Clinical Effectiveness of Tumor Markers (CEA, NSE, Cyfra 21-1) in Completely Resected Non-small Cell Lung Cancer

PURPOSE: The applicability of tumor markers still remains controversial in non-small cell lung cancer (NSCLC) due to lower sensitivity & specificity. And, tumor markers actually have not been used determining treatment plans in NSCLC patients yet. So, we evaluated correlation between levels of serum tumor marker (CEA, NSE and Cyfra 21-1) and prognosis in NSCLC patients underwent complete surgical resection. MATERIALS AND METHODS: We retrospectively studied 64 NSCLC patients underwent complete surgical resection in Yongdong severance hospital from April 2002 to October 2005. Preoperative and postoperative serum levels of tumor markers (CEA, NSE, Cyfra 21-1) were measured with commercialized kits and the correlation between the serum levels of tumor markers and prognosis was evaluated. Normal cutoff values of CEA, NSE and Cyfra 21-1 were 5.0 ng/ml, 12.5 ng/ml and 3.2 ng/ml. We estimated recurrence or distant metastasis with computed tomography, magnetic resonance imaging, whole body bone scan, positron emission tomography and biopsy. RESULTS: Preoperative and postoperative serum levels of tumor markers were not significantly correlated with lung cancer stages and histologies. The elevated levels of postoperative CEA (p=0.0142) and Cyfra 21-1 (p=0.0105) were correlated with shortened survival time. And, the shortened disease free interval was significantly associated with the elevated level of postoperative Cyfra 21-1 (p=0.0018). The elevated level of preoperative Cyfra 21-1 (p=0.0566) had a tendency to relate the shortened survival time, but it didn't reach statistical importance. CONCLUSION: Considering previous results, especially Cyfra 21-1 may be useful prognostic factor in predicting survival times, and recurrence or metastasis. But, further study and longer follow-up period were needed to make conclusion regarding usefulness of other tumor markers

A Case of Lambert-Eaton Myasthenic Syndrome Improved after Surgical Resection for Diagnosis of Small Cell carcinoma of the Lung / 결핵

Lambert Eaton myasthenic syndrome(LEMS) is a paraneoplastic syndrome caused by defects in the secretion of acetylcholine from the presynaptic membrane of nerve terminals and is strongly associated with small cell lung carcinoma. The pathogenesis of LEMS is the destruction of voltage gated calcium channels by an autoimmune process resulting in clinical manifestations consisting of lower extremity weakness, decreased deep tendon reflexes and autonomic dysfunctions. The diagnosis can be confirmed by the characteristic clinical features and repetitive nerve stimulation. The neurological symptoms and signs of LEMS may manifest themselves months before the clinical manifestation of the underlying malignancy. Therefore early diagnosis and treatment of the primary malignancy may become possible through the diagnosis of this rare paraneoplastic syndrome. We report a case of a patient diagnosed with LEMS who upon further evaluation for an underlying malignancy was found to have a 0.2cm sized nodular and infiltrative mass lesion at the bifurcation of the left apicoposterior segmental and anterior segmental bronchi by bronchoscopy. Although repeated bronchoscopic biopsies of the lesion was not able to disclose malignancy, under strong clinical suspicion left upper lobectomy was performed and subsequently the diagnosis of small cell carcinoma of the lung was confirmed. Muscle weakness began to improve starting from a week after the surgery, then reached a plateau 2 weeks later. Muscle weakness improved further after the trial of anticancer chemotherapy.