Serum CYFRA 21-1 (cytokeratin-19 fragments) is a useful tumour marker for detecting disease relapse and assessing treatment efficacy in breast cancer

Abstract

The usefulness of serum CYFRA 21-1 (cytokeratin-19 fragments) in monitoring the recurrence of breast cancer and in evaluating therapeutic effects was studied retrospectively. The sera from 173 patients with primary breast cancer or recurrent disease were measured for CYFRA 21-1, carcinoembryonic antigen (CEA), and carbohydrate antigen 15-3 (CA 15-3) levels. The positive rates of serum CYFRA 21-1 for stage IV (n=12) or recurrent disease (n=26) were 83.3 and 84.6%, respectively, while those of serum CEA were 41.7 and 26.9%, and those of serum CA 15-3 were 83.3 and 34.6%. The elevated preoperative levels of serum CYFRA 21-1 decreased to normal levels after curative operation, whereas the levels remained abnormally high after noncurative operation. There was a significantly high frequency of recurrence in patients with elevated levels of serum CYFRA 21-1 preoperatively compared to those with normal levels of the marker preoperatively. The serum CYFRA 21-1 levels were well correlated with response to chemotherapy. The positive rate of serum CYFRA 21-1 alone was higher than that of an assay combining CEA with CA 15-3, in both primary and recurrent cases (28.8 vs 18.8 and 84.6 vs 46.2%, respectively). These observations suggest that serum CYFRA 21-1 may be a reliable marker of recurrence or therapeutic efficacy.

Figure 1

Comparison of the positive rates of serum CYFRA 21-1 (solid bar), CEA (open bar), and CA 15-3 (striped bar) at each stage.

Figure 2

Distribution of patients with elevated levels of serum CYFRA 21-1, CEA, and CA 15-3 in primary and recurrent breast cancer. The number in each area is the number of patients with elevated levels of tumour markers.

Figure 3

Change of serum CYFRA 21-1 titres of patients within normal levels at preoperation. The recurrent site is demonstrated for each case, and the recurrent time after operation is shown within parentheses.

Figure 4

Changes in serum CYFRA 21-1 titres of patients with elevated levels at preoperation. Residual sites are within parentheses. A recurrent site is demonstrated for each case, and the postoperation time until recurrence is shown within parentheses. The open circle indicates a patient with an elevated level of serum CYFRA 21-1 at postoperation, who nevertheless has shown no evidence of relapse.

Figure 5

The decrement of serum CYFRA 21-1 titre after curative operation.

Figure 6

Change in serum CYFRA 21-1 titres after chemotherapy.