*For medical professionals only
According to the latest data from the National Cancer Center, the situation of cancer prevention and control in mainland China remains grim. In 2022, there were about 4,824,700 new cancer cases and 2,574,200 cancer deaths in China. Among them, the incidence and mortality of lung cancer are the highest among all malignant tumors [1]; Nearly 65 percent of patients with lung cancer are diagnosed at an advanced stage of the disease and have a five-year survival rate of less than 20 percent [2].
The "Healthy China Action (2019-2030)" proposes that by 2030, the goal is to achieve a 5-year survival rate of no less than 46.6% for overall cancer patients in mainland China. Promoting early diagnosis and treatment of cancer is crucial to reduce the incidence and mortality of lung cancer and improve the survival rate of lung cancer patients. Serum tumor marker detection has the advantages of non-invasive, fast and simple, and has become one of the main methods for lung cancer screening and diagnosis in recent years. Today, the "Seminar on the Value of Serum Marker Detection in the Diagnosis and Treatment Management of Lung Cancer in China, Health Economics Seminar and White Paper Release Ceremony", sponsored by the Key Laboratory of Health Technology Evaluation of the National Health Commission (Fudan University) and the China Pharmaceutical Biotechnology Association, and supported by Roche Diagnostics and IQVIA, was successfully held in Shanghai.
The White Paper on the Combined Detection of Serum Markers for the Diagnosis and Treatment Management of Lung Cancer in China (hereinafter referred to as the "White Paper") released at the conference for the first time deeply discussed the application value of serum markers in the auxiliary diagnosis of lung cancer and the risk prediction of translational small cell lung cancer from the perspective of health economics. So as to reduce the economic burden of patients, improve the quality of life of patients and provide strong support.
Five serum markers + CT were used for the auxiliary diagnosis of lung cancer, which was the most economical
Most of the patients with lung cancer have no specific symptoms in the early stage, and most lung cancer patients in mainland China are already at an advanced stage when they visit the hospital. Professor Chen Zhijun, Vice President of Jiangxi Provincial Cancer Hospital, said: "Early diagnosis is the key to improving the prognosis of lung cancer. In recent years, the continuous deepening of the clinical application of serum markers has provided more information of high medical value for the diagnosis and treatment of lung cancer. Serum tumor markers have the advantages of non-invasiveness, multiple sampling, and rapid diagnosis, which are helpful for early diagnosis, differential diagnosis, pathological type prediction, pathological diagnosis, and optimization of the whole process management of lung cancer patients. ”
Professor Sun Baoqing, Director of the Department of Clinical Laboratory, The First Affiliated Hospital of Guangzhou Medical University, said, "Common serum markers for lung cancer include carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin fragment 19 (CYFRA 21-1), squamous epithelial cell cancer antigen (SCCA), and gastrin precursor (ProGRP). Combined detection can improve the sensitivity and specificity of lung cancer diagnosis, and the application of serum markers should also be combined with clinical manifestations and imaging examinations. ”
The white paper released this time is based on the health economics evaluation research design of serum markers combined with CT detection for the auxiliary diagnosis of lung cancer according to the actual clinical diagnosis and treatment pathway, and through interviews with experts in related fields, the use of serum markers in the auxiliary diagnosis of lung cancer in China, the utilization of medical resources and the clinical diagnosis and treatment effect are clarified, and the structure of the health economics model is verified. This study used the perspective of the Chinese health system to measure the correct diagnosis rate, QALYs (quality-adjusted life years) and cost of patients with suspected lung cancer in the course of 1 year of diagnosis and treatment. According to the current status of serum markers, five (CEA, NSE, CYFRA21-1, SCCA, ProGRP) combined with CT, four (CEA, NSE, CYFRA21-1, SCCA) combined with CT, three (CEA, NSE, CYFRA21-1) combined CT and CT alone were included as comparison regimens, in order to seek the most cost-effective regimen.
