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Overview of Utilization of Tumor Markers for Cancer Diagnosis
Biomed Sci Letters 2022;28:223-228
Published online December 31, 2022;  https://doi.org/10.15616/BSL.2022.28.4.223
© 2022 The Korean Society For Biomedical Laboratory Sciences.

Hong Sung Kim†,*

Department of Biomedical Laboratory Science, Korea Nazarene University, Cheonan 31172, Korea
Correspondence to: Hong Sung Kim. Department of Biomedical Laboratory Science, Korea Nazarene University, 48 Wolbong-Ro, Seobuk-Gu, Cheonan-City, ChungNam 31172, Korea.
Tel: +82-41-570-4165, Fax: +82-41-570-4258, e-mail: hskim@ kornu.ac.kr
*Professor.
Received October 24, 2022; Revised November 26, 2022; Accepted November 28, 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
It has well reported that tumor markers have many advantages like minimally invasive, convenient use, low cost but also has many limitations like low sensitivity and specificity, relevance of prognosis, low organ specificity. Although no tumor markers are ideal, many tumor markers are used for cancer diagnosis, treatment monitoring, and surveillance monitoring after treatment. We review the classification and characteristics of tumor markers according cancer types and clinical roles in current times.
Keywords : Tumor markers, Role of tumor markers, Use of tumor markers
꽌 濡

醫낆뼇몴吏옄(Tumor marker)뒗 쟾넻쟻쑝濡 醫낆뼇꽭룷뿉꽌 吏곸젒 깮궛릺嫄곕굹 븙꽦醫낆뼇씠굹 뼇꽦醫낆뼇 媛숈 긽솴뿉 諛섏쓳븯뿬 떎瑜 꽭룷뱾뿉 쓽빐 깮꽦릺뒗 臾쇱쭏, 二쇰줈 떒諛깆쭏濡 媛꾩<맂떎. 醫낆뼇몴吏옄뒗 PSA 媛숈씠 湲곌 듅씠쟻쑝濡 븙꽦醫낆뼇怨 愿젴씠 엳쓣 닔룄 엳怨(Haythorn and Ablin, 2011), CEA 媛숈씠 떎뼇븳 븫醫낆뿉꽌 利앷맆 닔룄 엳떎(Yang et al., 2017). 삉븳 醫낆뼇몴吏옄뒗 궙 吏꾨떒 誘쇨컧룄 듅씠룄瑜 媛吏湲 븣臾몄뿉, 珥덇린 醫낆뼇 吏꾨떒뿉뒗 씠슜븯湲 뼱졄떎. 븯吏留 뿬쟾엳 졃븳 鍮꾩슜, 궗슜븯湲 렪由ъ꽦, 理쒖냼븳쓽 鍮꾩묠뒿꽦 寃궗濡 씤븳 솚옄쓽 留뚯”룄 벑 떎뼇븳 옣젏쓣 媛吏怨 엳뼱 떎젣 엫긽 醫낆뼇 吏꾨떒뿉꽌 留롮씠 솢슜릺怨 엳떎(Duffy, 2013). 蹂 끉臾몄뿉꽌뒗 쁽옱 엫긽쟻쑝濡 꼸由 씠슜릺뒗 醫낆뼇몴吏옄뿉 빐 솗씤븯怨, 醫낆뼇몴吏옄쓽 엫긽쟻 뿭븷뿉 빐 怨좎같븯怨좎옄 븳떎. 븘옒뒗 쁽옱 꼸由 씠슜릺뒗 몴쟻씤 醫낆뼇몴吏옄뱾쓣 냼媛쒗븯怨 엳떎(Table 1).

