title: Combining multiple serum biomarkers in tumor diagnosis: A clinical assessment.
abstract: The present study aimed to assess the diagnostic/prognostic value of various clinical tumor markers, including carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin 19 (CYFRA21-1), α-fetoprotein (AFP), carbohydrate antigen-125 (CA-125), carbohydrate antigen-19.9 (CA-19.9) and ferritin, individually or in combination. The electro-chemiluminescence immunization method was performed to detect the levels of seven tumor markers in 560 cancer patients and 103 healthy subjects for comparison. The serum levels of the seven markers measured in cancer patients were higher compared to healthy subjects (P<0.05 for AFP and P<0.001 for the remaining six markers). Different markers had different sensitivity towards different types of tumors. Combining more markers significantly increased the ratios of positive diagnosis in the tumors. The diagnostic sensitivities of combining seven markers were particularly high in digestive, urinary and skeletal tumors (82, 92 and 83%, respectively). Gynecological tumors have exhibited a constant yet relatively low positive diagnosis irrespective of the use of a single marker or combined markers. However, the increase in sensitivity when combining markers was accompanied by a decrease in specificity. Generally, combining more markers increased the tumor detection rates, while a combination of the seven markers provided the highest detection rate. Combined detection showed a particularly high sensitivity in detecting respiratory, digestive and urinary system tumors, with the lowest sensitivity observed in gynecological tumors. As a result, combining tumor markers may play an important role in early tumor detection/diagnosis while the loss of specificity can be tolerated.
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.affiliation: School of Interdisciplinary Health Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland 1142, New Zealand;
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Hui
authors.initials: H
authors.lastname: Ren
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Tianjun
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Lin
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Ligai
authors.initials: L
authors.lastname: DI
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Zhucui
authors.initials: Z
authors.lastname: Song
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Tian
authors.initials: T
authors.lastname: Yang
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Asmitananda
authors.initials: A
authors.lastname: Thakur
authors.affiliation: College of Pharmacy, University of South Florida, Tampa, FL 33612, USA.
authors.forename: Shu-Feng
authors.initials: SF
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Yanhai
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Department of Respiratory Medicine, The First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China;
authors.forename: Mingwei
authors.initials: M
authors.lastname: Chen
keywords: carcinoembryonic antigen; cytokeratin 19; diagnosis; lung cancer; neuron-specific enolase; tumor marker