Nonlinearity of measurements of a tumor marker for breast cancer.
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Antigens, Tumor-Associated, Carbohydrate↗
Biomedical subjects
E H Cooper
Publications and source records attributed to E H Cooper.
Neuron-specific enolase can be used as the sole guide to treat small-cell lung cancer patients in common clinical practice.
Serum samples were collected from 115 small-cell lung cancer patients before each course of chemotherapy and during follow-up. Levels of neuron-specific enolase (NSE) were measured and compared to the clinical assessments of the course of the disease, which were done by the responsible physician without knowledge of NSE-values. The predictive accuracy of an increase or decrease of NSE for a major response (CR + PR), SD or PD was 98%. Importantly no false-positive rises of NSE were observed. On the basis of this large number of data it seems justified to conclude that in common clinical practice the treatment of small-cell lung cancer patients can be monitored by serial measurements of NSE alone.
Biomarkers, Tumor↗
Neuron specific enolase, carcinoembryonic antigen and lactate dehydrogenase as indicators of disease activity in small cell lung cancer.
The clinical value of the three serum biomarkers neuron specific enolase (NSE), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) were evaluated prospectively in 86 patients with small cell lung cancer (SCLC) entered into randomized clinical trials. The patients were monitored clinically very closely and biomarkers were measured before each course of chemotherapy. The correlation between disease extent and biomarker was significant for both NSE (2P: 0.001) and LDH (2P:0.05). Of those two biomarkers NSE was the most sensitive and was raised in 75% of all patients at diagnosis, in 67% of patients with limited disease, and in 86% of patients with extensive disease. All patients with three or more sites involved presented raised serum NSE levels but there was no significant correlation between definite number or specific sites known to have metastatic disease. There was a tendency towards a higher serum CEA level in extensive disease than in local disease. Only half the patients with metastatic disease had elevated (greater than 5.0 ng/ml) levels of CEA, and values above 50.0 ng/ml were unusual. In patients initially seropositive for NSE a close correlation was found during follow up between serum NSE and response (98%) or progressive systemic disease (100%). During a major response, either complete or partial, serum NSE showed minor fluctuations (mean 8 ng/ml, S.D. 1.79, range 4.6-12.1). At present serum NSE seem to be the most sensitive and valuable biomarker in the management of SCLC, while the gain by adding CEA is small. Furthermore, NSE may be a useful tool in the estimation of disease extent and response to treatment in patients in whom clinical or radiological evaluation is difficult.
Adult↗
An evaluation of mucin-like carcinoma associated antigen (MCA) in breast cancer.
Serum levels of mucin-like carcinoma associated antigen (MCA) were measured in 80 healthy women, 109 patients with breast cancer at presentation and in samples taken from 45 patients with active metastatic breast cancer. The MCA levels in controls had an upper limit of normal of 19.6 U ml-1 in post-menopausal and 16.4 U ml-1 in premenopausal women. The levels at presentation in stages I and II and III were not significantly different from the post-menopausal controls. Longitudinal studies over 5-9 years in 20 patients with stage I and II disease who had remained tumour-free showed a narrow MCA range for each individual patient, but the mean and range of a single measurement in a further 63 of these patients were similar to those of the normal controls. Rising MCA levels occurred in 12/14 patients who developed metastases in 2-8 years after surgery, but local recurrence was not associated with a rise of MCA. Eighty per cent of patients with active metastatic disease had MCA levels greater than 15 U ml-1. MCA levels fell during clinical responses to therapy in metastatic cancer. In the context of follow-up serum MCA levels appear to be a sensitive indicator of metastatic disease; caution is required in the interpretation of isolated measurements.
Antigens, Neoplasm↗
Serum beta 2-microglobulin levels in haemophiliacs.
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Biomarkers↗
Renal failure in myelomatosis.
Renal failure is a common presenting feature in myelomatosis. This review offers a practical means for classifying renal failure in this disease. Three groups are identified: (1) those patients whose renal failure improves or is stable when they are maintained on a high fluid intake; (2) the minority of patients whose renal failure progresses despite high fluid intake; and (3) those patients who are fluid-intolerant due to oliguric renal failure or congestive cardiac failure. The difference between groups 1 and 2 is not simply due to differences in response to chemotherapy, for many group-1 patients achieve improvement in renal function without or before loss of light chain proteinuria. It is concluded that all patients with myelomatosis with excess monoclonal free light chain proteinuria are at risk from developing renal failure of the type associated with group 1. The chances of them doing so are diminished if they maintain a high fluid intake. Group 2 encompasses a range of conditions not all of which are clearly defined. There is generally a poor correlation between the physical characteristics of light chains and the presence of group-2 renal failure.
