CYFRA 21-1은 폐암중에서 편평상피성 암세포의 세포질에 존재하는 세포각질 분절 19의 분절들로서 암세 포가 파괴되거나 분해시 혈중내로 유리되는 것으로 특징적인 2개의 단일클론성의 항체인 KS 19-1과 BM 19-21로서 면역 방사계수검사를 이용하면 혈청내에 용해된 량을 정량할 수 있다. 암세포의 세포벽에 존재하는 EGF-R과 EGF에 대하여 관심이 집중되고 있다. EGF-R의 존재는 클론성 비소세포암 세포계열을 조사한 결과 4종의 비소세포암들은 EGF-R을 발현한다고 밝혀졌다. 그러나 현재의 검사법으로는 EGF 검출이 어려워서 EGF보다 TCF-Q의 역할에 초점이 모여지고 있다. 폐암세포에 EGF-R의 존재는 자가분비나 부분비성 성장기전이 작용된다는 것을 시사한다. 아울러 정상인 의 혈청과 소변에서 검출이 되며, 이러한 사실을 종합해 본 결과 EGF-R은 폐암의 발달과 진행에 중요한 역 할을 할 것으로 추정된다. 폐암으로 확진된 30례의 환자를 연구 대상으로 하고, 개흉수술로 적출한 표본을 주병소와 이행부위 그리 고 대조부위로 구분하여 조직 절편을 약 5 m3크기로각각 잘라서 액화 질소에 급속 냉동 보관을 하였다. 냉 동 보관한 조직 절편을 조직마쇄 藪$[$\ulcorner마쇄시킨후 원심분리기에서 상층액을 일정량 채취하여 방사선면역 분석법으로 CYFRA 21-1과 EGF-R 정량검사를 시행하였으며, 그 결과를 조직학적 분류와 병기에 따른 분류 로 상호 비교 분석하였다. 이상과 같은 연구결과로 아래와 같은 요점들을 발견하였다. 1. 암 이행부위에서는 악성화를 나타내는 경향이 더욱 활발하여 세포질성분의 부족으로 CYFRA 21-1의 농도 는 낮게 나타났다. CYFRA 21-1의 농도는 암이행부위에서 가장 낮았고, 병기가 증가할수록 증가하였다. 대 조조직에서는 세포질 성분이 풍부하여 주병변부위보다도 CYFRA 21-1의 농도가 높게 나왔다. 2. EGF-R의 농도는 주병변부위에서 가장 높게 나왔고, 편평세포암에서 보다는 선암에서 높았고, 병기별로는 1, 1띠에서는 이행부위가 111, IV기에섞는 주병변부위가 높게 나왔다. EGF-R의 농도는 대조조직보다는 암 주병변부위로 갈수록 증가하였다. 3. CYFBLt 21-1은 세포질성분이며, EGF-R은 세포벽 성분으로서 두 물질사이에 상관관계가 없었다. 결론적으로 현재까지 CYFRA 21-1은 혈청 내에서만 주로 연구되어져 왔으며 비소세포암 중에서 특히 편 평세포암종에서 의미있게 증가한다고 하였다. 그러나,. CYFRA 21-1의 조직과 혈청 내의 정량치가 뜻하는 의 미는 서로 달랐으며, 암조직내에서 대조조직내보다 CYFRA 21-1 치가 더 낮게 나온 것은 암세포내 에서는 세 포질 성분의 고갈로 인한 것으로 추정되며 암세포의 활동성과는 무관한 것으로 판단된다. EGF-R은 세포벽내에 존재하는 수용체로서 암세포의 증식에 따라 증가하는 양상을 보이며 대조조직보다는 암세포에서 유의한 증가를 보이는 것은 종양 증식과 암표지자로서 의의가 있는 것으로 판단된다.
Abstract
CYPRA 21-1 is known to be a cytokeratin 19 fragment, and it can be detected by using two specific monoclonal antibodies (KS 19-1 and BM 19-21) and can be clinically applied as a useful circulating tumor marker The epidermal growth factor receptor (EGF-R) expression was evaluated and characterized by its tyrosine protein kinase activity and by its ligand-stimulated autophosphorylation, a property shared with other peptide growth factor receptors. Autocrine or para'urine action was initiated by a growth factor, or by a transforming growth factor o, which had an extensive homology with EGP and which also stimulated tyrosine kinase activity on the EGF-R. The CYFRA 21-1 and the EGF-R levels in 30 patients with primary lung tumors were investigated. There were 24 patients with squamous cell carcinomas and 6 patients with adenocarcinomas. Specimen 5 mm3 in size were sampled at three different locations ; the main lesion, the boundary between the lesion and the unaffected tissue, and the unaffected tissue of the patients. The results were as follows 1. The CYPRA 21-1 concentration in the cancer boundary, the most malignant region,(348.6 : 89.9 ng/ml) was the lowest value. The CYFRA 21-1 concentration in unaffected tissue,(718.4$\pm$77.8 ng/ml) was higher than that in the main lesion. which had intact cellularity. 2. The EGF-R concentration in the main lesion was higher than that in the unaffected tissue, and the EGF-R concentration in a squamous cell cacinoma was higher than that in an adenocarcinoma. also, the EGF-R concentration in the cancer b undary was highest at stage 1, ll. The EGF-R concentration was higher in the main cancer lesion that in the unaffected tissue at stage 111, IV. 3. The CYFRA 21-1 was a cytoplasmic skeleton and the EGF-R was a cell-wall component; there was no correlation. In conclusion, CYFRA 21-1 was abundant in the cytoplasm but had a higher concentration in the unaffected tissue than in the main cancer lesion. The CYFRA 21-1 concentration of the tissue did not reflect the amount of cancer activity, the EGP-R was located in the cell membrane, the level of tissue that reflects cancer activity, so the main cancer lesion had a higher concentration than the unaffected tissue. CYFRA 21-1 is not a useful tumor maker at the tissue level. Because the EGF-R concentration re(looted the cancer activity, its a useful tumor marker for lung cancer.
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