Clinical value of tumor-associated antigens and autoantibody panel combination detection in the early diagnostic of lung cancer

Clinical application of serum seven tumour-associated autoantibodies in patients with pulmonary nodules

Background

The incidence of pulmonary nodules is increasing because of the promotion and popularisation of low-dose computed tomography (LDCT) screening for populations with suspected lung cancer. However, a high rate of false positives and concerns regarding the radiation-related cancer risk of repeated CT scanning remain major obstacles to its wide application. This study aimed to investigate the clinical value of seven tumour-associated autoantibodies (7-TAAbs) in the differentiation of malignant pulmonary tumours from benign ones and the early detection of lung cancer in routine clinical practice.

Methods

We included 377 patients who underwent both the 7-TAAbs panel test and LDCT screening, and were diagnosed with pulmonary nodules using LDCT. An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels antibodies for P53, PGP9.5, SOX2, GAGE7, GBU4-5, CAGE, and MAGE-A1. The relationships between the positive rates of the 7-TAAbs and the patient sex, and age, and the number, size, and composition of pulmonary nodules were analysed. We then statistically evaluated the clinical application value.

Results

The positive rates of the 7-TAAbs did not correlate with sex, age, number, size, or composition of pulmonary nodules. The serum antibody level of GBU4-5 in patients with pulmonary nodules tended to increase with age; the serum antibody level of SOX2 tended to increase with nodule size and was the highest among patients with mixed ground-glass opacity (mGGO) nodules. The antibody positive rate for CAGE in female patients with pulmonary nodules was significantly higher than that in male patients (P < 0.05). The positive rate of GBU4-5 antibody in patients aged 60 years and above was higher than that in younger patients (P < 0.05). The positive rate of GAGE7 antibody in patients with pulmonary nodules sized 8-20 mm was also significantly higher than that in patients with pulmonary nodules sized less than 8 mm (P < 0.01). Significant differences were observed in the GAGE7 antibody levels of patients with pulmonary nodules of different compositions (P < 0.01). The positive rate of the 7-TAAbs panel test in patients with lung cancer was significantly higher than in patients with pulmonary nodules (P < 0.01). Serum levels of P53, SOX2, GBU4-5, and MAGE-A1 antibodies were significantly higher in patients with lung cancer than in those with pulmonary nodules (P < 0.05).

Conclusion

The low positive rates of serum 7-TAAbs in patients with lung cancer and pulmonary nodules may be related to different case selection, population differences, geographical differences, different degrees of progression, and detection methods. The combined detection of 7-TAAbs has some clinical value for screening and early detection of lung cancer.

Identification of biomarkers for the early detection of non-small cell lung cancer: a systematic review and meta-analysis

Lung cancer (LC) causes few symptoms in the earliest stages, leading to one of the highest mortality rates among cancers. Low-dose computerised tomography (LDCT) is used to screen high-risk individuals, reducing the mortality rate by 20%. However, LDCT results in a high number of false positives and is associated with unnecessary follow-up and cost. Biomarkers with high sensitivities and specificities could assist in the early detection of LC, especially in patients with high-risk features. Carcinoembryonic antigen (CEA), cytokeratin 19 fragments and cancer antigen 125 have been found to be highly expressed during the later stages of LC but have low sensitivity in the earliest stages. We determined the best biomarkers for the early diagnosis of LC, using a systematic review of eight databases. We identified 98 articles that focussed on the identification and assessment of diagnostic biomarkers and achieved a pooled area under curve of 0.85 (95% CI 0.82-0.088), indicating that the diagnostic performance of these biomarkers when combined was excellent. Of the studies, 30 focussed on single/antigen panels, 22 on autoantibodies, 31 on miRNA and RNA panels, and 15 suggested the use of circulating DNA combined with CEA or neuron-specific enolase (NSE) for early LC detection. Verification of blood biomarkers with high sensitivities (Ciz1, exoGCC2, ITGA2B), high specificities (CYFR21-1, antiHE4, OPNV) or both (HSP90α, CEA) along with miR-15b and miR-27b/miR-21 from sputum may improve early LC detection. Further assessment is needed using appropriate sample sizes, control groups that include patients with non-malignant conditions, and standardised cut-off levels for each biomarker.

Accessing Antibody Reactivities in Serum or Plasma to (Auto-)antigens Using Multiplexed Bead-Based Protein Immunoassays

Antibody (AB) testing or serotesting for reactive ABs against antigenic proteins is broadly used. Parallel examination of many antigens is of high interest to identify autoantibodies (AAB) or differential antigenic reactivities in many biological settings like allergy and infectious autoimmune, cancerous, or systemic disease. The resulting AAB profiles can be used for diagnosis, prognosis, and monitoring of such conditions. Protein microarrays have been used for AB profiling over the past decade but show some significant limitations which make them unsuitable for clinical applications. Alternative multiplexing platforms such as bead arrays were shown to provide a versatile tool for the confirmation and efficient analysis of high numbers of biological samples. Luminex' bead-based xMAP technology combines advantages such as multiplexing and lower demand for sample volume and at the same time overcomes the challenges of microarrays. It works faster, shows better antigen stability, is more reproducible, and allows the analysis of up to 500 analytes in one sample well. In this chapter we introduce our established workflow for the use of the xMAP technology for AB profiling including an overview of the method principle and protocols for the covalent immobilization of proteins to the MagPlex beads, confirmation of protein coupling, the execution of a multiplexed bead-based protein immunoassay, and subsequent data handling.

