Serum CYFRA 21-1 in Biliary Tract Cancers: A Reliable Biomarker for Gallbladder Carcinoma and Intrahepatic Cholangiocarcinoma

• DOI: 10.1007/s10620-014-3472-0
• Publication Date: 2014-12-08T14:10:59Z
• Authors: Li Huang; Wei Chen; Peiwen Liang; Wenjie Hu; Kunsong Zhang; Shunli Shen; Jiancong Chen; Zhaohui Zhang; Bin Chen; Yuyan Han; Fanyin Meng; Sharon DeMorrow; Xiaoyu Yin; Jiaming Lai; Lijian Liang
• Keywords: Adult; Aged, 80 and over; Keratin-19; Male; 0301 basic medicine; Chi-Square Distribution; CA-19-9 Antigen; Kaplan-Meier Estimate; Middle Aged; Disease-Free Survival; Carcinoembryonic Antigen; 3. Good health; Cholangiocarcinoma; 03 medical and health sciences; Bile Ducts, Intrahepatic; Bile Duct Neoplasms; Antigens, Neoplasm; Area Under Curve; Biomarkers, Tumor; Humans; Female; Gallbladder Neoplasms; Aged

Biliary tract cancers encompass gallbladder carcinoma, and intrahepatic, perihilar and distal cholangiocarcinoma. Upregulated serum CYFRA 21-1 has been reported in intrahepatic cholangiocarcinoma.The present study aimed to explore the clinical significance of serum CYFRA 21-1 in all biliary tract cancer subtypes.Serum CYFRA 21-1, carbohydrate antigen 19-9 and carcinoembryonic antigen were quantitated preoperatively, postoperatively and during follow-up in 134 malignant and 52 benign patients. Receiver operator characteristic curves of biomarkers were analyzed. Level of CYFRA 21-1 was correlated with patients' clinicopathological features and follow-up data.CYFRA 21-1 was significantly upregulated in biliary malignancies, and expressional difference existed between these subtypes. Based on the maximal Youden's index, cutoff values were selected (ng/mL): 2.61 for biliary tract cancers (sensitivity 74.6 % and specificity 84.6 %); 3.27 for intrahepatic cholangiocarcinoma (75.6 and 96.2 %) and gallbladder carcinoma (93.7 and 96.2 %); 2.27 for perihilar cholangiocarcinoma (71.0 and 71.2 %); and 2.61 for distal cholangiocarcinoma (63.3 and 84.6 %). CYFRA 21-1 showed better diagnostic performance than other biomarkers in gallbladder carcinoma and intrahepatic cholangiocarcinoma; its performance was not inferior to that of the combination of these three biomarkers and declined after curative resection and re-elevated when tumor recurred, which was correlated with tumor aggressiveness and TNM stage; it was an independent predictor for 1-year recurrence-free survival and overall survival on multivariate analysis.Serum CYFRA 21-1 represents a reliable biomarker for gallbladder carcinoma and intrahepatic cholangiocarcinoma.