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To evaluate the pronostic value of an elevated seric carcinoembryonic antigen (CEA > 10 ng/ml) at diagnosis, in patients with lung cancer, a pair study was done: couples of patients with same staging and histologic type were established, one patient with high CEA level compared to one patient with normal CEA level (< 5.5 ng/ml). Other markers were measured: neuron specific enolase (NSE), squamous cell carcinoma (SCC) or Cyfra 21-1. Survival was the end point of comparison. For 89 couples created, patients with low CEA level had a better survival rate at one year ( p = 0.02), this prognosis advantage was confirmed by a comparison of survival curves with Mantel-Cox and Breslow test (p = 0.01), but not by the signs test. These differences were also observed for the 71 couples of squamous cell carcinomas and adenocarcinomas, and the apparied signs test was still not significant. The poor prognosis persisted for patients with high CEA level, when one another marker's level (NSE or SCC or Cyfra 21-1) was increased, in comparison with patients with any marker increased. On 29 couples of all histological subtypes or on the 25 couples of non small cell lung cancer, the signs test and the comparison of survival curves were significant, but not the 1 year survival rate. This study shows that a CEA level greater than 10 ng/ml at diagnosis is a poor pronostic factor in patients with lung carcinoma, independent of the stage of disease and of the histologic type.

A variety of markers have been used in the surveillance of carcinoma of the breast and malignant melanoma, including carcino-embryonic antigen (CEA) beta2-microglobulin (beta2m) and prolactin. The dual purpose of the surveillance was the detection of early recurrence or metastasis and the monitoring of the treatment. In cancer of the breast 92% of patients having bone metastases have elevated levels of CEA or beta2m. In malignant melanoma 2/3 of the patients in relapse have elevated beta2m levels.

Simultaneous dosage of carcino-embryonic antigen and beta 2-microglobulin was studied in serum and pleural liquid. Among the 20 patients with non-neoplasic infections, the carcino-embryonic antigen was not increased in the serum and only once at a border-line level in the pleura. The level of beta 2-microglobulin seems to be related to the number of lymphocytes in the pleural liquid (increase in 45% of the cases compared to 20% in the serum). Among the 31 cancer patients, carcino-embryonic antigen is increased in the serum of 36% of the cases and in the pleura of 48%. In 5 observations, the pleural levels were considerably increased compared with serum levels, suggesting the existence of a pleural metastasis. The beta 2-microglobulin is elevated in only 26% of the cases in the pleural liquid and in 13% in the serum. At the present state of knowledge, it therefore seems unnecessary to continue investigations concerning the beta 2-microglobulin. On the contrary, the pleural dosage of carcinoembryonic antigen could contribute to the diagnosis.

With the method used, the concentrations of carcinoembryonic in antigen serum can be said to be abnormal above 10 ng/ml. The concentrations are normal in benign mastopathies. In 131 cases of breast cancer were studied, they are high in 8 p. cent of T1 and T2 breast cancers, and in 53.9 p. cent of T3 and T4 cancers. They are high in 22 p. cent of cases in the first perceptible phase of their disease, and 92 p. cent relapsed cases. They are also high in 23 p. cent of cases without metastasis, in 32 p. cent of cases with only nodal metastasis, in 82 p. cent of cases with extra-nodal metastasis, and in 94 p. cent of cases with nodal and extra-nodal metastasis. Concentrations of carcinoembryonic in antigen serum which are abnormal before treatment and which do not completely return to normal after treatment, of which rise again, enable one to predict the appearance of a metastasis several months before its clinical manifestation. Determination of the concentrations of carcinoembryonic in antigen serum therefore deserves to become part of the battery of routine for all breast cancers. An initial high concentration is an argument for suggesting systematic chemotherapy. The fluctuations in the concentrations of carcinoembryonic in antigen serum under chemotherapy allow one to assess the efficiency of the treatment.

