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ProGRP: A New Biomarker for Small Cell Lung Cancer

Author(s): Rafael Molina

Journal: European Journal of Clinical & Medical Oncology
ISSN 1759-8958

Volume: 2;
Issue: 1;
Start page: 15;
Date: 2010;
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Keywords: tumor markers | small cell lung cancer (SCLC) | NSE | follow-up | ProGRP | neuroendocrine markers

Neuron-specific enolase (NSE) has been the tumor marker of choice in small cell lung cancer (SCLC). It is considered specific for this malignancy and for neuroendocrine tumors, and it is useful in the diagnosis, prognosis, and follow-up of these patients. However, its low sensitivity, mainly in patients with limited disease (LD), has led to its use in combination with other tumor markers not as specific for SCLC. ProGRP, the precursor form of gastrin-releasing peptide (GRP), the mammalian counterpart of amphibian bombesin, is a useful tumor marker in SCLC. Abnormal ProGRP (>50 pg/mL) may be found only in a small subset of patients with benign (0.4%) or malignant disease (24%, 99% with concentrations 150 pg/mL are indicative of SCLC with a probability of 93.7%. The ProGRP sensitivity in SCLC, the absence of false positive results in samples with hemolysis, the greater differences between normal ranges and the levels found in SCLC patients, and the higher specificity in other malignancies support ProGRP as the tumor marker of choice for SCLC. However, ProGRP and NSE are complementary tumor markers, and the use of both tumor markers simultaneously increases the sensitivity achieved with ProGRP by 15%. Tumor markers may be useful in the histological differentiation of non-small cell lung cancer (NSCLC) and SCLC. Patients with squamous cell carcinoma antigen (SCC) serum levels >2 ng/mL were always NSCLC, whereas those with SCC 100 pg/mL, and NSE >35 ng/mL were all SCLC patients. Using the criteria specified in Table 2, the sensitivity was 76.7% and 79.5% and the specificity was 97.2% and 99.6% in the differentiation of NSCLC and SCLC, respectively, with a positive predictive value of 98.6% and 98.6% and a negative predictive value of 60.7% and 92.9%. Tumor marker determination in patients with suspicious signs of lung cancer reveals the histological diagnosis in the majority of lung cancer patients in a few hours.
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