Abstract
Background:Reliable blood markers for aiding lung cancer (LC) diagnosis and differentiating LC from tuberculosis are lacking in India. Methodology:In this single-centre, cross-sectional, real-world study, serum levels of 5 TMs (CEA, CYFRA 21-1, SCC, ProGRP, NSE) were measured from consented patients with suspicious lung nodules who were candidates for biopsy, and also from healthy controls. TM level measurement was done through electrochemiluminescent immunoassay, followed by histological diagnosis on the biopsied specimen. Using package insert cut-offs, sensitivity and specificity of the 5 TMs were evaluated individually and in combination. Using receiver operating characteristic (ROC) curves of individual TMs, the ability of CEA, CYFRA 21-1, and ProGRP taken together was evaluated for its ability to differentiate LC from no-LC. Results:Out of 178 subjects, 160 had LC (147 NSCLC; 13 SCLC). NSCLC patients had higher median values of CYFRA 21-1 and SCC; SCLC patients had higher median values of CEA, NSE, and ProGRP. Adenocarcinoma-NSCLC patients had higher median values of CEA, CYFRA 21-1, NSE, and ProGRP; squamous-NSCLC patients had higher median value of SCC. For differentiating LC from no-LC, the combination of all 5 TMs (sensitivity:97.5%, specificity:33.3%) and combination of CEA, CYFRA 21-1 and ProGRP (sensitivity:91.3%, specificity:88.9%) were found suitable. Conclusion:Combination of all 5 TMs, and combination of CEA, CYFRA 21-1, and ProGRP represents an easy and non-invasive method for aid in LC diagnosis that does not require technical expertise. TM evaluation can also supplement histological diagnosis of LC.
Highlights
As per the Globocan 2020 data, lung cancer (LC) accounted for 11.4% of all new cases of cancer worldwide, second only to breast cancer, and 18% of all global cancer-related mortality was due to LC (WHO-IARC, 2020a)
Among NSCLC patients, adenocarcinoma, squamous carcinoma, and large cell carcinoma was found in 96, 38, and 1 patient respectively, with 12 patients receiving a diagnosis of NSCLC-not otherwise specified (NOS)
Based on the area under the curves (AUCs) observed in the receiver operating characteristic (ROC) curves, we further explored the diagnostic capability of using tumour markers (TMs) in combination
Summary
As per the Globocan 2020 data, lung cancer (LC) accounted for 11.4% of all new cases of cancer worldwide, second only to breast cancer, and 18% of all global cancer-related mortality was due to LC (WHO-IARC, 2020a). By 2040, it is predicted that in India there will be 120,000 new cases, and 110,000 deaths attributable to, cancers involving trachea, bronchus, and lung (WHO-IARC, 2020c). Methodology: In this single-centre, cross-sectional, real-world study, serum levels of 5 TMs (CEA, CYFRA 21-1, SCC, ProGRP, NSE) were measured from consented patients with suspicious lung nodules who were candidates for biopsy, and from healthy controls. NSCLC patients had higher median values of CYFRA 21-1 and SCC; SCLC patients had higher median values of CEA, NSE, and ProGRP. Adenocarcinoma-NSCLC patients had higher median values of CEA, CYFRA 21-1, NSE, and ProGRP; squamous-NSCLC patients had higher median value of SCC. Conclusion: Combination of all 5 TMs, and combination of CEA, CYFRA 21-1, and ProGRP represents an easy and non-invasive method for aid in LC diagnosis that does not require technical expertise.
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