The studies of the levels of the CEA and of the beta2m were both performed on 52 patients. The authors pointed out the interest of measurement of these 2 markers and above all the interest of their complementary before any therapy and during treatment by surgery or radiotherapy whether associated or not.

Antibody-dependent cell-mediated cytotoxicity (ADCC) against human colon carcinoma cells grown in vitro was demonstrated with two specific rabbit anti-carcinoembryonic antigen (cea) antisera. The same antisera did not lyse the colon carcinoma cells in the presence of complement but without lymphocytes. The normal human lymphocytes in the absence of anti-CEA antiserum had a very low cytotoxic activity during the three hours 51Cr release assay used in this study. Two colon carcinoma cell lines, HT-29 and Co-115, expressing CEA on their surface as demonstrated by immunofluorescence, were significantly lysed in the ADCC test, whereas control tumor cell lines, not expressing CEA, were not affected by the anti-CEA sera and the lymphocytes. The specificity of the reaction was further demonstrated by the inhibition of antibody-dependent cell-mediated cytotoxicity after the addition of increasing amounts of purified CEA to the antiserum. The absorption of the anti-CEA antisera was controlled by radioimmunoassay. Absorption of the antisera by normal lung extracts and red cells of different blood groups did not decrease the cytotoxicity.

beta2m was determined by radioimmunoassay in 43 serums from healthy blood donors. Serum concentrations varied from 0.67 to 1.9 mg/l with a mean of 1.29 mg/l. Reproductibility and sensitivity of the method were evaluated. 66 patients with advanced neoplasia were studied. Serum beta2m was greater than 2 mg/l in 70% of the cases and carcinoembryonic antigen (CEA) in 54%. In 26 documented cases with tumor progression and 14 with regression, associated variations of CEA were formed more frequent and of greater magnitude than those of beta2m.

Sipple's syndrome in three members of the same family (three successive generations) is reported, confirming that this syndrome is hereditary and transmitted in an autosomal and dominant way. Whereas pheochromocytoma was clinically detectable, medullary thyroïd carcinoma could only be detected in two cases by systematic search for high levels of calcitonin before and after stimulation. In 6 other siblings, thyroïd carcinoma was eliminated in view of negative stimulation tests. HLA groups were studied, but definite conclusions as to the interest of these data in Sipple's syndrome cannot be drawn from 10 few cases. Persistingly high levels of calcitonin after surgery is known to be of severe prognosis; in the present cases, the very short delay after surgery did not allow definite conclusion, since, according to some authors, several months are necessary to allow a return to normal levels.

While it is useful to carry out aspiration from the Pouch of Douglas for screening for cancer of the ovary, the technique is irreplaceable for the follow-up of tumours that have been operated on or irradiated or treated with chemotherapy. We have carried out 1,353 aspirations: 189 of these which were done routinely have been equivocal. 380 aspirations that were carried out because of abnormal symptoms led to the discovery of 26 cancers of which 2 were very early ones. 784 aspirations were carried out for follow-up. There were in all 4.8% blank aspirations, 0.5% false positives and 1.6% false negatives, which is an indication of the reliability of the method so long as certain points in the technique are carefully followed. These figures, which are quoted as a percentage of the total number of aspirations, however, become more important when considered as a percentage of the number of cancers that were diagnosed (5.5% false positive and 18% false negatives). Furthermore, the level of C.E.A. in peritoneal fluid is a method which can be added to cytology in following up the progress of the disease which is not to be dismissed.

Serum levels of carcino-embryonic antigen (CEA) and beta2-microglobulin (beta2m) were assayed on 133 sera during follow-up of 31 patients with lung carcinoma (squamous cell ca. without recurrence : 2, squamous cell ca. with recurrence : 11, anaplastic cell ca. : 4, adenocarcinoma : 2, unclassifiable : 5). Normal creatinine (less than or equal to 12 mg/l) levels were found in all sera. CEA and beta2m levels showed no correlation nor in these groups, nor in the whole. The squamous cell carcinomas with recurrence showed the largest dispersion for CEA as for beta2m levels. However, the trends of serial beta2m values did not correlate with clinical features. Increasing or decreasing levels of CEA and beta2m levels showed no correlation in the whole nor in patients undergoing radiotherapy. In our experience, beta2m levels failed to correlate with clinical findings during the follow-up of lung cancer patients.

