乳腺癌ER,PgR和CEA的免疫组化研究

乳腺癌雌激素受体(ER)、孕酮受体(PgR)的检测结果与其内分泌治疗及预后有密切关系,癌胚抗原(CEA)亦具有估计乳腺癌患者预后的作用。但迄今国内外对乳腺癌 ER、PgR和CEA同时标记研究较少,本文应用免疫组化方法对乳腺癌ER、PgR和CEA同时进行标记,以便为临床联合应用ER、PgR和CEA的检测结果指导乳腺癌的治疗提供帮助。     

消化道肿瘤CEA表达检测

CEA(carcinoembryonic antigen)即癌胚抗原表达于大多数肿瘤细胞,如胃癌、肠癌、乳腺癌等,是常见的肿瘤标志物,可用于癌细胞的检测及肿瘤的生物治疗等.我室目前开展的CEA肽类联合DC细胞治疗消化道肿瘤的研究,就是利用CEA诱导的DC细胞作为抗原递呈细胞,使体内的CTL杀伤表面带有CEA的肿瘤细胞,故需挑选CEA表达阳性的患者.用免疫组化法检测了113例患者的瘤组织,其中胃癌68例,     

乳腺癌雌激素受体,孕酮受体和癌胚抗原检测对原发性乳腺癌预后的分析

乳腺癌雌激素受体、孕酮受体和癌胚抗原检测对原发性乳腺癌预后的分析曾庆富，杨元华，黄俊辉，周作坪湖南医科大学病理学教研室（长沙·４１００７８）应用免疫组织化学方法检测１２６例原发性乳腺癌常规石蜡切片组织内的雌激素受体（ＥＲ），孕酮受体（ＰｇＲ）和癌胚抗...     

乳腺癌常用化疗药物的作用机制及血液学不良反应的研究进展

随着中国女性乳腺癌发病率的升高,辅助化疗广泛应用于乳腺癌患者,其产生的不良反应日益突出,尤其是血液学不良反应造成的骨髓抑制。在接受同样方案的化疗后,不同患者出现血液学不良反应的风险和程度存在明显差异,其原因尚未完全阐明。目前,有多项研究从遗传角度进行探索,部分药物代谢酶、转运蛋白、受体等的基因多态性被证实与个体不良反应差异有关。笔者从乳腺癌化疗药物的作用机制出发,就乳腺癌化疗的血液学不良反应与药物遗传学的相关性研究进展作一综述。     

乳腺癌患者外周血CEA mRNA-CEA蛋白系统的检测及其临床意义

乳腺癌是女性最常见的恶性肿瘤之一。近15年间,我国城乡妇女乳腺癌年龄调整发病率、死亡率及绝对患病人数星明显上升趋势。乳腺发育来自于内胚层,而癌胚抗原(CEA)作为一种上皮源性细胞肿瘤标志物,与胚胎期内胚层发育密切相关。我们检测了68例经手术治疗的乳腺癌患者     

早期乳腺癌的组织和血浆癌胚抗原:一种预测预后的因子

乳腺癌的预后,以往根据肿瘤的大小,局部淋巴结转移和雌激素受体(ER)蛋白状况等预测,近来有人发现存在于乳腺癌组织中的癌胚抗原(T-CEA)和血浆癌胚抗原(P-CEA)对于预测乳腺癌的复发和预后有较高价值。作者对此作了前瞻性研究,证实测定组织癌胚抗原和血浆癌胚抗原,可作为一种乳腺癌预后的预测因子。 63例诊断为早期乳腺癌患者,经术前临床检查和根治术,标本病理检查分为:Ⅰ期32例,Ⅱ期31例,平均年龄57.7岁,(TNM分类L_(1-2),N_(0-1),M_0),术前抽血作CEA放射免疫测定,手术切除的原发和转移肿瘤标本切片,用改良的PAP酶标技术测定组织中CEA。以经纯化CEA红细胞和人肺组织吸     

乳腺导管液中肿瘤标志物的检测

天津市肿瘤医院研究员、主任医师李树玲近年来对乳癌早诊问题做了大量的研究工作。目前由他主持的检测乳腺导管液中肿瘤标志物诊断早期乳癌的研究通过专家鉴定。过去的研究已证实，乳腺癌绝大多数发生在乳腺导管上皮细胞上，其分泌液必将滞留于导管内或排出管外。1988年以来，该院对患有乳头溢液的患者，进行乳头溢液所含癌胚抗原的检测研究，发现其中癌胚抗原含量远远高于血清中的含量，这就给人们一个新的启迪。采用人工方法进行乳腺导管的冲洗，通过采集导管冲洗液且对其进行多种肿瘤标志物即癌胚抗原（CEA）、铁蛋白（FT）、降钙素（…     

