胸水CA125、CA199、CEA、NSE、CYFRA21-1、CA72-4对原发性肺癌的诊断价值

目的探讨胸水中糖链抗原125（CA125）、糖链抗原199（CA199）、癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段（CYFRA21—1）和糖链抗原72-4（CA72-4）在原发性肺癌并胸腔积液的诊断和鉴别诊断、病理分型中的价值。方法采用电化学免疫荧光发光法同时检测90例原发性肺癌并胸腔积液患者（恶性胸腔积液组）和64例良性胸腔积液患者（良性胸腔积液组）胸水中CA125、CA199、CEA、NSE、CYFRA21-1和CA72-4水平。结果恶性胸腔积液组各胸水肿瘤标志物水平均高于良性胸腔积液组（P〈0．05）,其中CEA、CYFRA21-1、NSE分别对腺癌、鳞癌、小细胞肺癌最敏感。联合检测以CEA＋NSE＋CYFRA21-1最优,可使敏感性达98．9％,阴性预测值至96．6％,准确性提高至76．0％。结论胸水肿瘤标志物在原发性肺癌的诊断中价值较高,其中CEA的诊断价值最大,联合检测诊断准确性优于单项检测。     

A case of advanced mullerian cancer successfully treated with S-1 chemotherapy

A 79-year-old woman was referred to our hospital with complaints of dyspnea. She was diagnosed with massive pleural effusion and cytology demonstrated the presence of adenocarcinoma, but no solid tumors were found in the systemic examination. Her serum CYFRA and CA125 level were increased. She was diagnosed with an effusion type of lung cancer or a cancer of unknown origin. S-1/CDDP was the chemotherapy of choice. After 2 courses of the treatment, her serum CYFRA level and CA125 level were normalized, and a chest CT detected no pleural effusion. Two years and 3 months after the first treatment, her CA125 level was increased. We found an FDG accumulation in her pelvic lesion by PET examination. To identify the FDG accumulated lesion in her pelvis, an operation was performed. Histopathological examination of the right ovary demonstrated the presence of an adenocarcinoma. Postoperatively, we administered 2 courses of paclitaxel/carboplatin combination treatment, considering the right ovarian tumor was the primary lesion. The patient remained alive and in good condition without any signs of recurrence 2 years after second treatment. This case suggests that S-1 therapy may be effective for patients with mullerian cancer.     

A case of papillary adenocarcinoma of the ovary that responded favorably to irinotecan hydrochloride and cisplatin after the administration of paclitaxel and carboplatin]

Recently, the standard treatment for advanced ovarian cancer has changed from CP therapy (cyclophosphamide, cisplatin (CDDP)) to TJ therapy (paclitaxel (TXL), carboplatin (CBDCA)). Irinotecan (CPT-11) is one of the derivatives of camptotecin and has been reported to have a high efficacy for ovarian cancer. In one case of ovarian cancer, chemotherapy was applied with CBDCA and TXL. However, after 2 months of six courses of the chemotherapy, CA-125 was elevated. The elevation of tumor marker levels in serum without the recurrent focus forced us to treat the patient with CPT-11 and CDDP for the second line chemotherapy. Tumor marker levels improved at the beginning of the therapy. In conclusion, CPT-11 and CDDP was effective against the recurrence of ovarian cancer treated with TJ therapy.     

