小细胞肺癌与非小细胞肺癌中神经元烯醇化酶检测的临床意义

目的:探讨检测小细胞肺癌(small cell lung cancer,SCLC)与非小细胞肺癌(non-small cell lung cancer,NSCLC)患者血清神经元烯醇化酶(neuron specific enolase,NSE)对诊断、治疗及预后的临床意义。方法:放射免疫法检测NSCLC182例、SCLC33例(动态观察其中70例治疗有效的肺癌患者治疗后血清NSE的变化)、肺良性病变161例和正常对照组158例的血清NSE。结果:健康人NSE水平为(9.5±3.4)μg/L,异常率为10.1%(16/158);肺良性病变的NSE水平为(10.0±5.4)μg/L,异常率为16.8%(27/161);肺癌患者NSE水平为(20.7±22.5)μg/L,异常率为40.0%(86/215)。肺癌患者NSE水平和异常率均明显高于正常对照组,P=0.004。肺良性病变NSE水平亦有所升高,但与对照组相比差异无统计学意义,P=0.095。NSE水平随分期升高而增加,晚期肺癌患者NSE水平显著高于早期肺癌患者,P=0.004。有效治疗后NSE水平明显下降,P=0.003。NSE水平低的患者较NSE水平高的患者相对预后好。结论:NSE不仅可作为SCLC的标志,对NSCLC的诊断、治疗及预后评价也有一定的临床价值。     

神经元特异性烯醇化酶对小细胞肺癌诊断的临床价值

目的：探讨血清NSE对小细胞肺癌的诊断,分期及预后的临床价值,以及同时探讨标本溶血程度对NSE浓度的影响。方法：采用ELISA法,检测83例SCLC患者,63例肺良性疾病,62例正常对照及35例溶血标本的NSE水平。结果：SCLC组血清NSE水平（37．64±36．95）μg／L显著高于肺良性疾病组（11．94±4．19）μg／L和正常对照组（8．92±3．95）μg／L（P〈0．01）;SCLCⅢ,Ⅳ期患者血清NSE水平（53．58±40．87）明显高于Ⅰ,Ⅱ期（14．66±6．48）（P〈0．01）。SCLC治疗前NSE水平显著高于治疗后（P〈0．05）。以NSE水平为指标诊断SCLC的敏感性、特异性、准确性,分别为67．3％、83．1％和85．4％。标本溶血对NSE测定影响很大,并且随着溶血程度的增加NSE结果显著升高。结论：NSE可作为较好的小细胞肺癌肿瘤标志物,对SCLC诊断,尤其对临床分期及预后有重要参考价值。血清NSE值随溶血程度呈递增趋势,因此,应严格避免溶血,以减少假阳性的发生。     

神经元特异性烯醇化酶对小细胞肺癌诊断的临床价值

目的:探讨血清NSE对小细胞肺癌的诊断,分期及预后的临床价值,以及同时探讨标本溶血程度对NSE浓度的影响.方法:采用ELISA法,检测83例SCLC患者,63例肺良性疾病,62例正常对照及35例溶血标本的NSE水平.结果:SCLC组血清NSE水平(37.64±36.95)μg/L显著高于肺良性疾病组(11.94±4.19)μg/L和正常对照组(8.92±3.95)μg/L(P<0.01);SCLC Ⅲ,Ⅳ期患者血清NSE水平(53.58±40.87)明显高于Ⅰ,Ⅱ期(14.66±6.48)(P<0.01).SCLC治疗前NSE水平显著高于治疗后(P<0.05).以NSE水平为指标诊断SCLC的敏感性、特异性、准确性,分别为67.3%、83.1%和85.4%.标本溶血对NSE测定影响很大,并且随着溶血程度的增加NSE结果显著升高.结论:NSE可作为较好的小细胞肺癌肿瘤标志物,对SCLC诊断,尤其对临床分期及预后有重要参考价值.血清NSE值随溶血程度呈递增趋势,因此,应严格避免溶血,以减少假阳性的发生.     

The prognostic influence of serum neuron specific enolase in small cell lung cancer

An analysis of prognostic factors in small cell lung cancer has been made using presentation data from 86 of 101 consecutive patients referred to The Finsen Institute for chemotherapy. Prognosis was in univariate analysis significantly correlated with performance status (PS), disease extent, serum lactate dehydrogenase (LDH), neuron specific enolase (NSE), alpha-1-acid glycoprotein and plasma sodium. Multivariate analysis, taking stage of disease into account, resulted in selection of PS and NSE as the most influential of the investigated variables. LDH was excluded as an independent prognosticator, but there was a strong correlation between the influence of LDH and NSE (coefficient: -0.38) as well as between their serum concentrations (coefficient: 0.72). LDH and NSE apparently have similar prognostic influence, and NSE seems superior to LDH. A firm conclusion should, however, await our investigation of a large series of patients.     

