Prognostic significance of some tumor markers in head and neck carcinomas

ABSTRACT

Carcinoembryonic antigen [CEA], ferritin, tissue polypeptide antigen [TPA] and alkaline phosphatase [ALP] isoenzymes were evaluated in 41 patients with head and neck cancer before and [2-6] months after receiving treatment. The study included as well 13 apparently healthy age matched individuals as control group. Statistically significant elevation was found for CEA, ferritin, TPA and ALP in the patients before treatment compared to the control [P = 0.001, 0.0001, 0.04, 0.001 respectively], another statistically significant elevation was found for all the studied markers in patients before treatment compared to their levels after treatment [P < 0.001 for CEA, ferritin, TPA and ALP and 0.001 for PALP]. Ferritin was the only marker that showed statistically significant elevation in grade III compared to grade I and II [p - 0.001]. A significant elevation could be detected in the level of TPA and PALP in patients with positive regional L.N mecastasis compared with those without regional L.N metastasis [P = 0.03 and 0.04 respectively]. A statistically significant positive correlation was detected between ferritin level and tumor grade [r = 0.5, P 4 X 001]. Also a statistically significant negative correlations were found between TPA and regional L.N metastasis [r = -0.3, P = 0.04] and between ALP and CEA mean values in treated patients [r = -0.4, p = 0.009] Evaluation of tumor markers, separately revealed that CEA and then ferritin showed higher sensitivity [97.6 percent and 94.6 percent respectively], followed by ALP and TPA [75.6 percent and 5 8.3 percent respectively]. The specificity of CEA was higher than the other studied markers [100 percent]. As regards double combination, it was found that [CEA and ferritin] combination showed the highest sensitivity and specificity followed by [CEA and ALP] and [ferritin and ALP] [sensitivity, [either abnormal] 89 percent, 90 percent and 81 percent for the three previous combination respectively, [both abnormal] 46 percent, 23 percent, and 32 percent respectively] [specificity, "either abnormal" and "both abnormal was 100 percent and 92 percent for [CEA and Ferritin] and [CEA and ALP] respectively, and 100 percent and 85 percent for [ferritin and ALP]. All the triple combinations showed much lower sensitivity and specificity. Sixty one of untreated patients gave PALP bands. After treatment a reduction in PALP percentage was seen in 82 percent of patients. This reduction in PALP activity correlated to tumor stage, being one of the prognostic factors. A strategy requiring 2 or more markers to be abnormal while having both sensitivity and specificity high in monitoring head and neck cancer patients or detecting recurrence could be attained by trying more tumor markers to make firm conclusion: