Abstract
This study examines a new tumour marker, Cyfra 21-1, as a prognostic marker in predicting the survival of H&N cancer patients, and its correlation with clinical outcome during prolonged follow up of these patients. The study included 67 patients with primary detection of carcinoma of H&N. The survival of these patients was evaluated in correlation with the disease stage and Cyfra 21-1 levels at initial diagnosis. 38 patients were followed clinically and with serial assays for at least 12 months, or until recurrence was diagnosed. Cyfra 21-1 levels were determined periodically, using an Elisa kit. Patients with Cyfra 21-1 < 1.5 ng ml–1had a higher survival rate compared to patients with Cyfra 21-1 ≥ 1.5 ng ml–1(63% vs. 20%, respectively). The risk ratio of Ln(Cyfra 21-1) is 1.62 (P = 0.028). In a Cox regression model that included the disease stage and Ln(Cyfra 21-1), Ln(Cyfra 21-1) was preferred as the main parameter for predicting patients survival. In 83% of the 12 patients with recurrent or residual disease, Cyfra 21-1 was elevated before or during clinical detection of the recurrence. Cyfra 21-1 was found to be a prognostic marker for carcinoma of H&N, unrelated to the stage of the disease. Elevated levels of Cyfra 21-1 without clinical evidence of disease can be attributed to the marker's mean lead-time as compared to the clinical appearance of the disease. © 2000 Cancer Research Campaign http://www.bjcancer.com
Keywords: head and neck cancer, tumour marker, Cyfra 21-1, prognostic factor, recurrent cancer
Full Text
The Full Text of this article is available as a PDF (83.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bonfrer J. M., Gaarenstroom K. N., Kenter G. G., Korse C. M., Hart A. A., Gallee M. P., Helmerhorst T. J., Kenemans P. Prognostic significance of serum fragments of cytokeratin 19 measured by Cyfra 21-1 in cervical cancer. Gynecol Oncol. 1994 Dec;55(3 Pt 1):371–375. doi: 10.1006/gyno.1994.1309. [DOI] [PubMed] [Google Scholar]
- Clasen B., Péré P., Senekowitsch R., Menz E. Das plattenepithelkarzinomassoziierte Antigen (SCC) als Tumormarker bei der Initialdiagnostik von Karzinomen des Kopf-Hals-Gebietes. Ergebnisse einer prospektiven Studie nach 24 Monaten. Laryngorhinootologie. 1990 May;69(5):275–280. doi: 10.1055/s-2007-998189. [DOI] [PubMed] [Google Scholar]
- Daver A., Dalifard I., Pons-Anicet D., Krebs B. P., Gosselin P., Cazin J. L., Ricolleau G., Gaillard G., Gachon F., Goussard J. Intéret diagnostique du dosage du SCC-TA4 dans quatre localisations de cancers épidermoïdes. Expérience du sous-groupe de radio-analyse de la FNCLCC. Bull Cancer. 1990;77(8):781–792. [PubMed] [Google Scholar]
- Doweck I., Barak M., Greenberg E., Uri N., Kellner J., Lurie M., Gruener N. Cyfra 21-1. A new potential tumor marker for squamous cell carcinoma of head and neck. Arch Otolaryngol Head Neck Surg. 1995 Feb;121(2):177–181. doi: 10.1001/archotol.1995.01890020039009. [DOI] [PubMed] [Google Scholar]
- Ebert W., Bodenmüller H., Hölzel W. CYFRA 21-1--clinical applications and analytical requirements. Scand J Clin Lab Invest Suppl. 1995;221:72–80. doi: 10.3109/00365519509090568. [DOI] [PubMed] [Google Scholar]
