Preoperative serum CYFRA 21-1 level as a prognostic factor in surgically treated adenocarcinoma of lung

Abstract

BACKGROUND: High preoperative serum CYFRA 21-1 has been reported as diagnostic marker and poor prognostic factor in non-small cell lung cancer, especially in squamous cell carcinoma. However, the prognostic value in adenocarcinoma of lung has not been reported. This study is performed to investigate the prognostic impact of CYFRA 21-1 in adenocarcinoma of lung. METHODS: We retrospectively reviewed 298 patients who underwent lobectomy or above with complete mediastinal lymph node dissection for adenocarcinoma of lung, between 2004 and 2009. The patients were divided into 2 groups, by receiver operating characteristic (ROC) curve analysis. RESULTS: There were 145 male patients and mean age was 62.2 ± 26.4 years. The median follow-up period was 43.3 months. Mean and median value of CYFRA 21-1 were 2.16 ± 1.97 ng/mL and 1.68 ng/mL (range, 0.37-15.10), respectively. The optimal cut-off value of CYFRA 21-1 for overall survival was 1.95 ng/mL which was determined by ROC curve analysis. One hundred fourteen (38.4%) patients showed high level of CYFRA 21-1. Preoperative serum CYFRA 21-1 was higher in advanced stage (p=0.004). The high CYFRA 21-1 was also correlated with bigger tumor size (p<0.001) and poor differentiation (p=0.008). The 5-year overall survival of low group and high group was 79.1% and 58.4% (p<0.001), respectively. Univariate and multivariate analysis showed that CYFRA 21-1 level was related to the poor prognosis for overall survival (hazard ratio=1.1, p=0.033) in adenocarcinoma of lung. The concordance index for Cox model was also higher in multivariate analysis model with CYFRA 21-1 level than in model without CYFRA 21-1 level (0.722, 95% CI 0.718-0.726 vs. 0.701, 95% CI 0.697-0.705). CONCLUSIONS: High preoperative CYFRA 21-1 may be a determinant for poor prognosis in operated adenocarcinoma of lung.