Search

Cyfra 21-1 is a recognised marker for epidermoid lung and head and neck carcinomas oriented to the cytokeratin 19 that is expressed particularly in malignant epithelial cells. The aims of this study were to evaluate the importance of the use of this marker in nasopharyngeal carcinoma (NPC). Our prospective study interested 41 patients (33M/8F) with a mean age of 44 years (13 to 70) with 8 of them aged less than 30 years, presenting a nasopharyngeal carcinoma histologically confirmed from September 1999 to March 2000 and 45 healthy controls without evidence neoplasm. Undifferentiated forms represent 90.2% of cases and lesions are staged T2, T3 and T4 in 2.4%, 36.6% and 61% of cases, while N1, N2 and N3 represent 9.8%, 26.8% and 41.5% of cases. A blood sample was collected from each patient and control before any treatment, as well as controls to measure Cyfra 21-1 by immunoenzymatic assay, 2 groups of patients were selected after a period varying from 4 to 37 months with a median of 29 months: 27 patients with favourable evolution (without evidence of disease after initial treatment), 12 patients with non favourable evolution (1 death, 2 cases of loco-regional relapse and 9 patients with metastatic disease). 2 patients were lost to follow-up. The results showed that the mean serum Cyfra 21-1 values were significantly higher in patients with NPC than those in controls (p = 0.001). A significant correlation was found between the serum Cyfra 21-1 level before treatment and the clinical outcome of patients (p = 0.0009). Patients having a favourable evolution have the lowest level. Seric level of Cyfra 21-1 at diagnosis of NPC may play a predictive role to evaluate the risk of metastatic disease and prognosis.

Cyfra 21-1 is a useful marker in lung cancer. The only tumor marker used at the present time in oesophageal squamous cell carcinoma (OSCC) is SCC (squamous cell carcinoma). In this study we evaluated the pre-treatment sensitivity and specificity of these two markers in this setting. Cyfra 21-1 and SCC were determined by radio-immunoassay on 76 patients having OSCC. Staging was done according to the UICC 1978 classification based on endoscopy, baryum enema and CT scan. The sensitivity of Cyfra 21-1 is better at the 1.5 ng/ml level (54%) than at the usual reported level of 3.6 ng/ml (26%). The best level for sensitivity of SCC is 1.5 ng/ml. At these levels, sensitivity of Cyfra 21-1 and SCC for advanced stages (T3 or M1) are respectively 72% and 50%. The specificity of Cyfra 21-1 and SCC for stages T1 or T2 are respectively 53% and 73%. The combination of these two markers increase sensitivity at 64% for all stages and at 89% for advanced stages (T3 or M1) and is a significant prognostic factor for survival. This study confirms the value of Cyfra 21-1 in OSCC at the normal level of 1.5 ng/ml. The combination with SC improves the results. We now need to evaluate the role of these two markers in the follow up of oesophageal carcinoma.

In the daily clinical practice, serum calcium, albumin, and cyfra 21-1, are the only laboratory parameters officially recommended for the prognostic evaluation of primary lung cancer patients by the American, European or French respiratory/thoracic societies (and only in non-small cell lung cancer). The present review of the biomedical literature suggests that serum calcium for non operable non-small cell lung cancer, serum orosomucoid (alpha1-acid-glycoprotein) and serum cyfra 21-1 for non-small cell lung cancer, and perhaps plasma prothrombin time, might be the best laboratory parameters for the pre-therapeutic prognostic evaluation of the lung cancer patients, independently from the usual radio-clinical and histological parameters. Further prognostic evaluation studies are necessary in order notably to compare the prognostic values of the aforementioned parameters, not only aimed at evaluating the value of their pre-therapeutic levels, but also aimed at evaluating the value of their post-therapeutic changes. A higher pluridisciplinarity for such future publications also seem necessary.