Lab Med Online.  2020 Jan;10(1):66-74. 10.3343/lmo.2020.10.1.66.

Performances of CYFRA 21-1, Carcinoembryonic Antigen and Their Combination for Lung Cancer Diagnosis

• Kim JJ
• Ahn HJ
• Park Y

• KMID: 2466768
• DOI: http://doi.org/10.3343/lmo.2020.10.1.66

Abstract

BACKGROUND
The aim of this study was to compare the efficiency of cytokeratin 19 fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) for the diagnosis of lung cancer and to establish the optimal cut-off values.
METHODS
We retrospectively reviewed the medical records of 1,176 subjects with CYFRA 21-2 and CEA data; they were classified into 93 lung cancer cases and 1,083 total controls, including 146 age-matched controls. Multivariate analysis was used to determine the relationship between the concentration of each tumor marker and lung cancer diagnosis. The diagnostic efficiencies of tumor markers were evaluated using receiver operating characteristic curve analysis and areas under the curve (AUCs) were calculated. The optimal cut-offs for CYFRA 21-1 and CEA were also estimated.
RESULTS
Age, CYFRA 21-1, and CEA concentrations were independently associated with lung cancer diagnosis. Diagnostic efficiency of each tumor marker and its' combination was different according to the histological types of lung cancer. For non-small cell lung cancer, the AUCs for the two-marker combination were the highest: 0.8661 and 0.7559 for total and age-matched controls, respectively. For squamous cell carcinoma, the AUCs for CYFRA 21-1 were the highest: 0.9245 and 0.8428 for total and age-matched controls, respectively. The sensitivity and specificity of CYFRA 21-1 and CEA for lung cancer diagnosis were improved when the cutoffs determined based on this study were applied.
CONCLUSIONS
CYFRA 21-1 and CEA could be useful markers for diagnosing lung cancer and single or combination of markers may be useful according to different histological types of lung cancer.

Keyword

CYFRA 21-1; Carcinoembryonic antigen (CEA); Tumor marker; Lung cancer

MeSH Terms

Area Under Curve
Biomarkers, Tumor
Carcinoembryonic Antigen*
Carcinoma, Non-Small-Cell Lung
Carcinoma, Squamous Cell
Diagnosis*
Keratin-19
Lung Neoplasms*
Lung*
Medical Records
Multivariate Analysis
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Biomarkers, Tumor
Carcinoembryonic Antigen
Keratin-19

Figure

• 

  Fig. 1 Receiver operating characteristic curve analysis for the discrimination of lung cancer patients (N=93) from age-matched controls (N=146). Area under the curve (AUC) values for CYFRA 21-1, CEA, and their combination were compared pairwise. (A) Non-small cell lung cancer (N=86): CYFRA 21-1 vs. CEA, P=0.5578; CYFRA 21-1 vs. CYFRA 21-1+CEA, P=0.1163; CEA vs. CYFRA 21-1+CEA, P=0.0159. (B) Adenocarcinoma (N=50): CYFRA 21-1 vs. CEA, P=0.2803; CYFRA 21-1 vs. CYFRA 21-1+CEA, P=0.0783; CEA vs. CYFRA 21-1+CEA, P=0.7705. (C) Squamous cell carcinoma (N=18): CYFRA 21-1 vs. CEA, P=0.0005; CYFRA 21-1 vs. CYFRA 21-1+CEA, P=0.1130; CEA vs. CYFRA 21-1+CEA, P=0.0027. (D) All types of lung cancers (N=93): CYFRA 21-1 vs. CEA, P=0.4990; CYFRA 21-1 vs. CYFRA 21-1+CEA, P=0.1161; CEA vs. CYFRA 21-1+CEA, P=0.0119. Abbreviations: CI, confidence interval; FPF, false positive fraction; TPF, true positive fraction.

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