胸水和血清CEA、CA125、CYFRA21-1、NSE和Pro-GRP联合检测对肺癌的诊断价值

目的:探讨联合检测肺癌胸水和血清中癌胚抗原(CEA)、癌抗原125(CA125)、细胞角蛋白19片段(CYFRA21-1)、神经原特异性烯醇化酶(NSE)和胃泌素释放肽前体(Pro-GRP)5 种肿瘤标志物水平在肺癌临床诊断中的应用价值,以期提高鉴别良恶性胸水的能力。方法:用电化学发光法检测93例肺癌患者和54例肺炎性疾病患者的血清及胸水标本CEA、CA125、CYFRA21-1、NSE和Pro-GRP水平。结果:癌性胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物平均水平与炎性胸水组比较,差别均有统计学意义(P<0.05);癌性胸水组中CEA、CYFRA21-1、CA125的含量远远高于炎性胸水组（20~600倍）(P<0.01)。肺癌胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物水平与肺癌血清组比较,差别均有统计学意义(P<0.05)。肺癌胸水组中CEA、CYFRA21-1、CA125的含量远远高于肺癌血清组（7~80倍）(P<0.01),相比与正常对照组更是有200倍以上的增高(P<0.01),因此胸水中CEA、CYFRA21-1、CA125百倍左右的升高提示恶性肿瘤的存在。将93例癌性胸水和血清分为腺癌、鳞癌和小细胞癌。腺癌、鳞癌和小细胞癌胸水组中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物含量明显高于炎性胸水组(P<0.01);腺癌胸水组中CEA含量明显高于鳞癌和小细胞癌(P<0.01);鳞癌胸水组中CYFRA21-1含量明显高于腺癌和小细胞癌(P<0.01);小细胞癌胸水组中NSE和Pro-GRP含量明显高于腺癌和鳞癌(P<0.01)。CA125含量在胸水组中腺癌、鳞癌含量明显高于小细胞癌(P<0.01)。5 种标志物单项及联合检测的灵敏度肺癌胸水组均高于肺癌血清组,肺癌胸水中5项联合检测后灵敏度可达99.11%。结论:肺癌组胸水中CEA、CA125、CYFRA21-1、NSE和Pro-GRP 5种肿瘤标志物联合检测有利于良恶性胸水的鉴别诊断,联合检测可以提高肺癌诊断的灵敏度,当肿瘤标志物显著升高时,CEA可作为肺腺癌的肿瘤标志物;CYFRA21-1可作为肺鳞癌的肿瘤标志物;NSE和Pro-GRP可作为小细胞癌的肿瘤标志物;CA125可作为非小细胞肺癌的肿瘤标志物。     

卵巢癌术前腹腔化疗的临床应用及其评价

目的：探讨术前腹腔化疗对卵巢癌的临床应用价值。方法：对60例Ⅱ～Ⅳ期卵巢癌患者术前实施CAP或TP方案腹腔化疗，肿瘤减灭手术后再行6个疗程治疗，观察腹水和血清肿瘤标记物CA-125及CA19-9的变化，记录并分析近期疗效、肿瘤复发及患者生存情况。结果：经1～3个疗程的腹腔化疗，CA-125及CA19-9显著下降，癌性腹水基本消退，肿瘤缩小并易与周围组织分离，使所有病例均获得满意的手术，促腹水消退治疗有效率高达98．3％，并使患者的疾病无进展生存期明显延长，毒副作用并不严重。结论：术前腹腔化疗对卵巢癌的临床治疗具有积极作用，能有效改善手术条件，减少扩散病灶残留，提高生存质量。     

胸腔灌注化疗对肺癌合并胸腔积液患者血清Cyfra21-1、CA125、CEA、NSE的影响及意义

目的 观察胸腔灌注化疗对非小细胞肺癌合并恶性胸腔积液患者血清细胞角蛋白19片段（Cyfra21-1）、CA125、癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）的影响。方法 对70例非小细胞肺癌合并恶性胸腔积液患者,以中心静脉导管行胸腔闭式引流,排尽胸腔积液后给予胸腔灌注顺铂化疗,分别于灌注前后采用电化学发光免疫法检测患者血清Cyfra21-1、CA125、CEA、NSE水平的变化,采用WHO癌性渗出液疗效评定标准评价近期疗效,观察不良反应发生情况。结果 总有效率为75.70%,疾病控制率为85.71%,胸腔灌注后患者血清Cyfra21-1、CA125、CEA、NSE的水平均低于灌注前（P均〈0.001）。不良反应主要为胃肠道反应和骨髓抑制,均为Ⅰ~Ⅱ级,无肝肾功能损害。结论 胸腔灌注化疗治疗非小细胞肺癌合并胸腔积液可有效控制胸腔积液,并降低血清Cyfra21-1、CA125、CEA、NSE的水平,从而为胸腔灌注化疗的疗效提供可靠的实验室观察指标,预测患者对铂类药物的敏感性,有助于指导下一步的全身治疗。     

