| Lung cancer is one of the main causes of death . The mortalityand morbidity is ascending because of smoking and pollutedenvironments . Early detecting and diagnosis of carcinoma is still thevital tasks of our study. Recently investigation of markers of lungcancer is rather active and has developed from levels of protein to gene.Effects of tumor markers in clinical diagnosis, reflecting the state ofdisease and evaluating prognosis have been becoming more and moreimportant. Our study is studying clinical significance ofneuron-specific enolase in lung cancer.Enolase existing in the modality of 'γγ'or 'αγ'is calledneuron-specific enolase (NSE). NSE is one of important tumormarkers of series cells of amine precursor uptake and decarboxylation(APUD), is the inner-cell enzyme to produce energy. When cellsupdate or die, NSE is released and concentrate of NSE in bloodcirculation is ascending. Concentrate of NSE in blood circulation isassociated with death numbers of cells originating from endodermis ofnerve and it may reflect updating of cells and mortality, so NSE isregarded as one special marker of endocarcinoma. Concentrate of NSEis low in the healthiness and benign pulmonary disease, however it ishigh in patients having endocrine carcinoma.Previous searches showed that NSE was one sensitive marker ofSCLC, NSE may represent burthen of tumor, had more importantclinical significance in diagnosis, reflecting the state of disease andevaluating prognosis of SCLC. Many other scholars predicted thatmeasuring of NSE had the most significance in diagnosis of SCLC andother markers were not ideal at present. With deeper searching manypeople have attached importance to endocrine of NSCLC step by step,concentrate of NSE is not only ascending in SCLC, but in NSCLC,total positive rate is about 50%. Recently some dates indicated cellsoriginating from lung cancer (SCLC and NSCLC) expressed plenty ofNSE, the result showed all primary pulmonary carcinoma might havethe same cell origination, and different pathology types have differentdegrees of endocrine. We measured serum NSE levels using enzyme-linkedimmunosorbent assay in 96 patients with lung cancer before treatment,in 60 patients with benign pulmonary disease (BPD) and in 60 healthysubjects, the result showed serum NSE levels of lung cancer werehigher than other two teams significantly (P<0.001). An elevatedserum NSE level was found more frequently in patients with lungcancer especially for SCLC, the positive rate was 86.11%, and forBPD and healthy subjects was 8.33%, 6.67% respectively, the fakepositive rate is low. The specificity to diagnose lung cancer was 92.5%,PV+ was 88.00%, PV-was 78.72%, having clinical significance. Theserum levels in patients with SCLC was 49.81 ±15.86μg/l,adenocarcinoma 21.99±8.52μg/l, Squamous cell carcinoma 23.67±10.36μg/l, different pathology had different expression, the differencebetween SCLC and other two pathology had statistically significance.Serum NSE level assists in diagnosing of lung cancer greatly and hashigher specificity and sensitivity for SCLC. An elevated serum NSE level was found more frequently inpatients with extensive disease (ED) of SCLC than those with limiteddisease (LD) (P<0.05), the level of ED-SCLC was higher thanLD-SCLC, ED-SCLC was about twice times of LD-SCLC. This resultexpressed that serum NSE level was associated with clinical stages andsize of tumor, that was to say, the clinical stage was upper, the burdenof tumor was higher, however, the level in patients with NSCLC hadno statistically significance with TNM stages (P>0.05). Chemotherapy is one main treatment for patients with NSCLC, ittakes important place in synthetical therapy, especially when thelesions are extensive. Chemotherapy could make the lesions smaller,which could make chance for patients to take surgeon treatment orradiotherapy. Patients with SCLC are more sensitive to chemotherapy,but drug for chemotherapy may become drug resistant easily asantibiotics, if we use them for a long time. Especially curative effect ofpatients with NSCLC is usually not acceptable, one vital cause of thisphenomenon is multidrug resistance. However endocrine may one offactors to influence expression of this protein. Lung cancer withendocrine expresses this protein less frequently, so primary drugresistance is little, and it is more sensitive to chemotherapy relatively. We observed patients with SCLC and NSCLC for 3 cycles, thecurative effect for chemotherapy is 87.10%, 40.00%; 66.67%, 33.33%,respectively for positive and negative ones of NSE, two teams hadstatistically significance (P<0.05). Furthermore among patients withpositive expression of NSE, all patients had the curative phenomenafor different degrees, example for shrinking of the primary lesionsdifferently, disappearing or alleviating of clinical symptom such asache of thorax　hemosputum, the curative effect was higher thanpatients with negative ones. Domestic study showed that NSCLC withendocrine was more sensitive, the mechanism is not fully known yet,which is guessed resembling to SCLC. Moreover it requires moreefforts to testify whether NSCLC with elevating of NSE should adoptchemotherapy project for SCLC. We observed 16 patients with SCLC, the serum level beforechemotherapy was 46.83±12.63μg/l, after 3 weeks of chemotherapywas 68.19±28.12μg/l, when disease relieved, it was 10.72±4.28μg/l,difference among these three stages had statistical significance. Theserum level of NSE has transient hoist not long time after using drugof chemotherapy, then it can decrease to normal level for completelyand partially curative patients. It is known to everyone that NSE existsin cytoplasm, if cell of carcinoma is sensitive to chemotherapy, it is... |
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