Abstract
The detection of serum tumor markers is valuable for the early diagnosis of lung cancer. Tumor markers are frequently used for the management of cancer patients. However, single markers are less efficient but marker combinations increase the cost, which is troublesome for clinics. To find an optimal serum marker combination panel that benefits the patients and the medical management system as well, four routine lung cancer serum markers (SCCA, NSE, CEA, and CYFRA21-1) were evaluated individually and in combination. Meanwhile, the costs and effects of these markers in clinical practice in China were assessed by cost-effectiveness analysis. As expected, combinations of these tumor markers improved their sensitivity for lung cancer and different combination panels had their own usefulness. NSE + CEA + CYFRA21-1 was the optimal combination panel with highest Youden's index (0.64), higher sensitivity (75.76%), and specificity (88.57%), which can aid the clinical diagnosis of lung cancer. Nevertheless, the most cost-effective combination was SCCA + CEA, which can be used to screen the high-risk group.
Highlights
Lung cancer has the highest incidence and mortality of any cancer worldwide
With respect to TNM stage, only carcinoembryonic antigen (CEA) was dramatically increased in stages III/IV when compared to stages I/II (P < 0.05), while no differences were observed in the concentrations of the squamous carcinoma antigen (SCCA), neuron specific enolase (NSE), and CYFRA21-1 markers between the two stages
Similar to the trend in TNM stage, CEA demonstrated a higher concentration in the extensive disease group than in the limited disease
Summary
Lung cancer has the highest incidence and mortality of any cancer worldwide. In 2008, 1.61 million new cases were reported, and 1.38 million deaths were attributed to lung cancer. The highest rates are in Europe and North America. In contrast to the declining mortality rate in men, lung cancer mortality rates in women have been rising over the recent decades [1]. In China, lung cancer has the highest incidence, and it is the leading cause of mortality of all cancers. This cancer is increasing at a rapid rate, and both incidence and mortality are steadily growing. China will drive up global rates of lung cancer in the foreseeable future [2]
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