Classification of tumor markers by cancer types

Cancer types Tumor markers
Esophegeal SCC
Stomach CEA, STN, CA19-9
Colorectal CEA, CA19-9, CA125, NCC-ST-439, STN, SLX
Liver AFP, PIVKA-II, AFP-L3
Pancreatic CA19-9, CEA, SLX, CA125, NCC-ST-439, SLX, STN
Lung CEA, CA125, SLX, SCC, CYFRA 21-1, NSE, ProGRP
Breast CA15-3, BCA 225, NCC-ST-439, HER2
Cervical SCC, CA125
Ovary CA125, AFP
Prostate PSA, Ratio of free-PSA/total-PSA

STN: Sialyl-Tn antigen, NCC-ST-439: Nation Cancer Center Stomach-439, SLX: Sialy SSEA-1 antigen, BCA225: Breast Cancer Antigen 225


蹂 濡

I. 쁽옱 엫긽쟻쑝濡 꼸由 씠슜릺뒗 醫낆뼇몴吏옄(clinically used tumor markers in current times)

• CEA (Carcinoembryonic antigen)

CEA뒗 궗엺 寃곗옣吏곸옣븫 議곗쭅뿉꽌 1965뀈뿉 泥섏쓬쑝濡 遺꾨━릺뿀怨(Gold and Freedman, 1965), 꽭룷遺李⑸텇옄 愿젴맂 떦떒諛깆쭏濡쒖꽌 醫낆뼇깭븘빆썝씠떎. 鍮꾨줉 CEA媛 寃곗옣吏곸옣븫쓽 媛먮퀎吏꾨떒, 蹂묎린 媛젙, 寃곗옣吏곸옣븫 솚옄쓽 썑냽 議곗튂瑜 쐞븳 졃븯怨 븞쟾븯硫 鍮꾩묠뒿쟻씤 寃궗瑜 몴븯吏留(Staib et al., 2000; Sorensen et al., 2016), 궗留앸쪧쓣 媛먯냼븯뒗뜲 븳 쁺뼢怨 愿젴맂 寃곌낵뒗 紐⑥닚쟻씠怨(Fahy, 2014), 떎瑜 븫醫(Maestranzi et al., 1998; Wang et al., 2017b)씠굹 뼇꽦醫낆뼇(Ruibal Morell, 1992), 씉뿰옄(Fukuda et al., 1998)뿉寃 꽌 利앷븷 닔 엳떎.

• AFP (alpha-fetoprotein)

AFP뒗 깭븘 媛꾧낵 궃솴궘뿉꽌 젙긽쟻쑝濡 깮궛릺硫, 異쒖깮 썑뿉뒗 깮궛릺吏 븡뒗 몴쟻씤 븫諛곗븘빆썝씠떎(Cao et al., 2017). AFP뒗 媛꾩꽭룷븫醫낆뿉 넂 듅씠꽦쓣 媛吏吏留, 珥덇린 吏꾨떒뿉뒗 궗슜븷 닔 뾾떎. 삉븳 떎瑜 븫醫(van Heurn et al., 2020)씠굹, 엫떊(Johnson, 2001), 媛꾩뿼씠굹 媛꾧꼍솕(Arrieta et al., 2007) 媛숈 吏덊솚뿉꽌룄 利앷븷 닔 엳떎.

• PIVKA-II (Prothrombin in vitamin K absence)

PIVKA-II뒗 鍮꾪誘 K 寃고븤 떆 봽濡쒗듃濡щ퉰 쟾援щЪ吏덈줈遺꽣 깮꽦릺뒗 鍮꾩젙긽 봽濡쒗듃濡щ퉰씠硫, 媛꾩꽭룷븫醫낆뿉 넂 듅씠꽦쓣 蹂댁씤떎(Xu et al., 2021). AFP 媛숈씠 궗슜븯쓣 븣 吏꾨떒슚쑉씠 뼢긽맂떎怨 蹂닿퀬릺뿀떎. 쓳怨 湲곕뒫옣븷(Dauti et al., 2015) 媛꾧꼍솕(Di Bisceglie and Hoofnagle, 1989) 媛숈 吏덊솚뿉꽌룄 利앷븷 닔 엳떎.