Cyfra 21-1, neuron specific enolase and prognosis of non-small cell lung cancer: prospective study in 621 patients

BACKGROUND: CYFRA 21-1, a serum cytokeratin 19 fragment, and neuron specific enolase (NSE), the gamma-subunit of enolase, are putative markers of lung cancer. Their clinical applicability as prognostic factors in non-small cell lung cancer (NSCLC) would need an appraisal by simultaneous evaluation of other known survival determinants in a large population followed over a long period. AIM: To determine the prognostic value of different clinical and routine biological variables at presentation with particular attention paid to the above-mentioned markers. METHODS: 621 histologically proven and previously untreated NSCLC patients have been prospectively studied (seven were lost to follow-up). Median follow-up was 4 years and 2 months. At presentation, 16 clinical and biological variables were recorded. Serum NSE and CYFRA 21-1 were assayed blind without any clinical information given. RESULTS: The serum CYFRA 21-1 distribution differed significantly according to histology, disease stage and performance status, with the highest levels observed in squamous cell carcinomas, metastatic stage, positive mediastinal nodal status and poor performance status. However, the respective "receiver operating characteristic" curves showed that the CYFRA 21-1 serum level did not accurately predict tumour stage. Serum NSE distribution correlated neither with tumour stage nor with performance index and its sensitivity in the whole NSCLC was low. In the Cox proportional hazard model, the following variables were independent determinants of a poor outcome: performance status 2 or 3, hazard ratio (HR): 2.25; Nodal status N(2-3), HR: 1.84; Metastatic disease, HR: 1.73; NSE>12.5 ng/ml, HR: 1.52; CYFRA 21-1>3.6 ng/ml, HR: 1.41 and Tumour status T(3-4), HR: 1.31. When the survival analysis was restricted to the 274 patients affected by a metastatic stage, we observed that performance status, nodal status, NSE and CYFRA 21-1 remained prognostic determinants with similar hazard ratios. CONCLUSION: The prognostic information given by a high serum CYFRA 21-1 level is independent from other well-known variables such as performance status and disease stage and is perennial throughout extended follow-up period. A high NSE level also prognosticates a poor outcome probably by reflecting tumour heterogeneity and underestimated neuroendocrine differentiation.     

血清中神经特异性烯醇化酶水平对晚期非小细胞肺癌化疗疗效的影响

目的探讨血清中神经特异性烯醇化酶(NSE)水平对晚期非小细胞肺癌(NSCLC)化疗疗效的影响 .方法用放免法检测142例NSCLC治疗前NSE水平,选择阳性病例60例,随机分为两组,A组选用VDS(或NVB) DDP化疗方案,B组选用Vp-16 DDP化疗方案,评价3周期化疗后的疗效,随访生存率.结果 A组近期化疗有效率为51.2%,1年生存率为16.7%;B组近期化疗有效率为76.7%,1年生存率40.0%,两组差异有显著性(P＜0.05).结论血清NSE水平升高的晚期NSCLC患者选用常用的SCLC化疗方案较为合适.     

Prognostic factors in non-small cell lung cancer

Identification of prognostic factors is critical in optimizing treatment for patients with cancer. The purpose of this work is to review the modern literature with regard to prognostic factors for patients with non-small-cell lung cancer (NSCLC) taking into account ongoing advances in clinical evaluation, staging, surgery, radiation therapy, chemotherapy, and molecular biology in this widely heterogeneous patient population.     

治疗前血清神经元特异性烯醇化酶水平在预测晚期非小细胞肺癌脑转移及预后中的意义

目的：探讨治疗前血清神经元特异性烯醇化酶（ NSE）水平在预测晚期非小细胞肺癌（ NSCLC）发生脑转移和患者预后的价值。方法回顾性分析128例晚期NSCLC患者的临床病理特征和治疗前血清NSE、癌胚抗原（ CEA）、细胞角蛋白21?1片段（ cyfra 21?1）、白蛋白（ ALB）、白细胞（ WBC）水平与NSCLC患者发生脑转移及其预后的关系。结果128例晚期NSCLC患者中,肺腺癌90例,肺鳞癌30例,大细胞未分化癌8例。血清NSE、CEA和cyfra 21?1的中位水平分别为13．6、7．8和6．1 ng／ml,ALB和WBC水平分别为（35．41±5．60）g／L和（8．16±2．53）×109／ml。多因素Logistic分析结果显示,NSE水平与NSCLC患者脑转移有关（ P＝0．030）。28例脑转移患者和98例无脑转移患者治疗前NSE水平分别为（34．18±28．48）ng／ml和（13．87±4．49）ng／ml,差异有统计学意义（P＜0．05）。治疗前NSE水平升高组和NSE水平正常组患者的中位生存时间分别为3．5个月和10．7个月,差异有统计学意义（P＜0．05）。结论治疗前血清NSE水平与NSCLC患者脑转移和预后有关,可作为晚期NSCLC脑转移的预测因素,治疗前血清NSE高水平提示NSCLC患者预后较差。     

