There are urgent needs to develop methods for early detection of nonsmall cell lung cancer (NSCLC) because of its increasing incidence and poor prognosis. Here, we analyzed the production of IgG antibody (WT1 Ab) against WT1 (Wilms' tumor gene) protein that was overexpressed in the majority of NSCLC. Enzymelinked immuno-sorbent assay showed that WT1 Ab was produced in all of 91 NSCLC patients and 70 healthy individuals and that WT1 Ab titers were significantly higher in NSCLC patients compared with healthy individuals. When the cut-off level of WT1 Ab titers were fixed at mean 1 3SD of those in healthy individuals, 26.4% of NSCLC patients had WT1 Ab titers over the cut-off level, and positive rates of WT1 Ab at each clinical stage were 25.0, 30.8 and 38.4% in stage I, II and III NSCLC, respectively. When WT1 Ab was combined with CEA or CYFRA for detection of NSCLC, positive detection rates increased from 25.0 to 34.1 and 31.8%, respectively, in stage I and from 38.4 to 69.2 and 46.1%, respectively, in stage III, but not changed in stage II. Western blot analysis showed that dominant subclass of WT1 Ab was Th1-type IgG2. Interestingly, elevation of WT1 Ab titers was significantly associated with longer disease-free survival in patients with stages I-III NSCLC. These results showed that WT1 Ab could be a useful marker for early detection of NSCLC and its prognostic prediction. These results also suggested that WT1-specific immune responses played an important role in anti-cancer immunity in NSCLC. '
UICCKey words: lung cancer; WT1; humoral immune response; tumor marker; prognostic marker Lung cancer is the leading cause of cancer death in the world and nonsmall cell lung cancer (NSCLC) represents nearly 80% of the disease. 1 Because 75% of lung cancer patients are diagnosed at stages of metastatic spread when therapies are rarely curative, 2 early detection of localized lung cancer is the key to improve its clinical outcome.Although chest X-ray is routinely used as a screening tool, its limitation to detect localized lung cancer has been evident because of its insufficient sensitivity. 2 Recently, low-dose spiral computed tomography (CT) has been proposed as an early detection screening tool. However, despite its high sensitivity, specificity of CT in lung cancer detection is poor. 3 Therefore, serum biomarkers with high sensitivity and specificity for diagnosis of lung cancer are needed. However, current serum biomarkers for NSCLC such as carcino embryonic antigens (CEA) and squamous cell carcinoma antigen do not have sufficient sensitivity and specificity required for early detection of NSCLC. 4,5 It is now clear that malignant transformation occurs by changes in cellular gene expression with subsequent clonal proliferation. Altered gene expression in malignant cells may lead to the expression of aberrantly expressed proteins recognized by host immune system. If autoantibodies against these antigens are produced at early stage of NSCLC when quantity of the tumor antigens in the circulation is very small, these...