Carcinoembryonic antigen and cytokeratin-19 fragments for assessment of therapy response in non-small cell lung cancer: a systematic review and meta-analysis

Abstract

Background:This meta-analysis evaluated whether pretherapy serum levels of carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) are predictive of response to therapy in non-small cell lung cancer (NSCLC) and whether changes in these markers during vs pretherapy are indicative of response.Methods:Original peer-reviewed studies enrolling adults with untreated advanced NSCLC were identified using PubMed. Two reviewers independently extracted data from eligible studies and assessed study heterogeneity and the risk of study bias.Results:Fourteen studies were eligible; 11 had objective response as an end point and three evaluated clinical benefit (i.e., response and stable disease). Study bias was relatively low. Both markers showed comparable modest predictive value across studies, with baseline CYFRA 21-1 numerically better in predicting treatment benefit. A good performance in identifying objective response during treatment was seen (AUC 0.724 (95% CI 0.667–0.785) for CYFRA 21-1 and 0.728 (95% CI, 0.599–0.871) for CEA). A decline in CYFRA 21-1 levels during treatment was highly indicative for objective response (sensitivity 79.1% (95% CI 71.5–85.1)).Conclusions:Comprehensive analysis of study heterogeneity and bias provides a high level of evidence for the clinical utility of CEA and CYFRA 21-1 for the prediction and monitoring of response in NSCLC.

A machine learning evolutionary algorithm-based formula to assess tumor markers and predict lung cancer in cytologically negative pleural effusions

“…Moreover, our findings are in agreement with previous clinical studies (Feng et al 2017;Gu et al 2017;Holdenrieder et al 2017;Cedrés et al 2011;Trape et al 2017;Topolcan et al 2007;Antonangelo et al 2015;Sharma et al 2015), and achieved better performance in detecting malignant effusion showing a sensitivity of 98%, a specificity of 95%, and an AUC of 96%. Probably, the low performance of the other studies is due to the low number of MPEs with negative cytology and to the variety of primary tumor sites that they considered (Antonangelo et al 2015;Sharma et al 2015).…”

Histone-Related Genes Are Hypermethylated in Lung Cancer and Hypermethylated HIST1H4F Could Serve as a Pan-Cancer Biomarker

“…To improve the detection sensitivity in lung adenocarcinoma, we combined Max-IF with serum CEA. The sensitivity of CEA alone as a lung cancer biomarker is very low for lung cancer diagnosis (39). In our study, the sensitivities of CEA (cutoff ¼ 5 ng/mL) in the training set and validation set were 27.3% and 30.7%, respectively.…”

The combination of the blood based tumor biomarkers cytokeratin 19 fragments (CYFRA 21-1) and carcinoembryonic antigen (CEA) as a potential predictor of benefit from adjuvant chemotherapy in early stage squamous cell carcinoma of the lung (SCC)

“…Retrospective studies have shown that in patients with NSCLC, particularly those with early-stage disease, elevated levels of the tumor biomarkers, cytokeratin 19 fragment (CYFRA 21-1), and carcinoembryonic antigen (CEA), are associated with a poor prognosis [22][23][24]. A reduction in serum CYFRA 21-1 and CEA levels has also been correlated with response to treatment among patients receiving chemotherapy, although these studies have largely recruited patients with late-stage disease [25][26][27]; these findings were also confirmed in a recent metaanalysis [28]. However, the ability of these biomarkers to predict the outcome of adjuvant CTx in patients with early-stage NSCLC has yet to be determined.…”