Interpretation of lab tests - CRP, TUMOR MARKERS, SERUM FERRITIN
Serum ferritin levels in small cell lung cancer
Transcript of Serum ferritin levels in small cell lung cancer
SAA concentrations and depressed PBL
responses to Con A correlated with shortened
survival. Therefore, these parameters may be
of value in evaluating prognosis in patients
with lung cancer. In addition, serial
monitoring of SAA concentrations may be of
value in evaluating recurrence or cure of
lung cancer.
Multiple Markers for Lung Cancer Diagnosis:
Validation of Models for Advanced Lung Can-
cer.
Gall, M.H., Muenz, L., McIntire, K.R. et al.
Biostatistics Branch, National Cancer In-
stitute, National Institutes of Health,
Bethesda, MD 20892, U.S.A.J. Natl. Cancer
Inst. 76: 805-816, 1986.
Sera from 171 patients with advanced
lung cancer, from II0 normals, and from 123
subjects with benign respiratory diseases
were analyzed for i0 substances to detect
lung cancer: ferritin, lipid-bound sialic
acid, total sialic acid, beta 2-
microglobulin, lipotropic, the alpha and
beta subunits of hHman chorionic
gonadotropin, calcitonin (two assays),
parathyroid hormone, and carcinoembryonic
antigen. Individual markers were studied,
and optimal combinations of markers were
sought for discriminating lung cancer
patients from normals and from patients with
benign lung disease. Numerous methods for
combining the markers were examined, but the
methods of logistic regression and recursive
partitioning were finally adopted. The best
discrimination rules we could find used only
carcinoembryonic antigen (CEA) and total
sialic acid (TSA). The performance of these
rules was validated on an independent serum
panel containing sera from 68 patients with
advanced lung cancer, from 40 normals, and
form 52 patients with benign respiratory
disease. The combination rules based on TSA
and CEA performed better than a rule based
on CEA alone. Logistic discrimination rules
with TSA and CEA that were designed to have
95% specificity achieved 54% sensitivity for
discriminating advanced lung cancer from
normal controls and 52% sensitivity for dis-
criminating advanced lung cancer from con-
trols with benign disease. Some aspects of
clinical applicability are discussed, in-
cluding planned studies for localized lung
cancer and the requirement for further test-
ing in specific clinical settings.
Serum Deoxythymidine Kinase in Small Cell
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Carcinoma of the Lung: Relation to Clinical
Features, Prognosis, and Other Biochemical
Markers.
Gronowitz, J.S., Steinholtz, L., Kallander,
C.F.R. et al. Department of Medical Virol-
ogy, Biomedical Center, Uppsala University,
Uppsala, Sweden. Cancer 58: 111-118, 1986.
Thymidine kinase (s-TK), lactate
dehydrogenase (LDH), and carcinoembryonic
antigen (CEA) were determined in pretreat-
ment serum from 125 patients with small cell
carcinoma of the lung. The distribution of
marker levels into three ranges, when in-
cluding all patients were as follows: s-TK <
5 units 49%, 5-<10 units 25%, > or = i0
units 26%; LDH < 6.7 ~kat 31%, 6.7-< 13.4
~kat 48%, > or = 13.4 ~kat 21%; CEA < 7.5
~g/l 51%, 7.5-< 15 ug/l 25%, > or = 15 ~g/l
24%. The percentages of patients with
limited and with extensive disease within
each range were s-TK<5 82/18, 5-<10 29/71, >
or = I0 9/91; LDH < 6.7 76/24, 6.7-<13.4
51/49, > or = 13.4 21/79; CEA < 7.5 70/30,
7.5-<15 39/61, > or = 15 23/77. Analyses in
relation to metastases present showed that
patients with skeletal and bone marrow
metastases had significantly higher s-TK and
LDH than those without, while this was not
the case for CEA. A strong correlation be-
tween s-TK and LDH level, a weaker correla-
tion between CEA and s-TK, and no correla-
tion betwee CEA and LDH level, was found.
Both the level of s-TK and LDH correlated to
the patients' performance, as defined by the
Karnofsky index. These correlations were
mainly confined to the patients with exten-
sive disease. Analyses of the prognostic
capacity of variables showed that s-TK,
stage, and Karnofsky index could divide the
patients into groups with highly significant
difference in survival time, while LDH and
CEA were of less value. Longitudinal studies
showed that the serum markers mirrored the
disease activity, with the exception that
highly increased s-TK was found during
remission induction for some patients. It
was concluded that the expression of
pathologic levels for the serum markers were
dependent on different biological
parameters. Of the serum markers, only s-TK
was judged useful for estimation of disease
spread and prognosis of the individual
patient.
Serum Ferritin Levels in Small Cell Lung
Cancer.