• CA19-9 (Carbohydrate antigen 19-9)

CA19-9뒗 猷⑥씠뒪빆썝A 愿젴맂 깂닔솕臾 빆썝쑝濡 씠옄븫 吏꾨떒뿉 꼸由 궗슜븳떎(Cao et al., 2017). CA19-9뒗 씠옄븫 媛먮퀎吏꾨떒, 삁썑, 蹂묎린瑜 솗씤븯뒗뜲룄 쑀슜븳 寃껋쑝濡 蹂닿퀬릺怨 엳떎. 븯吏留 寃곗옣吏곸옣븫(Lakemeyer et al., 2021), 쐞븫(Wang et al., 2017a), 궃냼븫(Rao et al., 2021), 떞룄븫(Wongkham and Silsirivanit, 2012)뿉꽌룄 利앷븳떎.

• CA125 (Carbohydrate antigen 125)

CA125뒗 궃냼븫꽭룷 몴硫댁뿉꽌 諛쒓껄릺뒗 怨좊텇옄웾 젏븸꽦 떦떒諛깆쭏濡쒖꽌 궃냼븫 寃吏, 吏꾨떒, 愿由ъ뿉꽌 븘닔쟻씤 뿭븷쓣 닔뻾븯怨 엳떎(Charkhchi et al., 2020). 븯吏留 珥덇린 吏꾨떒뿉 뼱졄怨 쑀諛⑹븫(Yerushalmi et al., 2012), 씠옄븫(Meng et al., 2017), 옄沅곴꼍遺븫(Ran et al., 2021) 媛숈 떎瑜 븫醫낆뿉꽌룄 利앷븷 닔 엳떎.

• CA15-3 (Carbohydrate antigen 15-3)

CA15-3 쑀諛⑹꽭룷뿉꽌 깮궛릺뒗 怨좊텇옄웾 떦떒諛깆쭏濡쒖꽌 쑀諛⑹븫 珥덇린 吏꾨떒뿉뒗 쑀슚븯吏 븡吏留 쑀諛⑹븫 솚옄쓽 堉 쟾씠 삁썑瑜 솗씤븯뒗뜲 쑀슜븯떎(Yang et al., 2017).

• PSA (Prostate specific antigen)

PSA뒗 꽭由 떒諛깅텇빐슚냼濡, 깮由ъ쟻 湲곕뒫 궗젙 썑 젙븸쓣 븸솕떆궎뒗 寃껋쑝濡 븣젮졇 엳떎(Lilja et al., 2008). 삁븸 PSA뒗 遺遺 α1-빆궎紐⑦듃由쎌떊(ACT)怨 蹂듯빀泥대 삎꽦븯怨, 쟻 遺遺꾩쓽 PSA媛 α2 留덊겕濡쒓濡쒕텋由곌낵 寃고빀릺硫, 굹癒몄뒗 쑀由ы삎쑝濡 議댁옱븳떎(Shariat et al., 2011). PSA 媛믪씠 궙쓣 븣뒗 쟾由쎌깦 鍮꾨利앷낵 쟾由쎌깦븫쓣 援щ텇븯湲 뼱졄떎(Stenman et al., 1999). 쟾由쎌깦븫뿉꽌뒗 PSA-ACT 鍮꾩쑉씠 넂怨 쟾由쎌깦 鍮꾨利앹뿉꽌뒗 쑀由ы삎 PSA 鍮꾩쑉씠 넂떎(Cannon and Getzenberg, 2008; Kiebish et al., 2021).

• CYFRA 21-1 (Cytokeratin 19 fragment antigen)

CYFRA 21-1 떆넗耳씪떞議깆쑝濡 젙긽쟻쑝濡 긽뵾議곗쭅뿉꽌 諛쒗쁽맂떎(Chen et al., 2018a). CYFRA21-1 듅엳 CEA 렪룊꽭룷븫醫 뿰愿 빆썝(SCC) (Chen et al., 2018b)怨 븿猿 鍮꾩냼꽭룷꽦룓븫(Baek et al., 2018; Chen et al., 2018a)쓣 쐞븳 醫낆뼇몴吏옄濡 쑀슜븯吏留 諛⑷킅븫(Matuszczak and Salagierski, 2020) 媛숈 떎瑜 긽뵾꽦븫醫낆뿉룄 쑀슜븯떎.

