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ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 5  |  Page : 34-36

Serum carcinoembryonic antigen, neuron-specific enolase as biomarkers for diagnosis of nonsmall cell lung cancer


Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Henan University, Kaifeng 475000, PR China

Date of Web Publication7-Oct-2016

Correspondence Address:
Shuanglin Zhang
Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Henan University, Kaifeng 475000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.191626

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 > Abstract 


Objective: To investigate the clinical efficacy of serum carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) as biomarkers for diagnosis of nonsmall cell lung cancer (NSCLC).
Material and Methods: Forty-six cytology or pathology confirmed nonsmall cell lung patients and 33 cases of benign lung disease (BLD) were retrospective reviewed in our hospital from February 2013 to January 2016. The serum concentrations of CEA and NSE were measured by chemiluminescent assay. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (area under the curve) of serum CEA and NSE as biomarkers for diagnosis of lung cancer were analyzed by SPSS version 17.0 software.
Results: The serum CEA and NSE concentration were 30.69 ± 14.11 ng/mL, 52.36 ± 49.68 ng/mL for NSCLC patients and 12.69 ± 8.87 ng/mL, 5.32 ± 4.66 for BLD patients, respectively with statistical difference (P < 0.05); the diagnostic sensitivity and specificity were 58.66% and 76.48% for serum CEA at the cutoff value of 5.74 ng/mL and 66.67% and 78.69% for serum NSE at the cutoff value of 19.35 ng/mL; the diagnostic area under the ROC curve was 0.81 and 0.76 for CEA and NSE, respectively as biomarkers for diagnosis of NSCLC.
Conclusion: Serum CEA and NSE are potential biomarker for NSCLC diagnosis.

Keywords: Biomarker, carcinoembryonic antigen, diagnosis, neuron specific enolase, nonsmall cell lung cancer


How to cite this article:
Dong Y, Zheng X, Yang Z, Sun M, Zhang G, An X, Pan L, Zhang S. Serum carcinoembryonic antigen, neuron-specific enolase as biomarkers for diagnosis of nonsmall cell lung cancer. J Can Res Ther 2016;12:34-6

How to cite this URL:
Dong Y, Zheng X, Yang Z, Sun M, Zhang G, An X, Pan L, Zhang S. Serum carcinoembryonic antigen, neuron-specific enolase as biomarkers for diagnosis of nonsmall cell lung cancer. J Can Res Ther [serial online] 2016 [cited 2018 May 22];12:34-6. Available from: http://www.cancerjournal.net/text.asp?2016/12/5/34/191626




 > Introduction Top


Lung cancer is the first leading cause of cancer-related death worldwide according to the global cancer statistical reports.[1],[2] And in China, lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in men aged 75 years or older.[3] Early diagnosis of lung cancer can significant improves the prognosis in patients who received surgery. Serum biomarkers were known as effective and noninvasive for lung cancer diagnosis. Hence, the National Academy of Clinical Biochemistry (NACB) recommends the serum carcinoembryonic antigen (CEA), CYFRA 21-1, and NSE as the biomarker for adjuvant lung cancer diagnosis. In this study, we investigate the clinical efficacy of serum CEA and neuron-specific enolase (NSE) as biomarkers for diagnosis of nonsmall cell lung cancer (NSCLC).


 > Material and Methods Top


Patients included in this study

Forty-six cytology or pathology confirmed nonsmall cell lung patients and 33 cases of benign lung disease (BLD) were retrospective reviewed in our hospital from February 2013 to January 2016. The subjects inclusion criteria were (a) all the patients included in this study were diagnosed of NSCLC or BLD, (b) no other malignant disease can be found the included patients, and (c) the serum CEA and NSE can be extracted from the electronic medical records of our hospital.

Serum carcinoembryonic antigen and neuron-specific enolase detection

Four-milliliter fasting venous blood was collected for each of patients and 3000 rpm centrifugation for 10 min. CEA was measured by chemiluminescence (DxI 800, Beckman) and NSE by electrochemiluminescence assay (Cobase601, Roche).

Statistical analysis

The data of serum CEA and NSE were expressed by mean ± standard deviation. The Student's t- test was used to compare the difference between NSCLC patients group and BLD group. Two tails P < 0.05 was considered the significant statistical difference. All the statistical analysis was done by SPSS version 17.0 software (http://www-01.ibm.com/software/analytics/spss/).


