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Electronic Letters to:
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Electronic letters published:
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Neuron-specific enolase in non-small cell lung cancer
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Joseph C. Watine, Consultant, Laboratory Medicine Hôpital de Rodez, France
Send letter to journal:
watine61{at}hotmail.com Joseph C. Watine
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In the November 2002 issue of Clinical Chemistry, Kulpa et al. [1] observed, in a population of 200 patients suffering from squamous cell lung cancer, that the pretreatment serum concentrations of neuron-specific enolase (NSE) are of independent prognostic significance, more particularly in the 115 patients with inoperable disease, whereas CYFRA 21 -1 concentrations are of prognostic significance only in their operable subgroup of patients. These interesting results are in general agreement with the current state of the biomedical literature [recently reviewed in reference 2]. In particular, Kulpa et al.’s results add weigth to our recommendation [2] that serum NSE should be measured before treatment, together with blood hemoglobin, white blood cell count with differencial, serum LDH, albumin, calcium, in order to stratify inoperable non-small cell lung cancer patients participating in clinical trials. We would however like to discuss Kulpa et al.’s results a little bit further. First, in order to demonstrate the independent prognostic significance of any laboratory variable in non-small cell lung cancer patients, one has to demonstate that this significance is independent of at least the two most well known prognostic covariables in these patients, i.e. disease stage and performance status. To do this, one has therefore to perform a multivariate statistical analysis in which at least these two variables must be included together with the laboratory variables in point. From the data presented by Kulpa et al. [1], we do not know if the authors have incorporated performance status in their multivariate statistical analysis. How can therefore the authors conclude, as they did, that the prognostic significance of NSE (or CYFRA 21-1 to a lesser extent) is indeed independent in their series of patients? In the same way, since tumor markers are the only laboratory variables that the authors did include in their multivariate analysis, it should not have been possible for them to suggest at the end of their discussion, as they did, that the prognostic values of NSE (or CYFRA 21-1 to a lesser extent) add anything to that value already provided by other more classical laboratory variables such as serum LDH, albumin, calcium, blood hemoglobin, and white cell counts, which are already measured on a routine basis in most patients. In conclusion, Kulpa et al. seem quite likely to be right in suggesting that NSE (and CYFRA 21-1 to a lesser extent) probably are the most valuable tumor markers to assess the pretreatment prognosis of squamous cell lung cancer patients. It would therefore be worth to design clinical trials in order to adress the important question of whether or not non-small cell lung cancer patients with high serum NSE concentrations should enter chemotherapy protocols that would differ from those given to patients with low serum NSE. References 1) Kulpa J, Wojcik E, Reinfuss M, Kolodziejski L. Carcinoembryonic Antigen, Squamous Cell Carcinoma Antigen, CYFRA 21-1, and Neuron-specific Enolase in Squamous Cell Lung Cancer Patients. Clin Chem 2002; 48:1931-7. 2) Watine J, Friedberg B, Bouarioua N. [Biological variables and stratification of patients with inoperable non-small-cell bronchial cancer: recommendations for future trials]. Cancer Radiother 2002; 6:209- 16 [Article in French]. Key-words: NSE, clinical trials. |
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