• NSE (Neuron specific enolase)

NSE뒗 떊寃 諛 떊寃쎈궡遺꾨퉬 듅씠 뿉씪븘젣 룞醫낇슚냼濡 샇湲곗꽦 빐떦怨쇱젙쓽 二쇱슂 슚냼씠떎(Cheng et al., 2014). NSE뒗 냼꽭룷꽦 룓븫 吏꾨떒怨 移섎즺 媛먯떆뿉 쑀슜븳 醫낆뼇몴吏옄씠떎(Huang et al., 2017).

• ProGRP (Pro gastrin releasing peptide)

ProGRP뒗 깮由ы븰쟻쑝濡 냼솕怨쇱젙怨 愿젴맂 솢꽦 샇瑜대が씤 媛뒪듃由 諛⑹텧 렔떚뱶쓽 쟾援ъ껜씠떎(Molina et al., 2004; Dong et al., 2019). ProGRP뒗 냼꽭룷꽦 룓븫 吏꾨떒뿉 쑀슜븳 몴吏옄씠떎(Molina et al., 2004).

II. 醫낆뼇몴吏옄쓽 엫긽쟻 뿭븷(Clinical roles of tumor markers)

• 媛먮퀎吏꾨떒(Differential Diagnosis)

쁽옱 醫낆뼇몴吏옄뒗 옉嫄곕굹 珥덇린 醫낆뼇뿉 븳 젣븳맂 誘쇨컧룄 醫낆뼇 듅씠꽦 遺議깆쑝濡 씤빐 珥덇린 吏꾨떒쓣 쐞빐 궗슜릺뒗 寃껋 젣븳맂떎(Duffy, 2013). 媛쒖쓽 醫낆뼇몴吏옄뱾 옞옱쟻씤 媛먮퀎吏꾨떒쓣 醫곹엳뒗뜲 룄쓣 以 닔 엳떎(Liu et al., 2014). 媛 떒룆 醫낆뼇몴吏옄쓽 궗슜 醫낆뼇 媛먮퀎吏꾨떒쓣 쐞빐 異붿쿇릺吏 븡뒗떎. 삁瑜 뱾硫 CA125뒗 룓寃 썑 뿬꽦뿉꽌 怨⑤컲 醫낆뼇쓽 뼇꽦씠굹 븙꽦쓣 援щ퀎븯뒗뜲 궗슜븷 닔 엳怨, 理쒓렐뿉뒗 궃냼 븙꽦醫낆뼇 쐞뿕꽦 븣怨좊━利(ROMA)瑜 씠슜븳 CA125 HE4쓽 議고빀쑝濡 뜑 젙諛븳 궃냼븫 쐞뿕꽦쓣 吏꾨떒븳떎(Dochez et al., 2019). 룓븫쓽 寃쎌슦뿉룄 6媛吏 醫낆뼇몴吏옄 議고빀(CEA, CA15-3, SCCA, CYFRA 21-1, NSE, ProGRP)씠 떒룆 醫낆뼇몴吏옄 샊 엫긽쟻 슂씤 蹂대떎 룓븫쓽 議댁옱瑜 醫 뜑 젙솗븯寃 吏꾨떒븯怨 엳쓬쓣 蹂닿퀬븯怨 엳떎(Molina et al., 2016). 쟻젅븳 醫낆뼇몴吏옄쓽 궗슜 異붽쟻씤 吏꾨떒쓣 쐞빐 븘슂븳 뿬윭 媛吏 寃궗(諛섎났쟻씤 쟾궛솕 떒痢듭눋쁺, 깮寃 벑)쓽 異붽瑜 諛곗젣븷 닔 엳떎(Duffy, 2013).