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

An analysis has been made of the relationship between neuron specific enolase (NSE) in serum and immunohistochemically identified occurrence of NSE in the primary tumour in 56 patients with small cell lung cancer (SCLC). Patients were referred to the Finsen Institute for treatment during a period of 18 months. Forty-six tumours (82%) were NSE positive. To compare this staining with the occurrence of NSE in serum, a histological staining index (HSI) was established by semiquantitative gradation of the staining. No significant differences were found between distribution of serum NSE values in different HSI categories, and a high ranking in HSI was not associated with a high level of serum NSE. Both univariate and multivariate analysis selected serum NSE and not HSI as the most influential prognostic factor in SCLC.     

影响晚期非小细胞肺癌预后的相关因素分析

目的:探讨影响晚期非小细胞肺癌(NSCLC)预后的相关因素,为NSCLC的治疗提供参考.方法:对72例ⅢA～Ⅳ期NSCLC患者的临床资料进行回顾性分析,对晚期NSCLC预后的相关因素进行Logistic回归分析,筛选影响晚期NSCLC预后的相关因素.结果:单因素分析结果显示,KPS评分、临床分期、放化疗方式、手术与否与晚期NSCLC预后有关,x2值分别为15.421、4.676、33.124和8.932,P值分别为0.000、0.032、0.000和0.003;多因素Logistic回归法分析表明,放化疗方式、KPS评分是晚期NSCLC预后的独立因素,RR分别为2.339 37和2.136 42,P<0.05.结论:KPS评分、放疗和化疗结合方式是影响晚期NSCLC患者生存的独立预后因素,对这2个因素加以重点评估和合理控制,可为晚期NSCLC患者治疗方法选择以及预后判断提供可靠的指标.     

Prognostic value of serum thymidine kinase, tissue polypeptide antigen and neuron specific enolase in patients with small cell lung cancer.

In a group of seventy patients with small cell lung cancer the prognostic value of serum tumour markers was determined. Thymidine kinase (TK), tissue polypeptide antigen (TPA) and lactate dehydrogenase (LDH) but not neuron specific enolase (NSE) correlated significantly with survival. Since all markers were strongly interrelated with each other and with the extent of disease, the combined determination of TK, TPA and LDH or the combination of disease extent and a marker yielded no more prognostic information than a single measurement of one of these variables.     

非小细胞肺癌预后影响因素分析

目的:探讨非小细胞肺癌(NSCLC)患者的预后相关因素。方法:对2005年6月-2006年6月我院收治的162例非小细胞肺癌患者的临床、病理资料进行回顾性研究,采用Kaplan-Meier和COX回归方法分析评价各因素对预后的影响。结果:单因素分析表明KPS评分、手术与否、临床分期、治疗状况及治疗前血小板(PLT)、癌胚抗原(CEA)和神经元特异性烯醇化酶(NSE)的水平与NSCLC患者的预后有关。多因素分析表明,临床分期、治疗状况、血小板及血清癌胚抗原的水平是独立的预后影响因素。临床分期Ⅳ期、未治疗、PLT>300×109/L、CEA>5.0μg/L时,相对危险度(RR)分别为5.524、16.096、3.563、2.607。结论:治疗前血小板、血清CEA的水平、临床分期及治疗情况是NSCLC患者独立的预后影响因素。     

Ⅰ期非小细胞肺癌的预后因素

Ⅰ期非小细胞肺癌(NSCLC)临床预后因素包括肿瘤大小和患者年龄、手术方式和胸膜浸润情况等.分子生物学预后因素包括肿瘤细胞信号通路中的表皮生长因子及其受体、细胞周期素和凋亡基因Bcl-2、p53的异常表达等,以及肿瘤血管生成中基质金属蛋白酶(MMP)、血管内皮生长因子(VEGF)的异常表达等.因此,需要将Ⅰ期NSCLC临床和分子生物学预后因素两方面综合考虑,才能准确判断预后.     

Evaluation of a radioimmunoassay for neuron specific enolase in small cell lung cancer

A radioimmunoassay for neuron specific enolase (NSE), a marker of neuroendocrine differentiation, has been evaluated in small cell lung cancer (SCLC). In untreated patients 25/38 (68%) with localized SCLC had raised blood levels of NSE (greater than 13 ng ml-1), in extensive disease 34/39 (87%) patients had raised NSE levels. In patients with non-small cell lung cancer (NSCLC) the serum levels were raised in 16/94 (17%). In extensive tumours of non-pulmonary origin NSE levels were increased in 24/116 (20%) patients. Longitudinal studies indicated a good correlation between the response to chemotherapy and fall of NSE levels. Tumour progression was accompanied by a rising NSE in 25/29 patients, with doubling times of 7-90 days. In patients with progression with a normal NSE the recurrence was a NSCLC. Cerebral metastases occurring as the only recurrence during clinical complete remission were not accompanied by a rise of NSE. Serum NSE levels provides a valuable monitor for SCLC during and after chemotherapy.     