Radioimmunological assay of carcino-embryonic antigen (CEA) was performed in 238 patients with cancer of the upper respiratory and digestive tracts after a minimum follow-up period of 3 years. Secretion of CEA was observed in only 1 out of 3 cases, levels, always being low and only slightly influenced by the localization or size of the tumor, and the condition of the lymph nodes. Initial levels are of no prognostic significance. The appearance of high levels during the course of the disease corresponds to shorter survival, but as it does not precede clinical evidence of recurrence or metastases this assay cannot play a role as a tumor marker.

In a series of 52 patients with bronchogenic carcinoma serum levels of beta2-microglobulin (beta2m) and carcino-embryonic antigen (CEA) were studied. No correlation was found between the increase of beta2m (greater than 3,2 mg/l) and CEA (greater than 40 ng/l). High levels were found in 10 % of cases for CEA and in 30% of cases for beta2m. The follow-up of serum levels of beta2m and CEA was studied during the evolution of the disease through monthly assays. Upon 15 cases followed, the same dissociation between beta2m and CEA was observed.

In this preliminary study dealing with beta2-microglobulin (beta2m) levels in the series of 258 patients, two group are considered:--a group of 208 patients with evolutive tumour;--a group of 50 patients with no evolutive tumour. This study shows a significantly higher incidence of cases with elevated levels of carcinoembryonic antigen (CEA) and/or beta2m in group with evolutive cancer than in group with no evolutive cases. These elevated levels of beta2m are not related to other clinical, topographical, evolutive, immunological parameters. But the increase of serum beta2m levels in patients treated with combination of chemo and immunotherapy, may indicate a possible relationship between beta2m levels and lymphocyte activation.

Radioimmunological assays of carcino-embryonic antigen (CEA) and beta 2 microglobulin were carried out in 61 cases of malignant bone disease, including myeloma and metastases from carcinomas of the breast and prostate. CEA assays seemed to be of greater interest in mammary cancer metastases and beta 2 microglobulin assays in prostatic cancer metastases and myeloma. The correlation which appeared between CEA levels of the outcome of breast cancer metastases was of assistance in adjusting treatment. Combining CEA and beta 2 microglobulin assays would enhance their usefulness in current practice.

Abstract: Circulating proteinic biomarkers are secreted by tumor cells or by their environmental cells and they have a variable specificity. In case of breast cancer, carcino-embryonic antigen (CEA) was for a long time the only circulating biomarker used. Nowadays, the most useful biomarkers measure circulating levels of fragments of MUC1–polymorphic epithelial mucin (MUC1–PEM): cancer antigen (CA) 15.3, mucin-like carcinoma-associated antigen (MCA), CA 27–29, CA 549… They are useful for general disease follow-up. Other circulating markers belonging to keratins (tissue polypeptide antigen, TPA, TPS or Cyfra 21.1) are correlated with proliferative activity of breast tumors. More recently, the measure of the c-erb B2 circulating part (extra cellular domain, ECD) was proposed as a prognostic biomarker for breast tumors with c-erb B2 overexpression. Moreover, the determination of urinary level of trefoil factor1 (PS2–TFF1) might be useful for the follow-up of hormonodependent breast cancers. The present review describes the clinical interest of these different circulating biomarkers in case of breast cancer, emphasizing their biological characteristics. [Copyright &y& Elsevier]

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An abstract of the article "Pluripotent stem cells: a cell model for early cardiac development," by Michel Pucéat is presented.

Copyright of African Journal of Cancer / Journal Africain du Cancer is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)