• 삁썑(Prognosis)

醫낆뼇몴吏옄뒗 醫낆뼇 吏꾨떒 썑뿉 醫낆뼇 솚옄쓽 삁썑굹 蹂묎린瑜 삁痢≫븯怨 솗씤븯뒗뜲룄 쑀슜븯떎(Altman et al., 2012). 鍮꾩냼꽭룷꽦 룓븫 솚옄쓽 닔닠 썑 CEA CYFRA 21-1 뼇쓽 議고빀 옱諛 뾾뒗 깮議댁쑉쓣 쐞븳 삁썑쟻 씤옄씪 닔 엳떎(Okamura et al., 2013). 냼꽭룷꽦 룓븫 솚옄뿉꽌 ProGRP 뼇 쟾젣 깮議댁쑉쓣 쐞븳 삁썑 씤옄엫룄 蹂닿퀬릺怨 엳떎(Nisman et al., 2009). CA15-3, CA19-9 媛숈 醫낆뼇몴吏옄뱾룄 쑀諛⑹븫(Wang et al., 2017b)怨 媛꾨떞룄븫뿉꽌 삁썑쟻 씤옄濡 蹂닿퀬릺怨 엳떎.

• 移섎즺/媛먯떆 紐⑤땲꽣留(Treatment/Surveillance Monitoring)

쁽옱 븣젮졇 엳뒗 媛옣 씪諛섏쟻씠怨 옒 솗由쎈맂 醫낆뼇몴吏옄쓽 씠슜 移섎즺 룞븞 醫낆뼇쓣 紐⑤땲꽣留 븯嫄곕굹 移섎즺媛 셿猷뚮맂 썑 5뀈媛 솚옄쓽 긽깭瑜 媛먯떆븯뒗뜲 궗슜븯뒗 寃껋씠떎. 醫낆뼇긽깭瑜 紐⑤땲꽣留곹븯怨 媛먯떆븯뒗뜲 醫낆뼇몴吏옄쓽 옣젏 긽쟻쑝濡 졃븳 鍮꾩슜쑝濡, 솚옄뿉寃 理쒖냼븳쓽 遺덊렪븿留 二쇰㈃꽌 移섎즺寃곌낵瑜 鍮좊Ⅴ寃 븣븘궪 닔 엳떎뒗 寃껋씠떎(Duffy, 2013). Table 2뿉꽌 몴쟻씤 醫낆뼇몴吏옄쓽 媛먮퀎吏꾨떒, 삁썑, 移섎즺/媛먯떆 紐⑤땲꽣留 궗슜 뿬遺瑜 蹂댁뿬二쇨퀬 엳떎.

Clinical role of each tumor markers

Tumor markers Cancer types Differential diagnosis Staging/Prognosis Treatment/Surveillance monitoring
CEA Colorectal, Pancreatic, Lung O O O
AFP, PIVKA-II Liver O
CA19-9 Pancreatic, Stomach, Colorectal, Ovary O O
CA125 Ovary, Breast, Lung O O
CA15-3 Breast O
PSA Prostate O O
CYFRA 21-1, SCC Non-small cell Lung O
NSE, ProGRP Small cell Lung O


• 誘몃옒 쟾留

떒씪 醫낆뼇몴吏옄濡쒖꽌뒗 醫낆뼇 媛먮퀎吏꾨떒, 삁썑瑜 룊媛븯뒗뜲 쑀슜븯吏 븡吏留 쁽옱 뿬윭 媛吏 醫낆뼇몴吏옄瑜 議고빀븯뿬 醫 뜑 젙솗븳 醫낆뼇 吏꾨떒쓣 쐞븳 븣怨좊━利섏쓣 넻븳 醫낆뼇몴吏옄 議고빀쓣 씠슜븳 궃냼븫 吏꾨떒(Molina et al., 2011), 6媛쒖쓽 醫낆뼇몴吏옄 議고빀쓣 넻븳 룓븫 吏꾨떒(Liu et al., 2017) 벑씠 媛쒕컻릺怨 엳怨, 湲곗〈뿉 삤옖 湲곌컙 룞븞 궗슜릺뿀뜕 醫낆뼇몴吏옄뱾뿉 븳 뜲씠꽣瑜 옒 痍⑦빀븯뿬 醫 뜑 쑀슜븳 吏꾨떒留덉빱濡쒖꽌 뿭븷쓣 닔뻾븷 닔 엳寃 븷 닔 엳쓣 寃껋씠떎. 삉븳 理쒓렐 遺꾩옄吏꾨떒쓣 솢슜븳 媛쒖씤蹂 留욎땄삎 醫낆뼇 吏꾨떒怨 젒紐⑺븯硫 醫낆뼇몴吏옄쓽 誘쇨컧룄 듅씠꽦쓣 넂뿬以 닔 엳쓣 寃껋쑝濡 쟾留앺븳떎(Sokolenko and Imyanitov, 2018).

