IN A PRELIMINARY STUDY, RESEARCHers identified a novel biomarker that predicts cancer metastasis. If validated in more-rigorous studies, the biomarker could help clinicians improve treatment strategies for patients with certain types of cancer. Researchers with the National Institutes of Health and the University of Hong Kong in China discovered that an N-terminal truncated protein variant of carboxypeptidase E (CPEN) induces tumor growth and metastasis. Patients with high levels of this protein were more likely to have their cancer spread, regardless of staging and grading; those with low levels, regardless of staging and grading, were more likely to not have their cancers spread (Lee TK et al. J Clin Invest. doi:10.1172 /JCI40433 [published online ahead of print February 1, 2011]). “We can tell from the levels [of CPEN] whether the tumor has spread and predict whether the tumor is likely to recur in the same tissue or spread to other parts of the body in the future,” said Y. Peng Loh, PhD, a coauthor of the research paper and a member of the National Institute of Child Health and Human Development’s section on cellular neurobiology. Because currently available biomarkers cannot accurately achieve such predictions, prognosis is determined by staging of the cancer using histopathological techniques, he noted. The findings are based on analysis of tissue from 99 patients with liver cancer, which involved a comparison of levels of CPEN RNA in the tumors and in surrounding tissue. Patients whose tumors had a CPEN RNA level that was more than twice that found in the surrounding tissue were highly likely to experience a recurrence or metastasis of their cancer within 2 years. Using this threshold measure, the researchers accurately predicted metastasis or recurrence in more than 90% of cases. Their predictions that tumors would not return in the 2-year period were accurate 76% of the time. Measuring CPEN levels was predictive regardless of the staging of the cancers. For example, in 18 patients with stage II cancer, a stage in which patients are often told their cancer is in remission and no further follow-up care is necessary, recurrence or metastasis occurred within 2 years in only 1 of 10 patients with low levels of CPEN and in 4 of 7 patients with high levels of CPEN. For 12 patients with stage IV liver cancer, 4 of 5 with low levels of CPEN did not experience recurrence 2 years postsurgery, while 6 of the 7 with high levels of CPEN did. “Ourassay,whichcanbetterdetermine theaggressivenessofthetumor,canbring hope of longer survival and psychologicalcomforttothosestageIVpatientswith low CPEN RNA levels,” Loh said. “It will also encourage practitioners to actively treat these patients with chemotherapy, since they have a good chance of not having a recurrence.” A biomarker that outperforms staging and grading after surgical resection could be clinically useful, said Stephen M. Hewitt, MD, PhD, another of the researchers and a staff scientist with the National Cancer Institute. “Tests such as this, where one can perform it on a small sample of the specimens without full resection, have the opportunity of allowing physicians to better plan patient care ahead of time and direct the care in a more effective manner,” Hewitt said. The researchers also studied 14 patientswithpheochromocytomaandparaganglioma, who were followed up for 8 years. For these patients, CPEN RNA levels (measured in the tumor tissue only because tissue surrounding the tumor was not obtainable), ranged from 150 000 to 15 million per 200 μg. In all cases in which cancer recurred or me-
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