Abstract
To investigate the clinical value in lung cancer of a combination of four serum tumor markers, haptoglobin (Hp), carcinoembryonic antigen (CEA), neuron specific enolase (NSE) as well as the cytokeratin 19 fragment (CYFRA21-1). Serum Hp (with immune-turbidimetric method), CEA, NSE, CYFRA21-1 (with chemiluminescence method) level were assessed in 193 patients with lung cancer, 87 patients with benign lung disease and 150 healthy controls. Differences of expression were compared among groups, and joint effects of these tumor markers for the diagnosis of lung cancer were analyzed. Serum tumor marker levels in patients with lung cancer were obviously higher than those with benign lung disease and normal controls (p<0.01). The sensitivities of Hp, CEA, NSE and CYFRA21-1 were 43.5%, 40.9%, 23.3% and 41.5%, with specificities of 90.7%, 99.2%, 97.9% and 97.9%. Four tumor markers combined together could produce a positive detection rate of 85.0%, significantly higher than that of any single test. With squamous carcinomas, the positive detection rates with Hp and CYFRA21-1 were higher than that of other markers. In the adenocarcinoma case , the positive detection rate of CEA was higher than that of other markers. For small cell carcinomas, the positive detection rate of NSE was highest. The area under receiver operating characteristic curve (AUCROC) of Hp in squamous carcinoma (0.805) was higher than in adenocarcinoma (0.664) and small cell carcinoma (0.665). Hp can be used as a new serum tumor marker for lung cancer. Combination detection of Hp, CEA, NSE and CYFRA21-1 could significantly improve the sensitivity and specificity in diagnosis of lung cancer, and could be useful for pathological typing.
Highlights
Lung cancer is one of the most common malignant tumors in the world, and its morbidity and mortality are rising year by year
The tumor makes constant substance exchange with the surrounding environment in the process of growth and proliferation. These matters secreted by tumor are necessary for tumor cell growth, invasion and metastasis, proteins secreted by tumor can reach the blood and other body fluids as tumor markers
Serum levels of Hp, carcinoembryonic antigen (CEA), CYFRA21-1 and neuron specific enolase (NSE) in patients with lung cancer were significantly higher than those with lung benign disease group and healthy group, indicating that the four kinds of tumor markers had a certain value in diagnosis of lung cancer
Summary
Lung cancer is one of the most common malignant tumors in the world, and its morbidity and mortality are rising year by year. The method of joint detection of tumor markers for lung cancer early diagnosis and pathological typing was mostly used clinically. Studies have pointed out that Hp has higher expressions in oral squamous carcinoma, pancreatic cancer, lung cancer and other cancer patients serum or body fluids (Chih-Ho et al, 2010; Kang et al, 2011; Farooqui et al, 2012; Jessie et al, 2013), indicating that Hp has potential clinical application value in tumor diagnosis. This research, through the haptoglobin (Hp) in combination with carcinoembryonic antigen (CEA), neuron specific enolization enzyme (NSE) and cytokeratin 21-1 (CYFRA21-1) detect, to explore the clinical value of single or multiple markers detection to the diagnosis of lung cancer, and to further evaluate the application value of Hp as biomarker to diagnose lung cancer
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