Application Value Analysis of Seven-Autoantibody Panel in the Lung Cancer Screening in Yunnan

Objective

To study the application value of seven-autoantibody (anti-CAGE, anti-GAGE7, anti-GBU4-5, anti-MAGE A1, anti-P53, and anti-PGP9.5, anti-SOX2) in lung cancer (LC) screening in Yunnan.

Methods

The clinical data of 329 lung cancer patients and 202 nonlung cancer controls in the First People's Hospital of Yunnan Province from November 2018 to April 2022 were retrospectively analyzed. The detection results of anti-CAGE, anti-GAGE7, anti-GBU4-5, anti-MAGE A1, anti-P53, anti-PGP9.5, and anti-SOX2 were collected. The receiver operating curve (ROC) was used to analyze the value of these seven-autoantibody in the detection of LC alone and in combination, and the area under the curve (AUC), sensitivity, specificity, and cut-off values were calculated.

Results

The levels of anti-CAGE, anti-GAGE7, anti-GBU4-5, anti-MAGE A1, anti-P53, anti-PGP9.5 and anti-SOX2 in LC patients were significantly higher than those in the controls, and the differences were statistically significant (P < 0.001). The AUC of anti-CAGE, anti-GAGE7, anti-GBU4-5, anti-MAGE A1, anti-P53, anti-PGP9.5, and anti-SOX2 for the diagnosis of LC were 0.586 (95% CI: 0.537-0.634, P < 0.001), 0.620 (95% CI: 0.572-0.667, P < 0.001), 0.570 (95% CI: 0.521-0.619, P=0.007), 0.612 (95% CI: 0.563-0.660, P < 0.007) 0.001), 0.561 (95% CI: 0.510-0.611, P=0.019), 0.667 (95% CI: 0.619-0.715, P < 0.001), 0.587 (95% CI: 0.538-0.636, P < 0.001), respectively. The AUC of combined detection of LC was 0.719 (95% CI: 0.676-0.761, P < 0.001). The positive rate of the combined detection of seven-autoantibody in the LC group was 48.02% (158/329), which was significantly higher than that of the control group (13.86% (28/202)), the difference was statistically significant (χ 2 = 64.183, P < 0.001).

Conclusion

The individual detection and combined detection of the seven-autoantibody have a certain value in the diagnosis of LC in Yunnan, and it can provide a certain reference for clinical LC screening.

Efficacy of autoantibodies combined with tumor markers in the detection of lung cancer

BACKGROUND

The purpose of this study was to explore the detection value of seven autoantibodies (TAAbs): p53, PGP9.5, SOX2, GBU4-5, MAGE A1, CAGE, and GAGE7 and three tumor markers: CYFRA21-1, NSE, and SCCA in the diagnosis of lung cancer.

METHODS

ELISA was used to detect the levels of the TAAbs, and chemiluminescence immunoassay was used to test the levels of the tumor markers. The diagnostic efficacy of the TAAbs combined with the tumor markers for lung cancer was evaluated by receiver operating characteristic (ROC) curves.

RESULTS

The positive rate of the combined detection of seven TAAbs and three tumor markers in lung cancer (37.8%) was higher than that in other three groups. The positive rates of SOX2, GAGE7, MAGE A1, CAGE, CYFRA21-1, and SCCA had differences among the four groups. Compared with the benign lung disease group, only GAGE7, CYFRA21-1, and SCCA differed among the groups. The combined sensitivity of the TAAbs was 29.07% (AUC, 0.594), the combined sensitivity of all the markers was 37.76% (AUC, 0.660 [p < 0.05]), and Youden's index was 0.196. In the lung cancer group, CYFRA21-1 had a significant difference in age and sex, and SOX2, MAGE A1, CYFRA21-1, NSE, and SCCA were significantly different in pathological type and TNM. In contrast, p53 and GBU4-5 showed no significant differences in age, sex, pathological type, and TNM.

CONCLUSIONS

The combined detection of seven TAAbs and three tumor markers could be useful in early diagnosis of lung cancer.

Diagnostic value of conventional tumor markers in young patients with pulmonary nodules

Background

Lung cancer is one of the most common malignancies, and there is a trend of increasing incidence in young patients. The preoperative diagnosis of pulmonary nodules is mainly based on the combination of imaging and tumor markers. There is no relevant report on the diagnostic value of tumor markers in young pulmonary nodules. Our study was designed to explore the value of five tumor markers in young patients with pulmonary nodules.

Methods

We reviewed the medical records of 390 young patients (age ≤45 years) with pulmonary nodules treated at two separate centers from January 1, 2015, to January 1, 2021. Malignant pulmonary nodules were confirmed in 318 patients, and the other 72 patients were diagnosed with benign pulmonary nodules. The gold standard for diagnosis of pulmonary nodules was surgical biopsy. The conventional serum biomarkers included cytokeratin 19 (CYFRA21‐1), pro‐gastrin‐releasing‐peptide (ProGRP), carcinoembryonic antigen (CEA), neuron‐specific enolase (NSE), and squamous cell carcinoma‐associated antigen (SCCA). The diagnostic values of five tumor markers were analyzed by receiver operating characteristic (ROC) curves.

Results

There were no significant differences in the expression of five tumor markers between the groups (p > 0.05). Single tumor marker (CYFRA21‐1, ProGRP, CEA, NSE, and SCCA) showed a limited value in the diagnosis of malignant pulmonary nodules, with the AUC of 0.506, 0.503 0.532, 0.548, and 0.562, respectively. The AUC of the combined examination was only 0.502~0.596, which did not improve the diagnostic value.

Conclusions

Five conventional tumor markers had a limited diagnostic value in young patients with pulmonary nodules.