A case of recurrent pleural effusion and positive cytology of advanced gastric cancer treated by TS-1 plus weekly taxane as second-line chemotherapy

A second-line chemotherapy for advanced gastric cancer has not been established. We report a case of good response in a 39-year-old woman who had recurrent pleural effusion and positive cytology of type 4 gastric cancer and was treated with TS-1, a DPD inhibitory fluoropyrimidine, in combination with weekly taxane. After a partial response for type 4 gastric cancer from the treatment with 2 courses of TS-1 plus low-dose cisplatinum (CDDP), followed by outpatient chemotherapy with TS-1 alone or TS-1 plus weekly CDDP, left pleural effusion appeared and CA19-9 increased during the 7th course of the chemotherapy. Cytology of the effusion was class IV. The patient was treated with a course of TS-1 (120 mg/day, day 1-21) plus paclitaxel (50 mg/m2, day 1, 8) followed by 2 week washout. In the following courses, paclitaxel was replaced with docetaxel (30 mg/m2, day 1 and 8) and the course was continued in the outpatient setting. After 2 courses, the left pleural effusion disappeared and remained absent after 6 courses. Gastric biopsy showed no cancer cells and abdominal CT showed no recurrence. Serum CA19-9 doubled 1 week after taxane treatment and decreased gradually week by week during the course. This case suggests that a combination of TS-1 and taxane is effective against recurrent pleural effusion of advanced gastric cancer and useful as a second-line chemotherapy.     

Establishment and characterization of a novel cancer cell line (SMOV-1), derived from the ascitic fluid of a woman with ovarian cancer who had never responded to chemotherapeutic drugs

Background A novel cell line, designated SMOV-1, was established from the ascitic fluid of a woman with ovarian cancer. This report describes the process of establishment and characterization of this cell line. Methods The case involved a woman who had undergone a surgical intervention, due to a serous papillary adenocarcinoma of the ovary. She received the combination chemotherapy of PAC (cisplatin +doxorubicin+cyclophosphamide) 6 times after the surgery. However, as a result of malignant pleural effusion during chemotherapy, she died 7 months after surgery. Before surgery, ascitic fluid was removed from the patient for cell culture, after obtaining her consent. The cells were successfully subcultured, and designated SMOV-1. Results The cell line gave a pavement-stone pattern, without contact inhibition. SMOV-1 could also be transplanted into nude mice, and the tissue showed reconstruction of the original tumor. The chromosome number of the SMOV-1 cells was 57, and the DNA index was 2.28. The population-doubling time of the SMOV-1 cells was 61.4 hours. Cultured SMOV-1 cells were still capable of producing the tumor-associated antigens CA 125, CA 19-9, and sTn (sialosyl-Tn). Conclusion We propose that this novel cell line is of possible use for the investigation of drug resistance in ovarian cancer.     

Peritoneal and serum tumor markers predict recurrence and survival of patients with resectable gastric cancer

Background. Laparoscopy has become a useful adjunct for the staging of gastric cancer; yet, other than standard TNM staging, few additional variables can be used to predict survival. This study evaluated the utility of serum and peritoneal tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA]-125) as predictors of locoregional recurrence and distant disease-free survival in patients with gastric cancer. Methods. During the period June 1990 to February 1994, 86 patients with gastric cancer were evaluated and deemed resectable by preoperative imaging studies. Serum levels of CEA and CA-125 were determined, and all patients underwent laparoscopic staging. Peritoneal washings were obtained from all patients, and 56 of these samples were evaluated for levels of CEA and CA-125. Results. Sixteen (19%) of the 86 patients were found to have metastatic disease at laparoscopy; 67 of the remaining 70 patients underwent potentially curative gastrectomy. Serum CEA and CA-125 levels were predictive of survival in the entire group of patients. In patients who underwent curative gastrectomy, serum CEA predicted survival, whereas peritoneal CA-125 predicted peritoneal recurrence. Conclusions. Elevated serum levels of CEA and CA-125 are predictive of decreased survival in patients with gastric cancer. Furthermore, determination of peritoneal CA-125 helps to identify those patients at an increased risk for recurrent peritoneal disease. Received for publication on June 24, 1998; accepted on Nov. 16, 1998     

