Prognostic value of carcinoembryonic antigen and CYFRA21-1 in patients with pathological stage I non-small cell lung cancer

Abstract

Background: The aim of this retrospective study was to assess the prognostic value of serum tumor markers (carcinoembryonic antigen (CEA) and CYFRA21-1) in patients with pathologic (p-) stage I non-small cell lung cancer (NSCLC) undergoing complete resection. Methods: Two hundred and seventy-five patients (163 males, 112 females, mean age 67.1 years) with p-stage I NSCLC who underwent complete resection at our institution between April 1999 and October 2004 were examined. Patients who had received preoperative chemotherapy or radiotherapy were excluded, as were patients who had multiple malignancies including multiple lung cancer. The serum levels of tumor markers were measured using commercially available immunoassays within 1 month before surgical resection. Serum levels of CEA and CYFRA21-1 higher than 5.0 and 2.8 ng/ml, respectively, were considered as positive according to the manufacture's instructions. Results: The histological classification was adenocarcinoma in 193 patients, squamous cell carcinoma in 71, large cell carcinoma in 5, and other histological type in 6. One hundred and fiftyseven patients had T1 disease and 118 patients had T2 disease. The positive ratio of CEA and CYFRA21-1 was 25.7% and 13.7%, respectively, and in relation to histological type was 27.8% and 7.8% in adenocarcinoma, and 20.6% and 28.4% in squamous cell carcinoma. The overall 5-year survival rate was 79.3%. With a median follow-up of 35.5 month for surviving patients, those with initial CYFRA21-1 serum levels higher than 2.8 ng/ml had a significantly worse prognosis ( p = 0.0041). Patients with an elevated preoperative CEA level exceeding 5.0 ng/ml had a shorter disease-free survival period ( p = 0.0003). In patients with adenocarcinoma, a CEA level above 5.0 ng/ml was associated with shorter survival and early recurrence, whereas CYFRA21-1 showed no such association. In patients with squamous cell carcinoma, elevated preoperative CEA was not related to survival and recurrence. In these patients, preoperative CYFRA21-1 level exceeding 2.8 ng/ml was associated with a poorer outcome, whereas preoperative CYFRA21-1 level was not associated with cancer recurrence. Conclusion: The patients with p-stage I adenocarcinoma whose preoperative CEA level was high might be considered as good candidates for adjuvant chemotherapy. The prognostic value of CYFRA21-1 could not be confirmed for stage I NSCLC, and preoperative CYFRA21-1 level was not useful in selecting the candidates for adjuvant chemotherapy. #

Preoperative CYFRA 21-1 and CEA as Prognostic Factors in Patients with Stage I Non-Small Cell Lung Cancer

“…Two studies reported a survival rate of approximately 80% at 5 years [17,18] , but these studies had a higher percentage of female patients and in one of them [18] , patient follow-up was only 36 months versus 110 months in our study. The previously established prognostic factors age and sex [7,13,17,18] were confirmed in this investigation, whereas tumor size or histology were not associated with survival, in accord with the results of Muley et al [7] . However, the results of this study neither confirmed the association of TMI to survival nor the prognostic significance of CYFRA 21-1.…”

Serum-based protein biomarkers for detection of lung cancer

“…Preoperative values of CEA, even within their normal range (0 -5 ng mL ), are related to worse prognoses [71]. Although serum CEA assays have low sensitivity and specificity for diagnosing lung cancers [72], several studies have reported statistically significant evidence for the use of CEA as a prognostic marker in NSCLC patients, but not for SCLC patients [73][74][75][76][77].…”

Prognostic and predictive value of CEA and CYFRA 21-1 levels in advanced non-small cell lung cancer patients treated with gefitinib or erlotinib

“…CYFRA 21-1 was found to be associated with TNM stage and ECOG PS, reflecting an unfavorable prognosis for NSCLC patients regardless of treatment (8,21,(28)(29)(30). In our study, patients with a poor ECOG PS had a higher CYFRA 21-1 level than patients with a good ECOG PS (6.4 vs. 3.0 ng/ml; P=0.03).…”

“…CEA was first described by Gold and Freedman in 1965 as an antigen expressed by gastrointestinal carcinoma cells (17). Although CEA was often falsely elevated in smokers and in patients with restrictive or obstructive pulmonary disease (18)(19)(20), abnormally elevated CEA levels were reported in 30-70% of patients with NSCLC and were most frequently observed in patients with adenocarcinoma and advanced stage carcinoma (21). In addition, several studies have shown that h-CEA is a potential marker of poor prognosis in NSCLC regardless of treatment (7,21).…”