腫瘤標記的臨床應用與發展

Clinical application and development of tumor biomarkers

在健檢風行的今日台灣，腫瘤標記常常是各類健康檢查的熱門項目之一。惟腫瘤標記所代表的意義，多數民眾僅是一知半解。本文旨在報導近期腫瘤標記之臨床應用與發展。我們搜尋了2003至2013十年間的腫瘤標記相關回顧文獻並加以評讀、整理，依序介紹肺癌、肝癌、大腸直腸癌、乳癌、攝護腺癌、胰臟癌、卵巢癌與其對應的腫瘤標記之定義與分類，特性與臨床上之角色。本文也報導近期研究中發展之新興腫瘤標記，雖然近一、二十年來新興腫瘤標記蓬勃發展，都仍無法取代目前常用之標記如甲型胎兒蛋白、癌抗原125（CA125）等。且新興腫瘤標記在早期發現與診斷之應用相對局限，所以未來仍需要實驗室與臨床密切配合，追尋可廣為應用之標記來提升癌症之防治。同時，公衛領域人員在解釋這些腫瘤標記的意義時應小心謹慎，不宜過度解讀或依賴腫瘤標記。

Periodic health examinations are common practice in Taiwan. Tumor markers are popular laboratory tests which are ordered as part of a health check-up; however, the significance of tumor markers is only partially understood by people. The purpose of this article was to report recent clinical developments and applications of tumor markers. We searched and studied relevant review articles about tumor markers published in the 10 years between 2003 and 2013. We present the definition, classification, characteristics, and clinical roles of tumor markers corresponding to lung, hepatic, colorectal, breast, prostatic, pancreatic, and ovarian cancers. We also report newly de­veloped tumor markers. Although novel tumor markers have flourished in the recent 10-20 years, novel tumor markers cannot replace the well-established tumor markers, such as α-fetoprotein and cancer antigen 125. Studies focusing on the application of novel tumor markers in early disease detection and diagnosis are limited. There is still a need for close collaboration between bench and bedside to search for more widely applicable markers and to improve cancer prevention. Thus, public health workers should exercise caution in explaining the meaning of these tumor markers and avoid over-interpretation or over-reliance on novel tumor markers.