Primary peritoneal clear cell carcinoma: excellent results from paclitaxel and carboplatin combination chemotherapy

While papillary serous adenocarcinomas are histocytologically common in primary peritoneal carcinomas, clear cell carcinomas are rare. We report a new regimen for the treatment of recurrent clear cell carcinomas of the peritoneum. A 45-year-old woman was referred to our hospital and underwent optimal debulking surgery. Thirty-two months after the operation, lymph node swelling and elevation of serum CA19-9 were detected and recurrence was diagnosed. Paclitaxel (175 mg/m(2)) in a 3-hour and carboplatin (300 mg/m(2)) in a 1-hour infusion were repeated at three-week intervals. After completion of four courses, abdominal CT and serum CA19-9 were undertaken and results compared. Lymph node swelling was significantly decreased and the serum CA19-9 level was decreased to within a normal range. Paclitaxel and carboplatin combination chemotherapy may be effective in preventing the recurrence of peritoneal carcinomas.     

卵巢癌术前腹腔化疗的临床应用及其评价

Objective:To investigate the clinical efficacy of intraperitoneal chemotherapy before surgery for ovarian cancer. Methods:60 patients with stages Ⅱ-Ⅳ of ovarian cancer were treated with intraperitoneal chemotherapy of CAP or TP regimen followed by a surgery treatment and another chemotherapy for 6 cycles. And then the efficiency of the therapy was evaluated by analyzing the changes of ascites, the serum CA-125 and CA-19-9 levels and the findings in the operation, and investigating the recurrence of cancer and the survival. Results:After 1-3 cycles of intraperitoneal chemotherapy, serum levels of CA-125 and CA-19-9 and carcinous ascites significantly reduced in all patients, ascites reduce was over 50% in 98.3% cases;all cases were successfully treated with cytoreduction and it was found during the operation that bulky tumor was reduced and looser so as to be easily isolated and removed;PFS of the patients was prolonged, while the toxicity and side-effects were not so serious as beyond the patient toleration. Conclusion:Intraperitoneal chemotherapy before surgery for ovarian cancer has an active efficacy in clinic, being able to improve conditions of surgery and increase the opportunity of maximal cytoreduction, and prolong survival of the patients, and should be a good selection for the treatment of advanced ovarian cancer.     

A case of recurrent endometrial cancer (clear cell adenocarcinoma) remarkably responsive to combination chemotherapy containing cisplatin

A 60-year-old woman with recurrent stage II endometrial cancer (clear cell adenocarcinoma) was treated with combination chemotherapy containing cisplatin (CDDP). She had undergone abdominal radical hysterectomy (Okabayashi operation) and pelvic lymph node dissections. Endometrial cancerous tissue infiltrated the cervix and lymph nodes. Six months after the operation, the patient had ascites and dyspnea. She was given 25 mg CDDP intra-abdominally and combination chemotherapy containing CDDP (CAP: CDDP 100 mg, ADR 30 mg, CAP 500 mg) three times intravenously. After an administration of CDDP and combination chemotherapy, the amount of ascites and the serum level of CA 125 decreased remarkably. Although the combination chemotherapy containing CDDP for gynecological malignancy has not been sufficiently evaluated as for ovarian carcinomas, the therapy deserves further evaluation in patients with recurrent of endometrial cancer.     