By measuring the input and health output of the above four commonly used clinical auxiliary diagnostic methods for lung cancer, the results showed that the combination of five serum markers (CEA, NSE, CYFRA 21-1, SCCA, and ProGRP) combined with CT detection was a solution with absolute economic advantages compared with other diagnostic methods, with higher health yield, higher correct diagnosis rate and lower total cost.
The combined detection of ProGRP and NSE helps the risk prediction of translational SCLC, and the future is promising
In addition to early diagnosis, the impact of histological type conversion of lung cancer on the final prognosis of patients is also a major clinical concern. During the course of non-small cell lung cancer (NSCLC), some patients have a histological type that can be transformed into small cell lung cancer (SCLC), which is referred to as translational SCLC [3]. These patients tend to have rapid disease progression, an overall poor prognosis, and a lower median overall survival time than patients with primary SCLC.
Professor Liu Jiwei, Director of the Department of Oncology of the First Affiliated Hospital of Dalian Medical University, said: "At present, there is still a lack of effective means to detect and confirm the transformation of SCLC in clinical practice, which often leads to delayed treatment for patients. How to detect the transformation of SCLC earlier and guide patients to change the drug regimen is a difficult problem to be solved in the diagnosis and treatment of translational SCLC. In clinical practice, it is difficult to detect translational SCLC in routine imaging follow-up, and sampling biopsy is often limited by the patient's physical condition and sampling site. ProGRP and NSE play an important role in the prediction of translational SCLC and can greatly improve the prognosis of patients. ”
Abnormal levels of ProGRP and NSE were observed in different types of NSCLC patients before and after SCLC transformation. The combination of ProGRP and NSE can accurately and timely predict SCLC transformation, which is helpful to improve the prognosis of patients with transformational SCLC. At present, due to the lack of sensitivity and specificity data of ProGRP and NSE for the diagnosis of translational SCLC, the relevant health economics evaluation will be further carried out after the relevant data are improved.
Professor Chen Yingyao, Director of the Key Laboratory of Health Technology Assessment (Fudan University) of the National Health Commission, said: "At present, health economic evaluation has been widely used in many fields such as drug and medical insurance negotiation and health management decision-making, and the economic value of in vitro diagnostics is becoming more and more prominent in medical technology selection decisions. This white paper is the first to summarize the application value of serum markers in the auxiliary diagnosis of lung cancer and the risk prediction of translational SCLC from the perspective of health economics. It is expected that the research output will provide a scientific basis for clinical decision-making, so that the combined detection of serum markers can play a great role in the diagnosis and treatment of lung cancer, and help the early diagnosis and treatment of lung cancer. ”
Mr. Tim Chen, Vice President of Roche Diagnostics China – Specialty and Molecular Diagnostics Department, said, "Improving the early diagnosis rate of lung cancer is the key to improving the prognosis of patients and helping to achieve the goal of 'Healthy China 2030' malignant tumor prevention and treatment. Roche Diagnostics has always focused on the field of lung cancer and provides a complete menu of five tumor markers for lung cancer: Elecsys CEA, NSE, CYFRA 21-1, SCCA, and ProGRP. Taking the release of this white paper as an opportunity, we will uphold the concept of 'in China, for China', and work with all parties in the industry to provide reference for clinical decision-making of lung cancer, optimize the allocation of medical resources for lung cancer diagnosis and treatment management, and contribute to the high-quality development of lung cancer diagnosis and treatment in mainland China, so that more Chinese patients can benefit." ”
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Bibliography:
[1] Zheng Rongshou, Chen Ru, Han Bingfeng, et al. Analysis of the prevalence of malignant tumors in China in 2022. Chinese Journal of Oncology, 2024, 46(3):221-231.
[2] Zeng H, et al. Lancet Glob Health. 2018.5. 汪光蓉,等. 现代检验医学杂志,2013.6.Gu Y, et al. Oncol Lett.
[3] Guidelines for the diagnosis and treatment of small cell lung cancer of the Chinese Society of Clinical Oncology 2022 edition
* This article is only for the purpose of providing scientific information to medical professionals and does not represent the views of this platform