 > Results Top


Serum carcinoembryonic antigen and neuron specific enolase distribution

For the NSCLC patients, the mean serum CEA and NSE concentration were 30.69 ± 14.11 ng/mL, 52.36 ± 49.68 ng/mL, respectively. And for BLD patients, the mean serum CEA and NSE concentrations were 12.69 ± 8.87 ng/mL, 5.32 ± 4.66 ng/mL. The serum concentration of CEA and NSE were significant higher in nonsmall cancer group compared to BLD group with statistical difference [P < 0.05, [Figure 1].
Figure 1: Serum carcinoembryonic antigen and neuron-specific enolase distribution of nonsmall cell lung cancer and benign lung disease group

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The diagnostic efficacy for serum carcinoembryonic antigen and neuron-specific enolase

The diagnostic sensitivity and specificity were 58.66% and 76.48% for serum CEA at the cutoff value of 5.74ng/mL; the diagnostic sensitivity and specificity were 66.67% and 78.69% for serum NSE at the cutoff value of 19.35 ng/mL [Table 1].
Table 1: The diagnostic sensitivity and specificity for CEA and NSE

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The areas under the receiver operating characteristic curves

The diagnostic area under the receiver operating characteristic (ROC) curve was 0.81 and 0.76 for serum CEA and NSE as biomarkers for diagnosis of NSCLC [Figure 2].
Figure 2: The area under the receiver operating characteristic curve of serum carcinoembryonic antigen and neuron-specific enolase for diagnosis of nonsmall cell lung cancer

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 > Discussion Top


Tumor biomarkers were secreted by cancer cells in the process of development, invasion, and metastasis.[4] Moreover, tumor biomarkers were known as an important adjuvant tool for malignant tumor diagnosis with noninvasive and convenient detection.[5] Lung cancer is the most diagnosed malignant tumors for males and the second for females worldwide.[6] In the USA, it was reported that 221,200 new lung cancer cases and 158,040 deaths were found in the year 2015.[1] Hence, lung cancer has become the major problem of public health. The prognosis of lung cancer is generally poor with low 5 years survival rate for patients with advanced stage. However, for early stage lung cancer, the prognosis was relative well. Hence, the early diagnosis for lung cancer is important for improving the prognosis. The NACB recommend the serum CEA, CYFRA 21-1, and NSE as the biomarker for adjuvant lung cancer diagnosis. CEA is secreted by gastrointestinal tissue during fetal development which was low in serum healthy adults.[7] But for patients with malignant carcinomas, the serum concentration of CEA can be elevated significantly.[8],[9] In lung cancer patients, the serum level of CEA was relative high compared to patients with BLD, which could be used as diagnosis markers. In this study, we found that the serum CEA was 30.69 ± 14.11 ng/mL and 12.69 ± 8.87 ng/mL for NSCLC patients and benign lung disease patients with statistical difference. NSE is isoenzyme of NSE. Previously studies showed that the serum level of NSE was high in patients with small cell lung cancer.[10] In this study, we found that the serum NSE was also elevated in NSCLC patients compared to compared to BLD patients.


 > Conclusion Top


Serum CEA and NSE are significant elevated in serum of NSCLC, which could be a potential biomarker for NSCLC diagnosis. But for its retrospective study design, more prospective studies are need for further evaluation its diagnostic efficacy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.  Back to cited text no. 1
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2.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.  Back to cited text no. 2
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Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016;66:115-32.  Back to cited text no. 3
    
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Patel JN, Ersek JL, Kim ES. Lung cancer biomarkers, targeted therapies and clinical assays. Transl Lung Cancer Res 2015;4:503-14.  Back to cited text no. 4
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Sozzi G, Boeri M. Potential biomarkers for lung cancer screening. Transl Lung Cancer Res 2014;3:139-48.  Back to cited text no. 5
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Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.  Back to cited text no. 6
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7.
Ozhiganov EL. Carcino-embryonic antigen in cancer of the large intestine (review of the literature). Sov Med 1985;8:66-70.  Back to cited text no. 7
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8.
Zou Y, Wang L, Zhao C, Hu Y, Xu S, Ying K, et al. CEA, SCC and NSE levels in exhaled breath condensate – Possible markers for early detection of lung cancer. J Breath Res 2013;7:047101.  Back to cited text no. 8
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9.
Okamura K, Takayama K, Izumi M, Harada T, Furuyama K, Nakanishi Y. Diagnostic value of CEA and CYFRA 21-1 tumor markers in primary lung cancer. Lung Cancer 2013;80:45-9.  Back to cited text no. 9
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10.
Wu GP, Ba J, Zhao YJ, Wang EH. Diagnostic value of CEA, CYFRA 21-1, NSE and CA 125 assay in serum and pleural effusion of patients with lung cancer. Acta Cytol 2007;51:679-80.  Back to cited text no. 10
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