乳腺癌相关血清肿瘤标志物的临床研究进展

癌胚抗原(CEA)、糖类抗原(CA)15-3、CA125等血清肿瘤标志物异常表达提示肿瘤的发生风险.CA15-3过表达被认为与乳腺癌的疾病进展有关,不同临床分期乳腺癌患者血清CA15-3的阳性检出率对诊断临床分期有显著优势,灵敏度和特异度均较高.但目前认为,某项血清肿瘤标志物单独检测对乳腺癌的阳性检出率较低,对早期筛查及诊断的意义不大,因此,多主张血清肿瘤标志物联合检测以对乳腺肿瘤进行早期筛查和早期诊断.本文对CEA、CA15-3、CA125等已在临床一定范围内得到应用的肿瘤标志物,以及新发现、潜在可能用于指导乳腺癌临床决策及治疗方案的肿瘤生物标志物与乳腺癌诊断、治疗及预后相关的临床研究进行综述.     

负性情绪相关基因在乳腺癌复发与转移中的检测价值研究

目的 研究与观察负性情绪相关基因在乳腺癌复发与转移中的检测价值.方法 选取48例乳腺癌术后复发转移患者为观察组,同期的48例未发生复发转移的患者为对照组,然后将两组的5-HTTLPR及NPY2R基因型分布频率及血浆氨基酸类神经递质水平进行比较,并比较观察组中不同复发转移情况者的检测结果 ,同时以Logistic分析上述研究指标与乳腺癌复发转移的关系.结果 观察组的5-HTTLPR的SS基因型及NPY2R的TT基因型频率均高于对照组,血浆氨基酸类神经递质水平均低于对照组,且观察组中不同复发转移情况者的检测结果 也存在显著性差异,且经Logistic分析显示,上述研究方面均与乳腺癌复发转移有密切的关系,P均<0.05.结论 负性情绪相关基因在乳腺癌复发与转移中的检测价值较高,应重视对乳腺癌患者进行上述方面的检测.     

吉西他滨联合国产卡培他滨治疗晚期三阴性乳腺癌的临床观察

目的 观察吉西他滨联合国产卡培他滨化疗方案治疗晚期三阴性乳腺癌的近期疗效和安全性.方法 采用吉西他滨联合国产卡培他滨化疗方案治疗21例既往曾接受过蒽环类、紫杉类化疗失败的晚期三阴性乳腺癌者,2周期化疗后评价近期疗效和不良反应.结果 21例患者中,CR 1例,PR 6例,SD 9例,PD 5例,有效率为33.3%.不良反应主要为Ⅰ、Ⅱ度血液学毒性、消化道反应和手足综合征等.结论 吉西他滨联合国产卡培他滨化疗方案治疗晚期三阴性乳腺癌安全有效,值得临床推广应用.     

Serum tumor markers in skeletal metastasis

BACKGROUND: There have been no well-documented reports detailing the relationship between skeletal metastasis and tumor markers in a large series of patients. The purpose of our study was to assess the relationship between the clinical features of skeletal metastasis and serum tumor markers and to determine whether tumor markers are a useful modality in the differential diagnosis of skeletal metastasis. METHODS: We retrospectively reviewed consecutive 458 patients with skeletal metastasis and divided the patients into two groups according to six clinical presenting factors. We assessed whether these groups influenced the level of the tumor markers in univariate and multivariate analysis. RESULTS: Patients with skeletal metastasis of carcinoma had a higher level of markers CEA (P < 0.0001) and CA19-9 (P = 0.0008) than patients with primary bone tumors and hematological malignancies. Univariate analysis of clinical variables revealed that metastasis on axial skeleton, multiple skeletal metastases and visceral metastasis were associated with the serum CEA and CA19-9 levels. By multivariate analysis, metastasis on axial skeleton, multiple skeletal metastases and visceral metastasis were found to be associated with the serum CEA and CA19-9 levels. At least one of the tumor markers was elevated in 73% of all patients. CONCLUSIONS: The higher tumor marker level (CEA, CA19-9) is predictive of metastasis on the axial skeleton, multiple skeletal metastases and visceral metastasis. Tumor markers are useful as a screening test to distinguish skeletal metastases of carcinoma from primary bone tumors or hematological malignancy from primary bone tumor and hematological malignancy.     

Enzyme immunoassay of CEA using monoclonal antibody

Carcinoembryonic antigen (CEA) is important as one of the tumor markers, and enzyme-immunoassay using monoclonal anti-CEA, which is based on the Sandwich method and unnecessary for the treatment of CEA-extract from serum, was tried in this study. The standard curve obtained from this assay showed lineality on low CEA level. Sensitivity could allow to detect CEA below 5 ng/ml of CEA. Correlation between radioimmunoassay and this EIA was not found in especially high CEA-concentration. Reproducibility respect of Intra-assay and Inter-assay had good results. CEA value yielded by dilution of sample serum coincided with nearly expected value; this result indicated that dilution test was effective. CEA value determined by the assay to be necessary for treatment of extract was higher than that by the assay without treatment. Though the number of test samples used for assay of CEA in serum from various diseases were small, we considered it would be appropriate to set up a normal value range in 0.44-3.16 ng/ml (mean +/- 2 SD) and cut off value at 3.9 ng/ml (mean +/- 3 SD). We have been interested in cancer-specificity on monoclonal antibody, but we could not so for evaluate effects of the assay using monoclonal antibody.     