Colonic perforation in a patient treated with combination chemotherapy for recurrent ovarian clear cell adenocarcinoma

BACKGROUND: Colonic perforation due to colitis is a known and reported side effect of chemotherapy. CASE REPORT: A 53-year-old woman was treated with combination chemotherapy of irinotecan plus cisplatin for a recurrent ovarian clear cell adenocarcinoma. Steroid was also used for suspected interstitial pneumonia. After two cycles of treatment, she developed a colonic perforation. Emergency laparotomy was not performed because of poor performance status with multiple lung metastases, pleural effusion and pericardial effusion. Colonoscopy showed a perforated wall at the cecum, and a long tube with balloon was inserted for occlusion. In addition, a peritoneal drainage tube was inserted. Oral intake could be restarted for a while, but she died from tumor progression one and a half months after the diagnosis of perforation. CONCLUSION: Non-surgical management with peritoneal drainage and ileus tube was useful in this case of colonic perforation for preserving oral intake and quality of life.     

Serum CA125 level is a good prognostic indicator in lung cancer

The serum CA125 level was determined by a one-step immunoradiometric assay method in patients with lung cancer. Increased serum CA125 levels were observed in 37.8% of patients with squamous cell cancer, in 30.0% of those with adenocarcinoma and in 60.0% of those with small call cancer. Most patients with increased serum CA125 levels were in stages 3 or 4. Patients with pleural effusions or ascites showed high serum CA125 levels. The survival time was significantly shorter in patients with increased serum CA125 levels than in those within normal limits. Among patients with advanced disease (stages 3 and 4), an increased serum CA125 level was again a poor prognostic factor (P less than 0.01). The existence of a pleural effusion did not correlate with the survival time. We conclude that CA125 is a good indicator of disease extent and serum levels correlate to the length of survival.     

上皮性卵巢癌患者手术及化疗前后血清中人附睾蛋白4和糖类抗原125的变化

目的探讨上皮性卵巢癌患者手术及化疗前后血清中人附睾蛋白4(HE4)和糖类抗原125(CA125)的变化。方法选取2012年3月至2013年3月间收治的50例上皮性卵巢癌患者,采用酶联免疫吸附试验(ELISA)检测50例上皮性卵巢癌患者(研究组)手术及化疗前后、正常健康人群(健康组)及卵巢良性肿瘤患者(对照组)血清中HE4和CA125水平,探讨其在疾病预后的的价值。结果对照组患者CA125和HE4水平显著高于健康组,差异有统计学意义(P<0.05)。研究组患者术前CA125和HE4水平明显高于对照组和健康组,其中化疗3个疗程后血清CA125水平降至正常水平,化疗2个疗程后血清HE4水平降至正常水平。CA125阴转符合率为41.5%,HE4阴转符合率为75.6%,CA125+HE4联合检测阴转符合率则增至85.4%;联合检测阳转符合率高达100%。结论血清CA125和HE4联合检测对卵巢癌预后判断有重要指导意义,可作为卵巢癌病情检测指标之一。     

Immunological assay of the CA-125 value in pleural effusion in various types of pleuritis--its application as a differential diagnostic parameter of tuberculous or carcinomatous pleuritis

We measured the CA-125 value in the peripheral blood and pleural effusion of 85 patients with various types of pleural effusion using an immunoradiometric assay with a monoclonal antibody (CA-125 radioimmunoassay kit). In pleuritis with primary lung cancer, the positive rate of the CA-125 value in the peripheral blood was 53.6%. The CA-125 value in tuberculous pleural effusion was significantly lower than that in carcinomatous pleural effusion (p less than 0.02). Accordingly, this assay of CA-125 in the pleural effusion is useful in the differential diagnosis of whether the pleural effusion is tuberculous or carcinomatous.     