Acute Kidney Injury↗
Serum CA 125 antigen levels and disease severity in patients with endometriosis.
We wished to test whether there was a relationship between CA 125 levels and the severity of endometriosis that would allow CA 125 to be used to monitor disease progression. CA 125 levels were measured in 52 women with laparoscopically staged endometriosis and in eight women with normal pelvic findings at laparoscopy. There was a positive correlation (r = 0.63; P less than .0001) between disease severity and CA 125 levels. CA 125 was also elevated, compared with women with a normal pelvis, in patients with mild and moderate disease. There was no relationship between CA 125 levels and the day of the menstrual cycle. These results suggest that after malignancy has been excluded, CA 125 levels may offer a useful method of monitoring disease progress.
Antigens, Tumor-Associated, Carbohydrate↗
Purification and partial amino acid sequence of human urine protein 1. Evidence for homology with rabbit uteroglobin.
We describe the purification of Urine Protein 1 (UP1), a 14-16 kDa protein which occurs in the urine of patients with renal failure, and therefore may originate from the plasma or kidney. Amino acid sequencing shows that UP1 has significant homology with rabbit uteroglobin, a secretory protein of the uterus (during pregnancy) and lungs (both sexes), and previously identified only in lagomorphs (rabbits, hares, pikas). The finding of a human uteroglobin-like protein, which can be purified from a readily available source, may provide further opportunities to elucidate the, as yet, uncertain physiological functions of uteroglobin.
Amino Acid Sequence↗
A method to detect the in vitro modification of serum beta-2-microglobulin in health and disease.
The electrophoretically fast moving form of beta-2-microglobulin (alpha-B2m) was shown by crossed immunoelectrophoresis to be produced in vitro after incubation at room temperature and was not present in freshly drawn sera. A radioisotopic assay was developed to measure this conversion to alpha-B2m in sera from 14 healthy individuals and from 208 patients with benign and malignant disease. The activity was present in all the sera tested and the levels were significantly higher in sera from patients with small cell lung cancer, prostate cancer and in childhood lymphomas when compared to the level in normal sera.
Carcinoma, Small Cell↗
Renal biochemistry in rheumatic disease.
In patients with osteo-arthritis, renal disease will almost invariably be the consequence of unrelated coincidental renal pathology. In polyarthritic rheumatoid arthritis and ankylosing spondylitis, renal disease can arise as part of the pathology of a systemic disease, or more likely its treatment. As a rule amyloidosis is the most important complication in terms of progressive irreversible loss of renal function. By contrast, SLE, polyarteritis and Sjögren's disease carry a much higher risk of renal involvement. The regular evaluation of renal function in such patients can enable the kidney damage to be assessed at an early stage and allow treatment to be instituted early.
Aging↗
Serum hyaluronic acid levels in cancer.
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Adult↗
The prognostic influence of serum neuron specific enolase in small cell lung cancer.
An analysis of prognostic factors in small cell lung cancer has been made using presentation data from 86 of 101 consecutive patients referred to The Finsen Institute for chemotherapy. Prognosis was in univariate analysis significantly correlated with performance status (PS), disease extent, serum lactate dehydrogenase (LDH), neuron specific enolase (NSE), alpha-1-acid glycoprotein and plasma sodium. Multivariate analysis, taking stage of disease into account, resulted in selection of PS and NSE as the most influential of the investigated variables. LDH was excluded as an independent prognosticator, but there was a strong correlation between the influence of LDH and NSE (coefficient: -0.38) as well as between their serum concentrations (coefficient: 0.72). LDH and NSE apparently have similar prognostic influence, and NSE seems superior to LDH. A firm conclusion should, however, await our investigation of a large series of patients.
Adult↗
A longitudinal study of serum beta 2-microglobulin levels in haemophilia.