- Ebert W., Dienemann H., Fateh-Moghadam A., Scheulen M., Konietzko N., Schleich T., Bombardieri E. Cytokeratin 19 fragment CYFRA 21-1 compared with carcinoembryonic antigen, squamous cell carcinoma antigen and neuron-specific enolase in lung cancer. Results of an international multicentre study. Eur J Clin Chem Clin Biochem. 1994 Mar;32(3):189–199. [PubMed] [Google Scholar]
- Fischbach W., Meyer T., Barthel K. Squamous cell carcinoma antigen in the diagnosis and treatment follow-up of oral and facial squamous cell carcinoma. Cancer. 1990 Mar 15;65(6):1321–1324. doi: 10.1002/1097-0142(19900315)65:6<1321::aid-cncr2820650612>3.0.co;2-y. [DOI] [PubMed] [Google Scholar]
- Höfler H., Denk H. Immunocytochemical demonstration of cytokeratin in gastrointestinal carcinoids and their probable precursor cells. Virchows Arch A Pathol Anat Histopathol. 1984;403(3):235–240. doi: 10.1007/BF00694899. [DOI] [PubMed] [Google Scholar]
- Katopodis N., Hirshaut Y., Geller N. L., Stock C. C. Lipid-associated sialic acid test for the detection of human cancer. Cancer Res. 1982 Dec;42(12):5270–5275. [PubMed] [Google Scholar]
- Martin M., Rayo J. I., Talavera J. R., Muñoz A., Cañizo A. Evaluation of serum tumor markers in head and neck cancer. J Nucl Med Allied Sci. 1990 Oct-Dec;34(4 Suppl):235–238. [PubMed] [Google Scholar]
- Moll R., Franke W. W., Schiller D. L., Geiger B., Krepler R. The catalog of human cytokeratins: patterns of expression in normal epithelia, tumors and cultured cells. Cell. 1982 Nov;31(1):11–24. doi: 10.1016/0092-8674(82)90400-7. [DOI] [PubMed] [Google Scholar]
- Nakata B., Chung Y. S., Kato Y., Ogawa M., Ogawa Y., Inui A., Maeda K., Sawada T., Sowa M. Clinical significance of serum CYFRA 21-1 in gastric cancer. Br J Cancer. 1996 Jun;73(12):1529–1532. doi: 10.1038/bjc.1996.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Niklinski J., Furman M., Burzykowski T., Chyczewski L., Laudanski J., Chyczewska E., Rapellino M. Preoperative CYFRA 21-1 level as a prognostic indicator in resected primary squamous cell lung cancer. Br J Cancer. 1996 Sep;74(6):956–960. doi: 10.1038/bjc.1996.464. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Niklinski J., Furman M., Chyczewska E., Chyczewski L., Rogowski F., Laudanski J. Diagnostic and prognostic value of the new tumour marker CYFRA 21-1 in patients with squamous cell lung cancer. Eur Respir J. 1995 Feb;8(2):291–294. doi: 10.1183/09031936.95.08020291. [DOI] [PubMed] [Google Scholar]
- Ogawa T., Tsurusako Y., Kimura N., Nishioka S., Akagi H., Nishizaki K., Nishioka K., Rutka J. Comparison of tumor markers in patients with squamous cell carcinoma of the head and neck. Acta Otolaryngol Suppl. 1999;540:72–76. doi: 10.1080/00016489950181242. [DOI] [PubMed] [Google Scholar]
- Osborn M., Weber K. Intermediate filaments: cell-type-specific markers in differentiation and pathology. Cell. 1982 Dec;31(2 Pt 1):303–306. doi: 10.1016/0092-8674(82)90122-2. [DOI] [PubMed] [Google Scholar]
- Palermo F., Carniato A., Fede A., Boccaletto F., Marchiori C. Serum SCC-Ag in head and neck squamous cell carcinoma. Int J Biol Markers. 1990 Jul-Sep;5(3):118–120. [PubMed] [Google Scholar]
- Pujol J. L., Grenier J., Daurès J. P., Daver A., Pujol H., Michel F. B. Serum fragment of cytokeratin subunit 19 measured by CYFRA 21-1 immunoradiometric assay as a marker of lung cancer. Cancer Res. 1993 Jan 1;53(1):61–66. [PubMed] [Google Scholar]