癌胚抗原联合空腹血糖水平检测评估晚期胃癌预后的价值分析

目的:研究癌胚抗原（carcinoembryonic antigen，CEA）联合空腹血糖（fasting plasma glucose，FPG）水平检测在评估晚期胃癌预后中的应用价值。方法:回顾性分析我院接受化疗的300例晚期胃癌患者的临床资料。收集患者化疗前的人口学资料、血液学指标、病理及影像学资料，并对患者2年生存期进行随访。使用ROC曲线确定CEA、FPG最佳临界值。采用Kaplan－Meier分析法比较不同分组间患者的生存曲线情况。使用多元COX风险回归模型分析CEA、FPG与患者预后的相关性。结果:CEA、FPG评估胃癌预后的最佳临界值分别为5.865 mg/mL、6.845 mmol/L。Log－rank检验显示CEA、FPG与患者总生存期(overall survival，OS)显著相关（CEA组:P=0.000；FPG组:P=0.000）。低CEA-低FPG组2年存活率为67.9%，低CEA-高FPG组为16.9%，高CEA-低FPG组为26.4%，高CEA-高FPG组为6.9%，各组存活率差异具有统计学意义（P=0.00）。COX回归分析显示性别、TNM分期、分化程度、CEA水平、FPG水平、吸烟史、是否手术是影响患者预后的危险因素（HR=0.717、HR=0.162、HR=0.591、HR=1.006、HR=1.097、HR=0.421、HR=2.504，P＜0.05）。结论:联合检测CEA和FPG水平对评估晚期胃癌患者预后具有一定的临床价值。     

Pilot study of albendazole in patients with advanced malignancy. Effect on serum tumor markers/high incidence of neutropenia

Our preclinical studies have shown that the widely used antiparasitic drug albendazole has potent antiproliferative activity against colorectal cancer (CRC) and hepatocellular carcinoma (HCC). This trial was designed to evaluate albendazole in a small number of patients (n = 7) with either HCC or CRC and hepatic metastases refractory to other forms of therapy. Albendazole was given at 10 mg/kg/day orally in two divided doses for a period of 28 days. To follow the effect of treatment, tumor markers, carcinoembryonic antigen (CEA) or alpha-feto protein (AFP), were measured routinely in these patients. A range of hematological and biochemical indices were also serially measured to monitor bone marrow, kidney or liver toxicity. Albendazole therapy resulted in a decrease in CEA in 2 patients. In the remaining 5 with measurable tumor markers, serum CEA or AFP was stabilized in 3 patients, while in the other 2, after an initial stabilization (5-10 days), the markers began to increase. In the 7 patients completing the trial, albendazole was well tolerated and there were no significant changes in any hematological, kidney or liver function tests, but 3 patients were withdrawn for severe neutropenia which was probably contributory to the death of 1 patient. These data support our previous experimental results demonstrating that albendazole has antitumor effects.     

Carcinoembryonic antigen (CEA) as prognostic marker in colonic cancer.

Radioimmunoassay for serum carcinoembryonic antigen (CEA) was performed in 49 colonic cancer patients. The test results were positive in 42 patients (85.7%) in whom tumor was present at the time of assay. Preoperatively, CEA level suggested the extent and the prognosis of the disease. Strongly positive CEA test results in such patients correlated with metastatic tumors and poor prognosis. Postoperatively, a positive result for serum CEA indicated presence of residual tumor, while negative results did not exclude residual tumor. Periodic CEA determination in the patients who have undergone resection of colonic cancer may detect tumor recurrence that is at a treatable stage. The data show that patients in whom the immediate postoperative CEA concentration returns to normal have a much lower incidence of recurrent cancer of the colon than patients whose CEA level remains elevated.     

Risk factors for hematologic toxicity and multifaceted analysis of blood in Hodgkin's disease: a model for hematologic toxicity

Basic hematological features of CEA/ABVD medication for Hodgkin's disease were studied. An effective model was worked out on the principle of data discrimination for predicting different leukocytic toxicities induced by cytostatics-1 administration, once in two weeks. It might predict individual limits (dosage and intervals) of a chemotherapy course unless a colony-stimulation technique is used.     