Serum beta 2-microglobulin (beta 2-m) levels were measured in 75 adults with haemophilia A. Beta 2-microglobulin was found to be significantly elevated in haemophiliacs compared with the non-haemophiliac population. There was a greater rise in beta 2-m in HIV antibody-positive haemophiliacs. No further significant increase occurred in the subgroup with HIV-related disease but all these patients had beta 2-m levels greater than or equal to 3 mg/l. Over the study period of 18 months no significant increase in beta 2-m was documented in either HIV antibody-negative or -positive groups. Beta 2-microglobulin was elevated in HIV antibody-negative subjects with raised transaminase levels. No correlation was found between beta 2-m and the amount of factor VIII concentrate infused, T-cell subsets, thrombocytopenia or age. It is concluded that probable reasons for elevated beta 2-m levels in haemophiliacs include infection with HIV and other viruses, chronic liver disease, and repeated antigenic challenge from multiple infusions of factor VIII. The role of serial measurement of beta 2-m in haemophiliacs with a view to predicting the onset of HIV-related disease warrants further study.
Adolescent↗
TNM classification of genitourinary tumours 1987--position of the EORTC Genitourinary Group.
This report analyses the changes in the classification of the genitourinary tumours introduced by the 1987 edition of the TNM system. Criticism and suggestions for improvement are given. These are based on the extensive experience of the EORTC GU Group with clinical trial work particularly the identification of prognostic factors, on their success in reaching international consensus on tumour classification, and on information from the literature. Many of the changes introduced in the 1987 system are not considered to be strictly necessary. These include the introduction of the new additional descriptors, including "C" and "R", the changes in the T classification of prostatic and renal cancer, and the introduction of uniform N categories for all tumours and other features. We regret the omission of minimal requirements, the omission of the V classification for macroscopic or microscopic vascular invasion, the changes in the T categories of carcinoma of the bladder and the introduction of stage groupings for all urological tumours. Some of these changes are considered unacceptable. The attitude of the EORTC GU Group toward the use of the new TNM classification is indicated in detail.
Female↗
The value of the measurement of serum prostate specific antigen in patients with benign prostatic hyperplasia and untreated prostate cancer.
Serum prostate specific antigen (PSA) levels were measured in 139 patients with benign prostatic hyperplasia (BPH) and in 88 patients with prostate cancer who were managed by deferred treatment. Acute urinary retention and large prostate glands tended to be associated with high PSA levels, but at levels greater than 10 ng/ml there was a significant risk of carcinoma being found on subsequent histological examination. The risk of progression of untreated prostate cancer was associated with levels of PSA greater than 20 ng/ml and with a high rate of change of PSA level. The value of measuring PSA in these patients is discussed.
Aged↗
Tubular dysfunction and microalbuminuria in insulin dependent diabetes.
The nature of microproteinuria in the early years of insulin-dependent diabetes was investigated in a cross sectional study of 80 children with insulin-dependent diabetes and 40 normal children. Urinary excretion of three low molecular weight proteins: alpha-1-microglobulin, beta-2-microglobulin and kappa light chains was used as an index of proximal renal tubular function. The first urine samples of the morning were collected and excretion of proteins measured was expressed as ratio of protein to creatinine. There was a strong correlation between excretion of alpha-1-microglobulin and chi light chains and their excretion was significantly higher in diabetic children indicating decreased proximal tubular reabsorbtion. The excretion of beta-2-microglobulin was found to be an unsatisfactory index of proximal tubular function. Urinary albumin excretion was not significantly raised in diabetic children and did not correlate with urinary alpha-1-microglobulin or chi light chain excretion. Glycaemic control might influence proximal tubular function as both urinary glucose concentration and glycosylated haemoglobin showed correlations with urinary alpha-1-microglobulin excretion and with urinary chi light chain excretion.
Adolescent↗
Proteinuria after renal transplantation.
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Acetylglucosaminidase↗
Contribution of bone scintigraphy, prostatic acid phosphatase and prostate-specific antigen to the monitoring of prostatic cancer.
Changes in the serial measurements of serum prostatic acid phosphatase (PAP), and prostatic specific antigen (PSA) have been compared against changes in serial bone scans in 120 patients with prostatic cancer. Of 54 patients who presented with negative bone scans 10 developed skeletal metastases, the PAP and PSA levels were rising in 5 and 9 of these patients, respectively. Local progression occurred in a further 9 patients in whom PAP was rising in 8 and PSA in all 9. In the 66 patients with previously documented skeletal metastases bone scan evidence of progression was seen in 36. At the time of the first evidence of progression PAP was rising in 20 (55%) and PSA was rising in 26 (72%). In 4 patients neither marker was raised at the time of first evidence of progression. We discuss the value of 'routine' serial bone scintigraphy in monitoring patients with prostatic cancer.
Acid Phosphatase↗