Kivonat:
Background: Cathepsin B and L (CATB, CATL), urokinase-type plasminogen
activator (uPA) and its inhibitor PAI-I play an important role in
colorectal cancer invasion. The tumor marker utility and prognostic
relevance of these proteases have not been evaluated in the same
experimental setting and compared with that of CEA and CA-19-9.
Methods: Protease, CEA and CA 19-9 serum or plasma levels were
determined in 56 patients with colorectal cancer, 25 patients with
ulcerative colitis, 26 patients with colorectal adenomas and 35
tumor-free control patients. Protease, CEA, CA 19-9 levels have been
determined by ELISA and electrochemiluminescence immunoassay,
respectively; their sensitivity, specificity, diagnostic accuracy have
been calculated and correlated with clinicopathological staging.
Results: The protease antigen levels were significantly higher in
colorectal cancer compared with other groups. Sensitivity of PAI-I
(94%), CATB (82%), uPA (69%), CATL (41%) were higher than those of CEA
or CA 19-9 (30% and 18%, respectively). PAI-I, CATB and uPA
demonstrated a better accuracy than CEA or CA 19-9. A combination of
PAI-I with CATB or uPA exhibited the highest sensitivity value (98%).
High CATB, PAI-I, CEA and CA 19-9 levels correlated with advanced Dukes
stages. CATB (P = 0.0004), CATL (P = 0.02), PAI-I (P = 0.01) and CA
19-9 (P = 0.004) had a significant prognostic impact. PAI-I (P =
0.001), CATB (P = 0.04) and CA 19-9 (P = 0.02) proved as independent
prognostic variables.
Conclusion: At the time of clinical detection proteases are more
sensitive indicators for colorectal cancer than the commonly used tumor
markers. Determinations of CATB, CATL and PAI-I have a major prognostic
impact in patients with colorectal cancer.
