Dtsch Med Wochenschr 2015; 140(19): 1438-1441
DOI: 10.1055/s-0041-105626
Dossier
Krebsfrüherkennung
© Georg Thieme Verlag KG Stuttgart · New York

Tumormarker zur Früherkennung – sinnvoll oder sinnlos?

Use of tumor markers as screening tools – sense or nonsense?
Dominik Paul Modest
1   Medizinische Klinik und Poliklinik III, Klinikum der Universität München, München, Deutschland
,
Volker Heinemann
1   Medizinische Klinik und Poliklinik III, Klinikum der Universität München, München, Deutschland
› Author Affiliations
Further Information

Publication History

Publication Date:
24 September 2015 (online)

Zusammenfassung

Die Früherkennung von Krebserkrankungen soll eine Senkung von Mortalität und Morbidität bewirken. Dies beinhaltet, dass die untersuchte Erkrankung effektiv in frühen Stadien behandelbar ist. Tumormarker haben sich als Instrument zum Screening von gesunden Populationen bisher nicht etablieren können, da ihnen Sensitivität und Spezifität fehlen. Um Tumormarker im Screening einzusetzen, müssen Marker oder Markerprofile mit hoher Sensitivität und Spezifität gefunden und wenn nötig wiederholt bestimmt werden. An neuartigen Tumormarkern könnten microRNA, Antikörper gegen Tumorantigene, zellfreie DNA oder auch Exosomen in Zukunft zur Verfügung stehen. In der Nachsorge von Krebserkrankungen kann die Überwachung eines Tumormarkers bereits heute zur Früherkennung von Rezidiven eingesetzt werden.

Abstract

Screening programs for early detection of cancer aim to reduce mortality and mobidity. Therefore, effective therapy for early stages of the respective disease should be available. Tumor markers are not established tools for screening of healthy populations since they lack sensitivity and specificity in detecting diseases. Nevertheless, screening with tumor markers would be an attractive tool since side effects of other screening modalities (radiation endoscopy etc) are avoided. To implement tumor markers in screening programs, markers or marker profiles with higher sensitivity and specificity are needed. Novel tumor markers may include microRNA, antibodies directed against tumor-specific antigens, cell-free DNA as well as cir culating exosomes. Tumor markers may already be used in some follow-up care settings to detect recurrences at an early stage.

 
  • Literatur

  • 1 Loberg M, Lousdal ML, Bretthauer M, Kalager M. Benefits and harms of mammography screening. Breast Cancer Res 2015; 17: 63
  • 2 Schroder FH, Hugosson J, Roobol MJ et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014; 384: 2027-2035
  • 3 Jorgensen KJ, Gotzsche PC. Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends. BMJ 2009; 339: b2587
  • 4 Pox C, Aretz S, Bischoff SC et al. S3-guideline colorectal cancer version 1.0. Z Gastroenterol 2013; 51: 753-854
  • 5 Kreienberg R, Albert US, Follmann M et al. Interdisciplinary GoR level III guidelines for the diagnosis, therapy and follow-up care of breast cancer: short version – AWMF Registry No.: 032-045OL – Kurzversion 3.0, Juli 2012. Geburtshilfe Frauenheilkd 2013; 73: 556-583
  • 6 Harris L, Fritsche H, Mennel R et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 2007; 25: 5287-5312
  • 7 Fong Y, Fortner J, Sun RL et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309-318, discussion 318-321
  • 8 Chen H, Zucknick M, Werner S et al. Head-to-head comparison and evaluation of 92 plasma protein biomarkers for early detection of colorectal cancer in a true screening setting. Clin Cancer Res 2015; 21: 3318-3326
  • 9 Hirales Casillas CE, Flores Fernandez JM, Padilla Camberos E et al. Current status of circulating protein biomarkers to aid the early detection of lung cancer. Future Oncol 2014; 10: 1501-1513
  • 10 Berger AP, Deibl M, Strasak A et al. Large-scale study of clinical impact of PSA velocity: long-term PSA kinetics as method of differentiating men with from those without prostate cancer. Urology 2007; 69: 134-138
  • 11 Fesler A, Jiang J, Zhai H, Ju J. Circulating microRNA testing for the early diagnosis and follow-up of colorectal cancer patients. Mol Diagn Ther 2014; 18: 303-308
  • 12 Ng EK, Chong WW, Jin H et al. Differential expression of microRNAs in plasma of patients with colorectal cancer: a potential marker for colorectal cancer screening. Gut 2009; 58: 1375-1381
  • 13 Ng EK, Li R, Shin VY et al. Circulating microRNAs as specific biomarkers for breast cancer detection. PLoS One 2013; 8: e53141
  • 14 Ferracin M, Lupini L, Salamon I et al. Absolute quantification of cell-free microRNAs in cancer patients. Oncotarget 2015; 6: 14545-14555
  • 15 Wozniak MB, Scelo G, Muller DC et al. Circulating MicroRNAs as Non-Invasive Biomarkers for Early Detection of Non-Small-Cell Lung Cancer. PLoS One 2015; 10: e0125026
  • 16 Chen H, Werner S, Tao S et al. Blood autoantibodies against tumor-associated antigens as biomarkers in early detection of colorectal cancer. Cancer Lett 2014; 346: 178-187
  • 17 Werner S, Chen H, Tao S, Brenner H. Systematic review: serum autoantibodies in the early detection of gastric cancer. Int J Cancer 2015; 136: 2243-2252
  • 18 Liu W, De La Torre IG, Gutierrez-Rivera MC et al. Detection of autoantibodies to multiple tumor-associated antigens (TAAs) in the immunodiagnosis of breast cancer. Tumour Biol 2015; 36: 1307-1312
  • 19 Ummanni R, Duscharla D, Barett C et al. Prostate cancer-associated autoantibodies in serum against tumor-associated antigens as potential new biomarkers. J Proteomics 2015; 119: 218-229
  • 20 Zhong L, Ge K, Zu JC et al. Autoantibodies as potential biomarkers for breast cancer. Breast Cancer Res 2008; 10: R40
  • 21 Chang W, Wu L, Cao F et al. Development of autoantibody signatures as biomarkers for early detection of colorectal carcinoma. Clin Cancer Res 2011; 17: 5715-5724
  • 22 Ran Y, Hu H, Zhou Z et al. Profiling tumor-associated autoantibodies for the detection of colon cancer. Clin Cancer Res 2008; 14: 2696-2700
  • 23 Wu L, Chang W, Zhao J et al. Development of autoantibody signatures as novel diagnostic biomarkers of non-small cell lung cancer. Clin Cancer Res 2010; 16: 3760-3768
  • 24 Gormally E, Caboux E, Vineis P, Hainaut P. Circulating free DNA in plasma or serum as biomarker of carcinogenesis: practical aspects and biological significance. Mutat Res 2007; 635: 105-117
  • 25 Siravegna G, Mussolin B, Buscarino M et al. Clonal evolution and resistance to EGFR blockade in the blood of colorectal cancer patients. Nat Med 2015; 21: 795-801
  • 26 Melo SA, Luecke LB, Kahlert C et al. Glypican-1 identifies cancer exosomes and detects early pancreatic cancer. Nature 2015; 523: 177-182