The value of urinary polyamine assay in stomach cancer. Comparison with serum carcinoembryonic antigen.

Abstract

The authors recently established a new simple enzymatic assay method for total urinary polyamines (Cancer Res 1983; 43:2263-2367). In order to assess the clinical usefulness of measuring total urinary polyamines for the detection of cancer, this method has been applied to the assay of polyamines in the urine of 45 patients with stomach cancer who were classified as to clinical stage. In addition, the value of serum carcinoembryonic antigen (CEA) in the same individual patients was measured for comparison. Percentage of patients with elevated levels of total urinary polyamines increased with International Union Against Cancer (UICC) clinical stage, and was 40.0% (6/15), 50% (3/6), 72.7% (8/11), and 84.6% (11/13) for Stage I, II, III and IV stomach cancer patients, respectively. In 32 patients with stomach cancer of potentially operable Stage I, II, and III, elevated levels of total urinary polyamines were found in 17 patients and elevated levels of serum CEA were found in 5 patients. In 13 patients with inoperable stage IV stomach cancer, elevated levels of total urinary polyamines were found in 11 patients and elevated levels of serum CEA were found in 5 patients. Statistical differences in the detection rate were found between the two markers in these two groups of patients. The combination of these two markers did not increase the detection rate of stomach cancer significantly. The data indicate that the determination of total urinary polyamines by the new assay is clinically useful as a potential marker for the detection of advanced stages of stomach cancer and may be more useful than that of serum CEA. Furthermore, this study demonstrates the relationship between urinary polyamine levels and tumor regression and also the prognostic significance of polyamine determination in stomach cancer patients. In 6 of 13 patients who showed elevated levels of urinary polyamines before surgery, polyamine levels fell to within the normal range after successful surgical removal of tumor. In general, each polyamine level decreased significantly following surgery by paired Student's t test analysis. All of the five Stage IV patients with polyamine levels greater than 4.0 mumol/kg/24 hour died in less than 3 months whereas five of eight Stage IV patients with polyamine levels less than or equal to 4.0 mumol/kg/24 hour survived 10 to 20 months. Statistical differences in survival were observed between Stage IV patients with polyamine levels greater than 4.0 mumol/kg/24 hour and those with polyamine levels less than or equal to 4.0 mumol/kg/24 hour.(ABSTRACT TRUNCATED AT 400 WORDS)