was 262 days, 231 days and 159 days, while, for Chr A it was 245 days, 200 days and 238 days, respectively. The survival curves for both NSE and Chr A according to the various levels of positivity were not significantly different. The presence of neuroendocrine marker in pulmonary adenocarcinoma seems to be associated with increased sensitivity to chemotherapy.