- Pujol J. L., Grenier J., Parrat E., Lehmann M., Lafontaine T., Quantin X., Michel F. B. Cytokeratins as serum markers in lung cancer: a comparison of CYFRA 21-1 and TPS. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):725–733. doi: 10.1164/ajrccm.154.3.8810612. [DOI] [PubMed] [Google Scholar]
- Rastel D., Ramaioli A., Cornillie F., Thirion B. CYFRA 21-1, a sensitive and specific new tumour marker for squamous cell lung cancer. Report of the first European multicentre evaluation. CYFRA 21-1 Multicentre Study Group. Eur J Cancer. 1994;30A(5):601–606. doi: 10.1016/0959-8049(94)90528-2. [DOI] [PubMed] [Google Scholar]
- Ropka M. E., Goodwin W. J., Levine P. A., Sasaki C. T., Kirchner J. C., Cantrell R. W. Effective head and neck tumor markers. The continuing quest. Arch Otolaryngol Head Neck Surg. 1991 Sep;117(9):1011–1014. doi: 10.1001/archotol.1991.01870210083016. [DOI] [PubMed] [Google Scholar]
- Shideler C. E., Johns M. E., Cantrell R. W., Shipe J. R., Wills M. R., Savory J. Erythrocyte polyamine determinations in patients with head and neck cancer. Arch Otolaryngol. 1981 Dec;107(12):752–754. doi: 10.1001/archotol.1981.00790480028007. [DOI] [PubMed] [Google Scholar]
- Silverman N. A., Alexander J. C., Jr, Chretien P. B. CEA levels in head and neck cancer. Cancer. 1976 May;37(5):2204–2211. doi: 10.1002/1097-0142(197605)37:5<2204::aid-cncr2820370508>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
- Stieber P., Hasholzner U., Bodenmüller H., Nagel D., Sunder-Plassmann L., Dienemann H., Meier W., Fateh-Moghadam A. CYFRA 21-1. A new marker in lung cancer. Cancer. 1993 Aug 1;72(3):707–713. doi: 10.1002/1097-0142(19930801)72:3<707::aid-cncr2820720313>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
- Walther E. K., Dahlmann N., Gorgulla H. T. Tumormarker bei Patienten mit Kopf-Hals-Karzinomen. Laryngorhinootologie. 1990 May;69(5):271–274. doi: 10.1055/s-2007-998188. [DOI] [PubMed] [Google Scholar]
- Wolf G. T., Chretien P. B., Elias E. G., Makuch R. W., Baskies A. M., Spiegel H. E., Weiss J. F. Serum glycoproteins in head and neck squamous carcinoma: correlations with tumor extent, clinical tumor stage, and T-cell levels during chemotherapy. Am J Surg. 1979 Oct;138(4):489–500. doi: 10.1016/0002-9610(79)90407-0. [DOI] [PubMed] [Google Scholar]
- Yen T. C., Lin W. Y., Kao C. H., Cheng K. Y., Wang S. J. A study of a new tumour marker, CYFRA 21-1, in squamous cell carcinoma of the head and neck, and comparison with squamous cell carcinoma antigen. Clin Otolaryngol Allied Sci. 1998 Feb;23(1):82–86. doi: 10.1046/j.1365-2273.1998.00101.x. [DOI] [PubMed] [Google Scholar]
- Yoshimura Y., Oka M., Harada T. Squamous cell carcinoma-antigen for detection of squamous cell and mucoepidermoid carcinoma after primary treatment: a preliminary report. J Oral Maxillofac Surg. 1990 Dec;48(12):1288–1293. doi: 10.1016/0278-2391(90)90484-j. [DOI] [PubMed] [Google Scholar]
- van der Gaast A., Schoenmakers C. H., Kok T. C., Blijenberg B. G., Cornillie F., Splinter T. A. Evaluation of a new tumour marker in patients with non-small-cell lung cancer: Cyfra 21.1. Br J Cancer. 1994 Mar;69(3):525–528. doi: 10.1038/bjc.1994.95. [DOI] [PMC free article] [PubMed] [Google Scholar]