DIAGNOSTIC IMPLICATIONS OF IMMUNOHISTOCHEMICAL MARKERS IN UTERINE SMOOTH MUSCLE TUMORS

Objective: To evaluate the diagnostic implications of immunohistochemieal markers in uterine smooth muscle tumors. Methods: Formalin-fixed paraffin-embedded tissue blocks were selected from 17 uterine leiomyosarcomas, 40 uterine unusual leiomyomas and 25 uterine usual leiomyomas. Utilizing immunohistochemical techniques with antigen retrieval, serial sections of each tumor for immunoreactivity with myogenic markers, ovarian steroid receptors, CD44v3, proliferating cell nuclear antigen and mast cells were assessed. Results: Although the myogenic markers and CD44v3 showed less frequent positivity in uterine leiomyosarcomas than those in unusual leiomyomas,they were not reliable markers for differentiating leiomyosarcoma from leiomyoma. Uterine leiomyosarcoma tended to have lower ovarian steroid receptors immunoreactivity rates than leiomyoma. Leiomyoma tended to have a higher quantity of intratumoral mast cells than leiomyosarcoma, while the expression of proliferating cell nuclear antigen was lower in them. Conclusion: Because the estimation of mitotic count was subject to significant variation, the immunohistochemical expression of ovarian steroid receptors, mast cells and proliferating cell nuclear antigen seemed to be helpful for the discrimination of unusual leiomyoma from leiomyosarcoma.     

Prognostic molecular markers for planning adjuvant chemotherapy trials in Dukes' B colorectal cancer patients: how much evidence is enough?

The benefit of postoperative adjuvant chemotherapy in patients with Dukes' B colorectal cancer is still uncertain and its routine use is not recommended. Prognostic biomarkers may be useful for identifying high-risk patients with resected, node-negative disease, and this stratification may represent an innovative strategy for designing adjuvant chemotherapy trials. Featured prognostic molecular markers can be divided into the following categories: cell proliferation indices (Ki-67, Mib-1, proliferating cell nuclear antigen); oncogenes/tumor suppressor genes [p53, K-ras, Deleted in Colorectal Cancer (DCC), Bcl-2, c-erbB2]; DNA repair (microsatellite instability); markers of angiogenesis (vascular count, vascular endothelial growth factor); markers of invasion/metastasis (plasminogen-related molecules, matrix metalloproteinases); and biochemical markers (thymidylate synthase). Studies that have investigated their prognostic role in Dukes' B colorectal cancer patients are reviewed here. Current data do not provide sufficient evidence for the incorporation of available prognostic biomarkers into clinical practice. However, a biomarker-based approach could be an effective strategy for improving results of postoperative adjuvant treatments in high-risk Dukes' B colorectal cancer patients. Markers of altered DCC function have shown promising prognostic role and sufficient prevalence in retrospective investigations and they deserve further assessment in prospective studies.     

An endogastric capsule for measuring tumor markers in gastric juice: an evaluation of the safety and efficacy of a new diagnostic tool.

BACKGROUND: In gastric juice, high levels of the carcinoembryonic antigen (CEA) and the carbohydrate antigen 19-9 (CA 19-9) have been found to correlate with precancerous lesions and gastric cancer. So far, sampling of gastric juice has required upper endoscopy. In place of this invasive procedure, we investigated a new tool for the quantitation of tumor markers in gastric juice. MATERIALS AND METHODS: The study population consisted of healthy controls and consecutive subjects with suspected gastric cancer or dyspepsia/epigastric distress. Patients were asked to swallow a small gelatine capsule (14 mm in length and 5 mm in diameter) containing a pierced plastic cover and surrounding a piece of absorbent paper. The capsule was left in the gastric cavity for 60 min to allow saturation of the absorbent paper with gastric juice. A 45-50 cm length of nylon thread connected to the inner capsule was used to remove the device from the gastric cavity. After processing the absorbent paper for radioimmunoassay, CEA and CA 19-9 levels were correlated to the findings of upper endoscopy and biopsies of gastric mucosa or suspected lesions. RESULTS: The endogastric capsule did not cause any side-effects and 62 participants were fully compliant to the procedure. Assessable gastric juice samples were taken from 23 patients with gastric cancer, 15 patients with intestinal metaplasia or dysplasia, 12 patients with gastritis and 12 controls without gastric diseases. In the 12 samples of gastric juice from control patients, mean values of CEA and CA 19-9 were 1.1 +/- 0.9 ng/ml and 16 +/- 7.5 ng/ml, respectively. The mean levels of both markers were found to increase according to the severity of gastric lesions and in patients with cancer, mean CEA and CA 19-9 levels were 513 +/- 627 ng/ml and 545 +/- 510 ng/ml, respectively. Patients with precancerous lesions and cancer showed higher levels of CEA and CA 19-9 than patients with normal findings or gastritis (P <0.001). CONCLUSIONS: The endogastric capsule is a simple, non-invasive tool for the measurement of CEA and CA 19-9 levels in gastric juice. These values may discriminate between normal or minor pathologic changes and precancerous lesions or carcinomas. Further investigations are warranted, since this may represent a new method for gastric cancer screening.     