Prognostic factors in non-small cell lung cancer surgery.

AIMS: Complete surgical resection of primary tumours remains the treatment with the greatest likelihood for survival in early-stage non-small cell lung cancer (NSCLC). Although TNM stage is the most important prognostic parameter in NSCLC, additional parameters are required to explain the large variability in postoperative outcome. The present review aims at providing an overview of the currently known prognostic markers for postoperative outcome. METHODS: We performed an electronic literature search on the MEDLINE database to identify relevant studies describing the risk factors in NSCLC surgery. The references reported in all the identified studies were used for completion of the literature search. RESULTS: Poor pulmonary function, cardiovascular disease, male gender, advanced age, TNM stage, non-squamous cell histology, pneumonectomy, low hospital volume and little experience of the surgeon were identified as risk factors for postoperative outcome. However, with the exception of TNM stage and extent of resection, the literature demonstrates conflicting results on the prognostic power of most factors. The role of molecular biological factors, neoadjuvant treatment and adjuvant treatment is not well investigated yet. CONCLUSIONS: The advantage of knowing about the existence of comorbidity and prognostic risk factors may provide the clinician with the ability to identify poor prognostic patients and establish the most appropriate treatment strategy. The assessment of prognostic factors remains an area of active investigation and a promising field of research in optimising therapy of NSCLC patients.     

VEGF and TSP1 levels correlate with prognosis in advanced non-small cell lung cancer

Purpose

There is a need for biomarkers that may help in selecting the most effective anticancer treatments for each patient. We have investigated the prognostic value of a set of angiogenesis, inflammation and coagulation markers in patients treated for advanced non-small cell lung cancer.

Patients and methods

Peripheral blood samples were obtained from 60 patients before first line platinum-based chemotherapy ± bevacizumab, and after the third cycle of treatment. Blood samples from 60 healthy volunteers were also obtained as controls. Angiogenesis, inflammation and coagulation markers vascular endothelial growth factor (VEGF), their soluble receptors 1 (VEGFR1) and 2 (VEGFR2), thrombospondin-1 (TSP-1), interleukin-6 (IL6), sialic acid (SA) and tissue factor (TF) were quantified by ELISA.

Results

Except for TSP-1, pre- and post-treatment levels of all markers were higher in patients than in controls (p < 0.05). There was a positive and significant correlation between VEGF and VEGFR2 before treatment. VEGF also correlated with inflammatory markers IL-6 and SA. Moreover, there was a positive and significant correlation between levels of VEGFR1 and TF. Decreased levels of TSP-1 and increased levels of VEGF were associated with shorter survival. Bevacizumab significantly modified angiogenesis parameters and caused a decrease of VEGF and an increase of TSP-1.

Conclusion

Angiogenesis, inflammation and coagulation markers were increased in NSCLC patients. Increased levels of VEGF and low levels of TSP-1 correlated with a poor prognosis.     

晚期非小细胞肺癌患者血清CA125水平的预后价值

目的　通过检测晚期非小细胞肺癌 (NSCLC)患者血清CA12 5 ,以判断血清CA12 5水平对患者预后的影响。方法　 6 6例晚期NSCLC患者 ,接受 2～ 4周期化疗 ,其中 17例辅助放疗。所有患者在治疗前抽血测血清CA12 5。结果　 2 4例患者血清CA12 5水平升高 ,占 36 4%。CA12 5升高患者的 1年生存率为 12 5 % ,2年生存率为 0 ,与CA12 5正常患者的生存率差异有显著性 (P <0 0 5 )。Cox模型多因素分析表明 ,患者的预后与CA12 5水平 (P =0 0 0 0 )和疗效 (P =0 0 46 )有关。结论　血清CA12 5水平升高的晚期NSCLC患者生存期缩短 ,预后差 ,可以将血清CA12 5水平作为判断晚期NSCLC患者预后的一个独立指标。     

血清胃泌素释放肽前体与神经元特异性烯醇化酶水平在小细胞肺癌同步放化疗中的变化及其意义

目的:观察小细胞肺癌（SCLC）患者同步放化疗过程中血清胃泌素释放肽前体（Pro-GRP）与神经元特异性烯醇化酶（NSE）水平的变化情况及其意义。方法:回顾性分析2018年6月至2019年12月山西省肿瘤医院收治的80例SCLC患者资料,分为同步放化疗组（26例）与单纯化疗组（54例）,采用酶联免疫吸附试验（ELISA...