PREOPERATIVE CYFRA-21-1 LEVEL AS A PROGNOSTIC INDICATOR IN RESECTED PRIMARY SQUAMOUS-CELL LUNG-CANCER

The CYFRA 21-1 assay is a test that has been developed recently for de tection of a cytokeratin 19 fragment in serum. A diagnostic role for C YFRA 21-1 has already been proposed. The question of whether this mark er is prognostically significant is important in clarifying the role o f CYFRA 21-1 in clinical practice. The aim of this study was to evalua te the prognostic significance of elevated preoperative CYFRA 21-1 lev els in patients with resected primary squamous-cell lung cancer (SqCC) . Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (CIS bio) in 91 patients with operable SqCC. Survival and diseas e-free survival curves related to initial levels of this marker were e stimated using the Kaplan-Meier method. In the univariate analysis the log-rank test and the log-rank test for trend were used. In the multi variate analysis the stratified log-rank test and the proportional haz ard model were used. Elevated preoperative CYFRA 21-1 levels were iden tified in 55% of patients with SqCC. The number of patients with eleva ted levels of this marker increased with TNM stage (P = 0.0001). In un ivariate analysis elevated levels of CYFRA 21-1 were significantly ass ociated with poor overall survival (P < 0.00005) and with disease-free survival (P < 0.00005). In multivariate analysis elevated levels of t his marker were also found to be associated with poor overall and dise ase-free survival (P = 0.01 and P = 0.003 respectively). In conclusion , CYFRA 21-1 may be an independent prognostic parameter of survival an d tumour relapse in SqCC and may be useful in identifying resected SqC C patients at high risk of treatment failure.