A case of ovarian cancer stage IV and advanced rectal cancer responding to paclitaxel/carboplatin

A 43-year-old woman who had ovarian cancer with massive ascites and pleural effusion as well as rectal cancer underwent probe laparotomy. However, only bilateral adnexectomy was performed since radical surgery was impossible due to severe carcinomatosa peritonitis. Three courses of chemotherapy with paclitaxel and carboplatin (T-J therapy) were carried out. Following chemotherapy, the ascites and pleural effusion had completely disappeared and the size of rectal cancer had shrunk as well. The chemotherapeutic effect was evaluated as a partial response in the rectal cancer. Therefore, as interval debulking surgery, abdominal total hysterectomy, omentectomy, low anterior resection pelvic lymphadenectomy were performed. Three further courses of chemotherapy were performed. There is no evidence of recurrence of ovarian cancer and rectal cancer 3 years after the first surgery.     

Successful treatment of a patient with recurrent ovarian clear cell adenocarcinoma under combination chemotherapy of 5-FU (civ) and low-dose CDDP (i.v.)

Resistance to conventional chemotherapy including CDDP is the most important therapeutic problem in ovarian cancer. The combination chemotherapy of 5-FU (civ) and low-dose CDDP (i.v.) was applied to a patient with recurrent ovarian clear cell adenocarcinoma (stage IIa), which is often more resistant to systemic chemotherapy than other ovarian adenocarcinomas and is a poor prognostic factor. The patient underwent cytoreductive surgery. Then, 5-FU 375 mg/m2/day civ (days 1-5, 8-12, 15-19, 22-26) and CDDP 3.75 mg/m2/day i.v. (days 1-5, 8-12, 15-19, 22-26) were administered. After four courses of this treatment, there is no sign of recurrence. This result indicates that the combination of 5-FU and CDDP is useful in the treatment of recurrent ovarian cancers.     

不同标本肿瘤标志物联合检测对肺癌的诊断价值

目的：检测血液、痰液、支气管肺泡灌洗液（BALF）、胸腔积液四种标本中癌胚抗原（CEA）、癌抗原125（CA125）、癌抗原199（CA199）和细胞角蛋白21—1片段（CYFRA21—1）的浓度,探讨不同标本肿瘤标志物（TM）联合检测在肺癌诊断中的意义。方法：采用化学发光免疫分析法检测52例肺癌和46例肺部良性病变患者血液、痰液、BALF、胸腔积液中CEA、CA125、CA199和CYFRA21—1的浓度。结果：52例肺癌患者血液、痰液、BALF、胸腔积液中四种TM联合检测的阳性率分别为69．2％、90．4％、88．5％和82．1％;而46例肺部良性病变患者的阳性率分别为19．6％、26．1％、23．9％、21．7％。经统计学检验两组问四种标本TM联合检测阳性率差异有统计学意义（P〈0．05）。肺癌组不同标本之间TM联合检测的阳性率差异有统计学意义（P=0．02）;痰液和BALF标本TM联合检测较血液临床意义更大（P=0．01;P=0．02）。联合两个或三个标本检测与单个血液标本检测相比,其差异有统计学意义（P〈0．05）。结论：不同标本肿瘤标志物CEA、CA125、CA199和CYFRA21—1联合检测对肺癌的诊断具有一定的意义。联合不同标本检测四种TM能提高肺癌诊断的敏感性。     

A case of advanced colon cancer with peritoneal dissemination effectively treated with modified FOLFOX6 chemotherapy

A 50-year-old woman was diagnosed with ascending colon cancer with bilateral ovarian metastases, carcinomatous peritonitis, and carcinomatous pleurisy. Nine courses of mFOLFOX6 treatment resulted in the disappearance of her ascites and pleural effusion and a marked decrease in her serum CEA and CA19-9 levels. Additionally, the primary tumor and ovarian metastases became smaller. Therefore, a right hemicolectomy with D3 lymph node dissection, total hysterectomy, and bilateral salpingo-oophorectomy were performed. Postoperatively, we changed the chemotherapy from mFOLFOX6 to bevacizumab+FOLFIRI because the patient had an allergic reaction to oxaliplatin, and we suspected lung metastasis. Because the lung metastasis grew after ten courses of bevacizumab+FOLFIRI, we changed to cetuximab+FOLFIRI. Unfortunately, 28 months after her diagnosis, the patient died of carcinomatous pleurisy.