Adrenocorticotropin, calcitonin, and antidiuretic hormone as tumor markers in patients with bronchogenic carcinoma of various histological types

Neuron-Specific Enolase in the Diagnosis and Therapy Monitoring of Lung Cancer: A Comparison with Cea, Tpa, Ferritin and Calcitonin

The significance of neuron-specific enolase (NSE) in the diagnosis and treatment monitoring of lung cancer was investigated in comparison with such established tumour markers as carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), ferritin and calcitonin. We determined the serum concentrations of these tumour markers in 25 patients with small cell lung cancer (SCLC), 30 patients with non small cell lung cancer (NSCLC), and 38 patients with benign pulmonary diseases (BPD). In 14 patients with lung cancer, it was possible to follow up the behaviour of the tumour markers under treatment for up to 16 months. Calcitonin proved to have a surprisingly low sensitivity for SCLC. The utility of TPA and of ferritin was restricted, although the sensitivity was comparably high, by the high rate of false positive results. For NSCLC, CEA proved to be the best tumour marker. At present, NSE appears to be the tumour marker with the greatest specificity and sensitivity for SCLC. Its determination in the diagnosis, treatment and follow-up of SCLC makes good sense.

Measurements of hormonal peptides in the bronchoalveolar fluid as tumor markers of lung cancer

A large number of lung cancers contains and releases a variety of neuropeptides such as adrenocorticotropic hormone (ACTH) and beta-endorphin (beta-EP). Although the plasma levels of these peptides have been extensively investigated as possible markers that may help in the early diagnosis of the disease, the data collected have shown their limited clinical usefulness. The present study was undertaken to evaluate whether corticotropin-releasing hormone (CRH), ACTH or beta-EP levels in the bronchoalveolar lavage (BAL) fluid of patients with lung cancer might have been more helpful. To accomplish this, bronchial lavages were carried out in 25 patients affected by lung cancer (17 squamous carcinomas, 4 adenocarcinomas, 2 small cell carcinomas, and 2 not classified) and 18 controls. After centrifugation, BAL fluid was extracted using cartridges of SepPak C-18 and CRH, ACTH and beta-EP levels were measured by radioimmunoassay. CRH and ACTH BAL levels in patients with lung cancer were not significantly different from those of controls. beta-EP concentrations in the BAL fluid were about 200-fold higher than those of ACTH and showed a downward trend (p = 0.08, Mann-Whitney test) in patients with cancer. No histologic tumor type was associated with particularly elevated levels of any of the peptides measured, not even the two patients with small cell carcinoma, a tumor type which tends to release higher peptide levels. Therefore we conclude that measurements of CRH, ACTH and/or beta-EP in the BAL fluid are not useful diagnostic tumor markers of lung cancer.

Limited clinical usefulness of plasma corticotropin-releasing hormone, adrenocorticotropin and beta-endorphin measurements as markers of lung cancer

We measured plasma corticotropin-releasing hormone (CRH), ACTH, beta-endorphin (beta-EP), and cortisol levels as possible tumor markers in a sequence of 103, randomly selected, patients with lung cancer but without the ectopic Cushing's syndrome and in 72 age- and sex-matched controls. Plasma CRH levels of cancer patients were similar to those of controls both in patients sampled in the morning or in the afternoon. On the other hand, plasma ACTH levels of cancer patients were significantly higher than control patients both in the morning and in the afternoon and showed a preserved circadian rhythm. However, about 35% of cancer patients sampled in the morning and about 60% of those sampled in the afternoon had ACTH levels within the 95% confidence interval (CI) of controls. Also plasma beta-EP levels were more elevated in cancer patients than controls in the morning but about 33% of them and about 80% of those sampled in the afternoon had beta-EP levels within the 95% CI of controls. Despite the higher plasma ACTH levels, cancer patients had cortisol plasma levels similar to controls with preserved circadian rhythm. In conclusion, although mean plasma ACTH and beta-EP were higher in patients affected by lung cancer, their measurements, as well as those of CRH, have practically no diagnostic value. Perhaps measurement of ACTH levels in the bronchial lavage may be more helpful.

Plasma growth hormone (GH)-releasing hormone levels in patients with lung carcinoma

OBJECTIVE

The aim was to investigate the serum levels of growth hormone releasing hormone and GH in patients with lung carcinoma. DESIGN After an overnight fast a plasma sample was collected for determination of growth hormone releasing hormone and GH.

PATIENTS

The investigation was performed in 28 patients with non small cell lung carcinoma, in 44 patients with small cell lung carcinoma, and 10 patients with non malignant lung disease. A group of 37 normal subjects served as control.

MEASUREMENTS

Growth hormone releasing hormone and GH were determined by radioimmunoassay.

RESULTS

Patients with small cell lung carcinoma showed higher plasma growth hormone releasing hormone levels (49 +/- 9.4 ng/l) than control subjects (16.3 +/- 2.1 ng/l; P less than 0.05), patients with non small cell lung carcinoma (23.9 +/- 8.8 ng/l; P less than 0.05), and patients with non malignant lung disease (12.7 +/- 5.5; P less than 0.05). Basal GH level was lower than 5 micrograms/l in all patients except five patients with small cell lung carcinoma and one patient with non small cell lung carcinoma.

CONCLUSIONS

The higher plasma growth hormone releasing hormone levels in patients with small cell lung carcinoma compared to normal controls and patients with non small cell lung carcinoma and patients with non malignant lung disease, confirm the frequent neuroendocrine activity of this particular tumour.

Radiosensitivity related to neuroendocrine and endodermal differentiation in lung carcinoma lines

A panel of human lung carcinoma lines was studied with respect to hormone production and intermediate filament expression to distinguish between endodermal and neuroendocrine differentiation. An index of the degree of neuroendocrine differentiation of each line was derived from the presence or absence of hormone production, cytokeratins, neurofilaments and an embryonic endodermal cell marker, which allowed identification of three groups showing high, intermediate or low neuroendocrine expression. This grouping correlated well with the in vitro radiosensitivity of the lines, those expressing pure neuroendocrine features being significantly more radiosensitive than those with an endodermal phenotype, with the intermediate group having intermediate sensitivity. Use of such an index might predict those patients likely to benefit from the use of radiotherapy in their management.

Peptide hormones in patients with acute leukaemia

Paraneoplastic production and secretion of peptide hormones by numerous malignant tumours is a well-known phenomenon. The incidence of the production of six peptide hormones was evaluated in patients with acute leukaemia. Most often the calcitonin gene-related peptides were found to be elevated in sera at the time of diagnosis. The values evaluated for the hormones were: h-CT 46.7%, CGRP 51%, s-CT 20.7%, PTH 15.7%, beta-HCG 15%, and ACTH 11.6%. A significant coincidence of two or more hormones was not observed. In 83.4% of the patients increased concentrations of at least one of the six hormones were found. Clinical and biochemical parameters showed no influence on the serum levels of these peptides. Analysis of elevated hormone serum levels in subtypes of leukaemia revealed that the calcitonin-related hormones were significantly correlated to more immature forms of leukaemia such as AUL and M1. Synthesis of calcitonin gene-related peptides was also seen in established leukaemic cell lines and in buffy coat cells of untreated patients with acute leukaemia. This investigation provides further evidence that peptide hormone production in leukaemic blasts is a common finding. These results further suggest hormone production to be a universal concommitant of neoplasia. A possible influence of these peptide hormones on the biological behaviour of the malignant cells is discussed.