Clinical Usefulness of Serum CYFRA 21-1 in Patients with Colorectal Cancer

Abstract

Purpose: Among diverse tumor markers, pretreatment evaluation and follow-up detection of recurrence in colorectal cancer are generally evaluated by serum carcinoembryonic antigen (CEA) levels. However, there have been some reports about the low accuracy and high false-positive results of CEA in colorectal cancer. We investigated the clinical utilities of CYFRA 21-1 by comparing CEA and cancer antigen 19-9 (CA 19-9) in pretreatment and recurrent colorectal cancer.

Methods: Using a solid-phase immunoradiometric assay, serum levels of CYFRA 21-1, CEA and CA 19-9 were analyzed in 132 patients with primary colorectal cancer, 124 healthy controls, 104 patients with benign colorectal disease and 19 patients with recurrent colorectal cancer. We determined three different cutoff values to evaluate the sensitivity of diagnostic performance in pretreatment and recurrent colorectal cancer.

Results: CYFRA 21-1 (≥ 1.13 ng/ml) had a sensitivity of 47 %, compared with 37 % for CEA (≥ 3.05 ng/ml) and 32.6 % for CA 19-9 (≥ 23.1 ng/ml) in the initial staging of primary colorectal cancer. Using different cutoff values, CYFRA 21-1 showed higher sensitivity for pretreatment colorectal cancer than CEA and CA 19-9 in adenocarcinoma and adenosquamous carcinoma of this study. A mildly significant correlative relationship was noted between Dukes' stages and three tumor markers (p < 0.01). The areas under the receiver operating characteristic curves of CYFRA 21-1, CEA and CA 19-9 were 0.81 ± 0.03, 0.74 ± 0.03 and 0.62 ± 0.04, respectively, for discriminating colorectal cancer patients from patients with benign colorectal disease. In addition, CYFRA 21-1 was determined as the most sensitive tumor marker for evaluating recurrent colorectal cancer for all cutoff values.

Conclusion: This study showed that CYFRA 21-1 could be a useful and dependable tumor marker for pretreatment and recurrent colorectal cancer. Further prospective studies on its usefulness with respect to the prognosis and utility of combined tumor markers are needed.

Keywords: CEA and CA 19–9; CYFRA 21–1; Colorectal cancer.

Fig. 1

Receiver operating characteristic (ROC) curves combined with CYFRA 21–1, CEA and CA 19–9 between colorectal cancer patients and patients with benign colorectal diseases were constructed. The areas under the ROC curves (AUCs) for CYFRA 21–1, CEA and CA 19–9 were 0.81 ± 0.03, 0.74 ± 0.03 and 0.62 ± 0.04 (p < 0.0001, p < 0.0001 and p = 0.002)

Fig. 2

ROC curves combined with CYFRA 21–1, CEA and CA 19–9 between colorectal cancer patients and healthy controls were constructed. The AUCs for CYFRA 21–1, CEA and CA 19–9 were 0.84 ± 0.03, 0.80 ± 0.03 and 0.55 ± 0.04 (p < 0.0001, p < 0.0001 and p = 0.17)