Cox, R., Gyde, O.H., Leyland, M.J. Depart-
42
ment of Haematology, East Birmingham Hospi-
tal, Birmingham B9 5ST, U.K. Eur. J. Cancer
Clin. Oncol. 22: 831-835, 1986.
Serum ferritin levels were measured
before treatment, using an im~noradiometric
method, in 39 patients with small cell lung
cancer. In ii patients serial estimations
were also made. The medium serum ferritin
level for male patients was 666 mug/l (range
13-1329) and for females 306 (range 134-
5300), the normal range being 32-501. This
increase is significant (P < 0.001). Serum
ferritin levels were not related to metas-
tatic, haematological or iron status. Serial
ferritin levels did not reflect the clinical
course of the disease. Patients with a pre-
treatment serum ferritin of <600 mug/l had a
significant prolongation of median survival
compared to those with an initial serum fer-
ritin of > 600 mug/l (P < 0.02). Serum fer-
ritin levels are not of value in staging
small cell lung cancer nor in monitoring its
progress. However, the initial serum fer-
ritin is of prognostic significance.
Diagnostic Value of High Molecular Weight
Alkaline Phosphatase in Detection of Hepatic
Metastasis in Patients with Lung Cancer.
Nishio, H., Sakuma, T., Nakamura, S.-I. et
al. Department of Lung Cancer, The Center
for Adult Diseases, Osaka 537, Japan. Cancer
57: 1815-1819, 1986.
High molecular weight alkaline phos-
phatase (HMW-ALP) was measured in the sera
of 126 patients with lung cancer to deter-
mine its diagnostic value in the detection
of hepatic metastasis. This isoenzyme was
found in 21 of 24 patients with hepatic
metastasis and in 27 of 102 patients without
hepatic metastasis. When i0 U/L was used as
a cut-off value, the sensitivity,
specificity, and accuracy of this test were
71%, 89%, and 86%, respectively. From the
standpoint of histologic type, this test was
most useful in patients with small cell car-
cinoma. HMW-ALP was not detected in the sera
of 15 controls. It is concluded that HMW-ALP
is a useful marker for hepatic metastasis in
patients with lung cancer.
Plasma Angiotensin-Converting Enzyme Ac-
tivity in Patients with Bronchial Carcinoma.
Roulston, J.E., Galloway, P.J., Douglas,
J.G. University Department of Clinical
Chemistry, Royal Infirmary of Edinburgh,
Edinburgh, U.K. Br. J. Dis. Chest 80: 229-
234, 1986.
Plasma angiotensin-converting enzyme
(ACE) activities were measured in 58 con-
secutive patients presenting with bronchial
carcinoma. The mean ACE activity before
treatment was significantly lower than that
of a control population (P < 0.005). There
was a significant and direct relationship
between the initial plasma ACE activity and
survival time (P < 0.01) which could not be
explained by further analysis for age,
clinical staging, or respiratory function,
as judged by 9~EV. There was a significant
increase in plasma ACE activity (P < 0.03)
in nine patients with three or more plasma
samples after treatment with chemotherapy or
radiotherapy. These results suggest that low
plasma ACE activity is associated with poor
prognosis in bronchial carcinoma.
Bronchogenic Carcinoma Associated with Upper
Aerodigestive Cancers.
Yellin, A., Hill, L.R., Benfield, J.R.
Department of Thoracic Surgery, City of Hope
National Medical Center, Duarte, CA 91010,
U.S.A.J. Thorac. Cardiovasc. Surg. 91: 674-
683, 1986.
Of 1,450 patients with upper airway
cancers, 189 (13%) had additional cancers.
There were 60 cases in which lung cancer oc-
curred after upper airway cancer and a
single case in which it preceded upper air-
way cancer. The occurrence of upper airway
plus lung cancer in 61 patients was referred
to as multiple airway cancers. The overall
incidence of multiple airway cancers was
4.1% or 1:112 patient-years at risk. The
highest incidence of lung cancer was 1:70
patients-years, and this was associated with
laryngeal cancer. The mean diagnostic inter-
val between upper airway and lung cancers
was 6.1 (0 to 23) years, including nine
cases (14.8%) in which the two were
synchronous. Triple endoscopy revealed oc-
cult lung cancer only once. The use of
mediastinoscopy (n = 9) and other surgical
staging procedures (n = 9) was limited, be-
cause previous treatment of upper airway
cancers made such procedures impractical and
also because interpretation of findings
would have been difficult. Past reports have
indicated that lung cancer in association
with upper airway cancer is almost in-
variably squamous cell and almost always
develops in men. By contrast, among our 61
patients, the incidence of adenocarcinomas
was 24%, and 16 patients or 26% were women.
Among patients whose records could be