SAA concentrations and depressed PBL

responses to Con A correlated with shortened

survival. Therefore, these parameters may be

of value in evaluating prognosis in patients

with lung cancer. In addition, serial

monitoring of SAA concentrations may be of

value in evaluating recurrence or cure of

lung cancer.

Multiple Markers for Lung Cancer Diagnosis:

Validation of Models for Advanced Lung Can-

cer.

Gall, M.H., Muenz, L., McIntire, K.R. et al.

Biostatistics Branch, National Cancer In-

stitute, National Institutes of Health,

Bethesda, MD 20892, U.S.A.J. Natl. Cancer

Inst. 76: 805-816, 1986.

Sera from 171 patients with advanced

lung cancer, from II0 normals, and from 123

subjects with benign respiratory diseases

were analyzed for i0 substances to detect

lung cancer: ferritin, lipid-bound sialic

acid, total sialic acid, beta 2-

microglobulin, lipotropic, the alpha and

beta subunits of hHman chorionic

gonadotropin, calcitonin (two assays),

parathyroid hormone, and carcinoembryonic

antigen. Individual markers were studied,

and optimal combinations of markers were

sought for discriminating lung cancer

patients from normals and from patients with

benign lung disease. Numerous methods for

combining the markers were examined, but the

methods of logistic regression and recursive

partitioning were finally adopted. The best

discrimination rules we could find used only

carcinoembryonic antigen (CEA) and total

sialic acid (TSA). The performance of these

rules was validated on an independent serum

panel containing sera from 68 patients with

advanced lung cancer, from 40 normals, and

form 52 patients with benign respiratory

disease. The combination rules based on TSA

and CEA performed better than a rule based

on CEA alone. Logistic discrimination rules

with TSA and CEA that were designed to have

95% specificity achieved 54% sensitivity for

discriminating advanced lung cancer from

normal controls and 52% sensitivity for dis-

criminating advanced lung cancer from con-

trols with benign disease. Some aspects of

clinical applicability are discussed, in-

cluding planned studies for localized lung

cancer and the requirement for further test-

ing in specific clinical settings.

Serum Deoxythymidine Kinase in Small Cell

41

Carcinoma of the Lung: Relation to Clinical

Features, Prognosis, and Other Biochemical

Markers.

Gronowitz, J.S., Steinholtz, L., Kallander,

C.F.R. et al. Department of Medical Virol-

ogy, Biomedical Center, Uppsala University,

Uppsala, Sweden. Cancer 58: 111-118, 1986.

Thymidine kinase (s-TK), lactate

dehydrogenase (LDH), and carcinoembryonic

antigen (CEA) were determined in pretreat-

ment serum from 125 patients with small cell

carcinoma of the lung. The distribution of

marker levels into three ranges, when in-

cluding all patients were as follows: s-TK <

5 units 49%, 5-<10 units 25%, > or = i0

units 26%; LDH < 6.7 ~kat 31%, 6.7-< 13.4

~kat 48%, > or = 13.4 ~kat 21%; CEA < 7.5

~g/l 51%, 7.5-< 15 ug/l 25%, > or = 15 ~g/l

24%. The percentages of patients with

limited and with extensive disease within

each range were s-TK<5 82/18, 5-<10 29/71, >

or = I0 9/91; LDH < 6.7 76/24, 6.7-<13.4

51/49, > or = 13.4 21/79; CEA < 7.5 70/30,

7.5-<15 39/61, > or = 15 23/77. Analyses in

relation to metastases present showed that

patients with skeletal and bone marrow

metastases had significantly higher s-TK and

LDH than those without, while this was not

the case for CEA. A strong correlation be-

tween s-TK and LDH level, a weaker correla-

tion between CEA and s-TK, and no correla-

tion betwee CEA and LDH level, was found.

Both the level of s-TK and LDH correlated to

the patients' performance, as defined by the

Karnofsky index. These correlations were

mainly confined to the patients with exten-

sive disease. Analyses of the prognostic

capacity of variables showed that s-TK,

stage, and Karnofsky index could divide the

patients into groups with highly significant

difference in survival time, while LDH and

CEA were of less value. Longitudinal studies

showed that the serum markers mirrored the

disease activity, with the exception that

highly increased s-TK was found during

remission induction for some patients. It

was concluded that the expression of

pathologic levels for the serum markers were

dependent on different biological

parameters. Of the serum markers, only s-TK

was judged useful for estimation of disease

spread and prognosis of the individual

patient.

Serum Ferritin Levels in Small Cell Lung

Cancer.