寃 濡

醫낆뼇몴吏옄뒗 CEA媛 1965뀈 泥섏쓬쑝濡 솗씤맂 씠옒濡 뿬윭 媛吏 븫醫낆쓣 긽쑝濡 떎뼇븳 醫낅쪟쓽 醫낆뼇몴吏옄媛 솗씤릺뿀怨 醫낆뼇 寃吏, 吏꾨떒, 移섎즺슚怨 솗씤, 移섎즺 썑 媛먯떆瑜 紐⑹쟻쑝濡 궗슜릺뼱 솕떎. 蹂 끉臾몄뿉꽌뒗 쁽옱 媛쒕컻릺뼱吏 醫낆뼇몴吏옄뱾쓣 븫醫낅퀎濡 젙由ы븯怨(Table 1) 쁽옱 엫긽쟻쑝濡 궗슜릺怨 엳뒗 醫낆뼇몴吏옄쓽 寃吏, 吏꾨떒, 移섎즺슚怨 솗씤, 移섎즺 썑 媛먯떆 紐⑹쟻뿉 궗슜 뿬遺瑜 뿬윭 由щ럭 끉臾몄쓣 솗씤븯뿬 젙由ы븯떎(Table 2). 떒씪 醫낆뼇몴吏옄쓽 궗슜 留롮 븳怨꾩젏쓣 媛吏怨 엳뼱 쐞뿉꽌 뼵湲됲븳 寃껋쿂읆 븣怨좊━利섏쓣 넻븳 醫낆뼇몴吏옄 議고빀 꽑깮(Molina et al., 2011) 샊 룓븫 吏꾨떒쓣 쐞븳 6媛쒖쓽 醫낆뼇몴吏옄 議고빀 (Liu et al., 2017) 벑 떎뼇븳 蹂듯빀 醫낆뼇몴吏옄瑜 씠슜븳 諛⑸쾿씠 媛쒕컻릺怨 엳뼱 醫뜑 듅씠쟻씠怨 誘쇨컧룄媛 넂 醫낆뼇몴吏옄 뙣꼸쓣 솗由쏀븯由щ씪怨 깮媛곹븳떎. 삉븳 遺꾩옄 吏꾨떒쟻씤 諛⑸쾿씠 異붽맖쑝濡쒖뜥 珥덇린 醫낆뼇 吏꾨떒쓣 쐞븳 졃븯怨 媛꾪렪븳 諛⑸쾿쑝濡 솗릺由щ씪 깮媛곹븳떎(Fig. 1). 湲곗〈쓽 醫낆뼇몴吏옄쓽 떎뼇븳 議고빀怨 遺꾩옄吏꾨떒쟻 諛⑸쾿쓽 異붽瑜 넻븯뿬 쁽옱 遺議깊븳 醫낆뼇몴吏옄쓽 엫긽쟻슜씠 듅엳 媛먮퀎吏꾨떒, 삁썑 쟻슜 벑뿉 솗맆 寃껋쑝濡 湲곕븳떎.

Fig. 1. Scheme of tumor marker for future clinical use.
ACKNOWLEDGEMENT

This research was supported by Korea Nazarene University Research Fund.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

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