CEA tissue staining in colorectal cancer patients. A way to improve the usefulness of serial serum CEA evaluation

The evaluation of serial plasma carcinoembryonic antigen (CEA) levels is one of the most important parameter used to establish the prognosis of surgically cured colorectal cancer patients. Carcinoembryonic antigen is particularly useful in the identification of recurrences and metastasis. However, to improve the usefulness of this assay, it would be helpful to accurately determine, if possible, those patients whose cancers produce CEA. The evaluation of the presence of CEA in these cancer specimens by means of immunoperoxidase staining technique does seem to improve the sensitivity of the CEA test. Fifty-seven patients with colorectal cancer who underwent surgical treatment were studied. Tissue CEA evaluation was correlated with the plasma CEA levels, the pathologic stage and grade, and histologic type of the cancers. Results demonstrate that 66.6% of Dukes' B cancers, 78.9% of Dukes' C, and 77.7% of Dukes' D cancers stained positively for CEA by immunoperoxidase. Thirty of 57 patients with preoperative pathologic plasma CEA levels had positive tissue CEA, whereas 8/57 patients did not. Of patients with a well-differentiated cancer (G1), 81.4% had positive tissue CEA versus the 64% of G2 and 60% of G3 cancers. The authors conclude that the use of the immunoperoxidase stain to measure CEA in tissue, so that the CEA serum assay may be used in those patients known to produce CEA, results in a major increase in the sensitivity of the test.     

Prognostic value of carbohydrate tumor markers and inflammation-based markers in metastatic or recurrent gastric cancer

We examined the relationship between hematological parameters and clinicopathologic significance in metastatic or recurrent gastric cancer (MRGC) patients, and construct a prognostic index for MRGC patients. We retrospectively reviewed the medical records of 439 patients with MRGC. Tumor markers, inflammation-based markers such as mGPS (which combines CRP and albumin concentrations), NLR, PLR and other hematological parameters were observed in the study. CA125 was more frequently positive with peritoneal recurrence, and CEA was more frequently positive in patients with liver metastases. In the univariate analysis of survival, the following variables were associated with shorter overall survival (OS): male, previous pathology such as nerves invasion and vessel invasion, elevated CEA, CA72-4, CA125 and CA19-9, and inflammation-based variables such as Alb, CRP, mGPS, PLR, NLR, Hb, LDH, AchE and AKP. In the multivariate analysis, mGPS, CEA and CA125 were independent prognostic factors for OS. An exploration of the potential prognostic index model including the three independent factors was carried out, MSTs for the low-, moderate- and high-risk groups were 12, 10.5 and 5 months. Elevated serum CEA, CA125 and mGPS in patients with MRGC are independent negative predictor of prognosis. And the prognostic index was constructed to predict prognosis of MRGC patients more accurately.     

The use and abuse of CEA test in clinical practice.

Charts of 437 patients having plasma carcinoembryonic antigen determinations during the period January 1, 1976 through April 30, 1976 were reviewed to determine whether CEA results led to clinical decisions altering management patterns. Data analysis disclosed that CEA test results did not result in any change in management in 167 patients with non-neoplastic disease. Most had single determinations. In 270 patients with neoplastic disease, CEA results led to changes in management in one patient with lung cancer and two patients with colon cancer, which may have altered prognosis. In a fourth patient, CEA results led to discovery of unresectable pancreatic cancer at laparotomy. Cost benefit analysis indicated a CEA test cost of $5,047.50 per patient benefitted in 299 patients eligible for analysis. We conclude that maximal benefit to the patient results from serial CEA test use in follow-up of colon cancer patients after curative therapy.     

Clinical use of carcinoembryonic antigen (CEA) determination]

The carcinoembryonic antigen (CEA) is a tumor marker defined by specific heterologous antisera. Elevated levels of circulating CEA have been detected by radioimmunoassay in 20-90 per cent of cases of colorectal carcinomas depending on the degree of tumor spread. The fact that elevation of CEA level can also be observed in other types of carcinomas and in several non malignant conditions greatly limit the value of the CEA test for the early diagnosis of colorectal carcinoma. Thus, the CEA assay should not be used as a screening test for cancer. Repeated CEA measurements, however, appear to be of importance for the evaluation of tumor resection and the detection of tumor recurrence. The only localized tumors known to produce elevation of CEA above the levels observed in non malignant diseases are carcinomas of the large bowel and the pancreas. In carcinomas derived from other organs a marked increase of CEA level is always associated with the presence of distant metastasis. Therefore at the present time the clinical applications of the CEA radioimmunoassay should be limited to the differential diagnosis of patients with suspicion of primary colorectal or pancreatic carcinoma, to the detection of distant metastasis in other types of carcinomas and to the post operative follow up of patients who had elevated levels of CEA before surgery. Well-controlled studies are still needed to determine if therapeutic decisions based on CEA results can lead to improved survival.