Cox, R., Gyde, O.H., Leyland, M.J. Depart-

42

ment of Haematology, East Birmingham Hospi-

tal, Birmingham B9 5ST, U.K. Eur. J. Cancer

Clin. Oncol. 22: 831-835, 1986.

Serum ferritin levels were measured

before treatment, using an im~noradiometric

method, in 39 patients with small cell lung

cancer. In ii patients serial estimations

were also made. The medium serum ferritin

level for male patients was 666 mug/l (range

13-1329) and for females 306 (range 134-

5300), the normal range being 32-501. This

increase is significant (P < 0.001). Serum

ferritin levels were not related to metas-

tatic, haematological or iron status. Serial

ferritin levels did not reflect the clinical

course of the disease. Patients with a pre-

treatment serum ferritin of <600 mug/l had a

significant prolongation of median survival

compared to those with an initial serum fer-

ritin of > 600 mug/l (P < 0.02). Serum fer-

ritin levels are not of value in staging

small cell lung cancer nor in monitoring its

progress. However, the initial serum fer-

ritin is of prognostic significance.

Diagnostic Value of High Molecular Weight

Alkaline Phosphatase in Detection of Hepatic

Metastasis in Patients with Lung Cancer.

Nishio, H., Sakuma, T., Nakamura, S.-I. et

al. Department of Lung Cancer, The Center

for Adult Diseases, Osaka 537, Japan. Cancer

57: 1815-1819, 1986.

High molecular weight alkaline phos-

phatase (HMW-ALP) was measured in the sera

of 126 patients with lung cancer to deter-

mine its diagnostic value in the detection

of hepatic metastasis. This isoenzyme was

found in 21 of 24 patients with hepatic

metastasis and in 27 of 102 patients without

hepatic metastasis. When i0 U/L was used as

a cut-off value, the sensitivity,

specificity, and accuracy of this test were

71%, 89%, and 86%, respectively. From the

standpoint of histologic type, this test was

most useful in patients with small cell car-

cinoma. HMW-ALP was not detected in the sera

of 15 controls. It is concluded that HMW-ALP

is a useful marker for hepatic metastasis in

patients with lung cancer.

Plasma Angiotensin-Converting Enzyme Ac-

tivity in Patients with Bronchial Carcinoma.

Roulston, J.E., Galloway, P.J., Douglas,

J.G. University Department of Clinical

Chemistry, Royal Infirmary of Edinburgh,

Edinburgh, U.K. Br. J. Dis. Chest 80: 229-

234, 1986.

Plasma angiotensin-converting enzyme

(ACE) activities were measured in 58 con-

secutive patients presenting with bronchial

carcinoma. The mean ACE activity before

treatment was significantly lower than that

of a control population (P < 0.005). There

was a significant and direct relationship

between the initial plasma ACE activity and

survival time (P < 0.01) which could not be

explained by further analysis for age,

clinical staging, or respiratory function,

as judged by 9~EV. There was a significant

increase in plasma ACE activity (P < 0.03)

in nine patients with three or more plasma

samples after treatment with chemotherapy or

radiotherapy. These results suggest that low

plasma ACE activity is associated with poor

prognosis in bronchial carcinoma.

Bronchogenic Carcinoma Associated with Upper

Aerodigestive Cancers.

Yellin, A., Hill, L.R., Benfield, J.R.

Department of Thoracic Surgery, City of Hope

National Medical Center, Duarte, CA 91010,

U.S.A.J. Thorac. Cardiovasc. Surg. 91: 674-

683, 1986.

Of 1,450 patients with upper airway

cancers, 189 (13%) had additional cancers.

There were 60 cases in which lung cancer oc-

curred after upper airway cancer and a

single case in which it preceded upper air-

way cancer. The occurrence of upper airway

plus lung cancer in 61 patients was referred

to as multiple airway cancers. The overall

incidence of multiple airway cancers was

4.1% or 1:112 patient-years at risk. The

highest incidence of lung cancer was 1:70

patients-years, and this was associated with

laryngeal cancer. The mean diagnostic inter-

val between upper airway and lung cancers

was 6.1 (0 to 23) years, including nine

cases (14.8%) in which the two were

synchronous. Triple endoscopy revealed oc-

cult lung cancer only once. The use of

mediastinoscopy (n = 9) and other surgical

staging procedures (n = 9) was limited, be-

cause previous treatment of upper airway

cancers made such procedures impractical and

also because interpretation of findings

would have been difficult. Past reports have

indicated that lung cancer in association

with upper airway cancer is almost in-

variably squamous cell and almost always

develops in men. By contrast, among our 61

patients, the incidence of adenocarcinomas

was 24%, and 16 patients or 26% were women.

Among patients whose records could be