Prognostic value of serial CA125 measurements during chemotherapy for patients with advanced ovarian cancer

Serum CA125 concentrations measured before and during chemotherapy may provide additional information for prognostic assessment of patients with epithelial ovarian cancer (EOC), and enable discrimination between patients who are likely to benefit from further therapy and those who will not. Medical records of 40 patients with advanced EOC, treated at the Department of Obstetrics and Gynecology of the University Hospital Nijmegen between July 1984 and April 1993, were examined. All patients had primary cytoreductive surgery followed by platinum-based chemotherapy. Serum samples were obtained before surgery and during chemotherapy. Follow-up information and patient and tumor characteristics were abstracted from medical records until December 1, 1994. By using multivariate Cox proportional hazards models for disease-free and overall survival it was evaluated whether outcome prediction was improved by inclusion of serum CA125 quantitations.
  Only FIGO stage and extent of residual tumor were significant independent prognostic factors before the start of chemotherapy. When such regression models were constructed after subsequent courses of chemotherapy, serum CA125 measurements conducted after each of the first three chemotherapy courses improved the prediction of disease-free survival. Prediction of overall survival was improved by inclusion of serum CA125 measurements after courses 1–6. Inclusion of serum CA125 measurements during chemotherapy improved prognostic assessment of patients with advanced EOC.     

Prognostic significance of loss of heterozygosity on chromosome 9p21–22 in human esophageal cancer

Background Deletions involving chromosome 9p21, on which the tumor suppressor genep16/MTS1 is located, have been noted in esophageal cancer. We investigated the relationship between the deletion of chromosome 9p21–22 and the clinical features of esophageal cancer. Methods We examined the loss of heterozygosity (LOH) on chromosome 9p21–22 in 56 esophageal cancers using polymerase chain reaction (PCR) analysis and 2 microsatellite markers (RPS6 and IFNA). Results In 18 out of 50 informative cases (36%), LOH had occurred at 1 or 2 loci on chromosome 9p21–22. We found no relationship between LOH on chromosome 9p21–22 and patient sex, age tumor length, location, histologic differentiation, depth of tumor invasion, the extent of lymph node metastasis, histologic stage, or curability. Among 35 patients without an absolute noncurative resection, the mean survival of 11 patients with LOH on chromosome 9p21–22 was 19.3 months, compared with 42.3 months for 24 patients with a normal allele; thus, the survival rate of those with LOH was significantly lower than that of patients without LOH on chromosome 9p21–22 (log-rank test;P=0.03). Conclusion These data suggest that LOH on chromosome 9p21–22, on which the cell-cycle regulatorp16/MTS1 gene is located, may be related to cancer development, and probably can serve as a clinical marker for evaluating a patient's prognosis.     

BRCA1有关微卫星多态与乳腺癌生物学特性的关系

目的了解BRCA1附近的4个多态标记位点在散发性乳腺癌中发生LOH（杂合性丢失）和MSI（微卫星不稳定性）的情况，探讨LOH和MSI和乳腺癌临床病理参数之间的关系。方法应用聚合酶链式反应（PCR）一变性聚丙烯酰胺凝胶电泳（PAUGE）－DNA银染方法。结果4个多态位点总的LOH和MSI的发生率分别为62．5％和45．0％。肿瘤最大径≤2cm的患者MSI的发生率显著高于肿瘤最大径＞2cm的患者（P相似文献   

原发性肺癌患者外周血肿瘤标记物联合检测的临床意义

目的探讨外周血CEA、CYFRA21-1、NSE联合检测对原发性肺癌的诊断、病理分型、分期和疗效判断的临床应用价值。方法采用放射免疫技术,检测72例原发性肺癌患者化学治疗前后、38例良性肺部疾病患者及30例健康人血清CEA、CYFRA21-1、NSE水平。结果肺癌组治疗前CEA、CYFRA21-1、NSE水平显著高于良性肺部疾病组及正常对照组(P均<0.01),且不同病理类型肺癌3种肿瘤标记物的水平有显著性差异。3种肿瘤标记物联合检测与各单项指标检测比较,对肺癌诊断的敏感性显著增高(P<0.01),肺癌NSE检出阳性率最高(63.9%),但特异性有所下降。肺癌组化疗有效者3种肿瘤标记物水平显著下降,病情稳定和进展者三者水平无变化或升高。结论血清CEA、CYFRA21-1、NSE联合检测用于肺癌的诊断有较好的临床参考价值,并有助于肺癌病理类型的评估,亦可作为肺癌病情监测和疗效判断方面有价值的指标。     

淋巴瘤患者血清中肿瘤相关物质群的水平及其临床意义

目的:探讨肿瘤相关物质群(tumor supplied group of factors,TSGF)在淋巴瘤患者血清中的含量变化及其临床意义。方法:用比色法测定60例淋巴瘤(霍奇金淋巴瘤2例,非霍奇金淋巴瘤58例)患者的血清TSGF水平,以血清TSGF≥64U/mL定为阳性阈值。结果:初治前(n=25)不同临床分期(Ⅰ期3例,Ⅱ期7例,Ⅲ期10例,Ⅳ期5例)患者的血清TSGF水平差异无纺计学意义[Ⅰ期(57·33±8·58)、Ⅱ期(68·43±9·21)、Ⅲ期(66·20±7·73)、Ⅳ期(59·80±5·31)U/mL],各临床分期患者TSGF阳性率分别为33·3%、71·4%、70%和40%;未缓解/难治复发组[n=17,(69·35±11·53)U/mL]和初诊治疗前组[n=25,(64·64±8·36)U/mL]的血清TSGF水平显著高于CR/PR组[n=18,(56·83±6·26)U/mL]和正常对照组[n=66,(55·53±5·26)U/mL];各组TSGF阳性率分别为70·6%、60%、16·7%和1·5%;未发现初治前组TSGF值的高低与化疗反应有关;血清TSGF值持续高水平的患者顽固耐受化疗且预后极差。结论:血清TSGF水平与淋巴瘤病理状态有关,并具有预后意义。     

肿瘤标记物和CT联检对肺癌的诊断价值

目的:探讨多种肿瘤标记物检测联合CT扫描在肺癌诊断中的价值。方法:90例肺癌和20例肺良性病变患者与20名正常人,检测其血清NSE、CEA和CYFRA21-1三项肿瘤标记物含量,同时行肺部CT扫描检查。结果:肺癌组血清三项肿瘤标记物含量均高于正常对照组和肺良性病变组,P=0·000;NSE在小细胞肺癌中高表达(36·21±19·01)μg/L,CEA在肺腺癌中高表达(50·09±25·36)μg/L,CYFRA21-1在肺鳞癌中高表达(17·72±12·05)μg/L,三项肿瘤标记物的血清浓度与肺癌病理类型有关,P=0·001;肿瘤标记物和CT扫查对肺癌分型诊断总体符合率分别为79·2%和62·5%,联合检测的总体符合率为87·8%,联合检测优于单项检测,P=0·039;三项肿瘤标记物的含量在肺癌各期间差异无统计学意义,P>0·05。结论:多种肿瘤标记物联检,可提高肺癌分型的诊断符合率,结合CT分期有助于选择针对性的治疗方案。肿瘤防治杂志,2005,12(19):1480-1482     

血清CA125、CA153、CA242三种肿瘤标志物联合检测对肺癌诊断的价值

目的探讨CA125、CA153、CA242联合检测在肺癌筛查与临床诊断中的应用价值.方法采用CanAg诊断试剂盒,对56例肺癌患者及108例健康人血清进行CA125、CA153、CA242测定.结果肺癌患者组CA125、CA153、CA242值分别为54.97±95.70,36.02±40.38,14.38±21.99;阳性率分别为41.07%、44.64%、23.21%.健康人组CA125、CA153、CA242值分别为11.23±1.58,12.73±11.92,15.11±13.60,阳性率均为0%,肺癌患者组CA125、CA153值明显高于健康人组(P＜0.01),肺癌患者组中CA125、CA153阳性率明显高于CA242(P＜0.05),CA125、CA153联合检测阳性率明显大于单独检测(P＜0.05)、Ⅰ-Ⅱ期肺癌患者与Ⅲ、Ⅳ期肺癌患者CA125、CA153值相比有显著性差异(P＜0.05).结论 CA125、CA153联合检测对肺癌筛查与临床诊断有良好辅助价值,CA242测定对肺癌筛查与临床诊断价值不大.