title: Prognostic significance of CYFRA21-1, CEA and hemoglobin in patients with esophageal squamous cancer undergoing concurrent chemoradiotherapy.
abstract: OBJECTIVE
  To evaluate the prognostic value of serum CYFRA21-1, CEA and hemoglobin levels regarding long-term survival of patients with esophageal squamous cell carcinoma (ESCC) treated with concurrent chemoradiotherapy (CRT).
  
  
  METHODS
  Age, gender, Karnofsky Performance Status (KPS), tumor location, tumor length, T stage, N stage and serum hemoglobin, and CYFRA21-1 and CEA levels before concurrent CRT were retrospectively investigated and related to outcome in 113 patients receiving 5-fluorouracil and cisplatin combined with radiotherapy for ESCC. The Kaplan-Meier method was used to analyze prognosis, the log-rank to compare groups, the Cox proportional hazards model for multivariate analysis, and ROC curve analysis for assessment of predictive performance of biologic markers.
  
  
  RESULTS
  The median survival time was 20.1 months and the 1-, 2-, 3-, 5- year overall survival rates were 66.4%, 43.4%, 31.9% and 15.0%, respectively. Univariate analysis showed that factors associated with prognosis were KPS, tumor length, T-stage, N-stage, hemoglobin, CYFRA21-1 and CEA level. Multivariate analysis showed T-stage, N-stage, hemoglobin, CYFRA21-1 and CEA level were independent predictors of prognosis. By ROC curve, CYFRA21-1 and hemoglobin showed better predictive performance for OS than CEA (AUC= 0.791, 0.704, 0.545; P=0.000, 0.000, 0.409).
  
  
  CONCLUSIONS
  Of all clinicopathological and molecular factors, T stage, N stage, hemoglobin, CYFRA21-1 and CEA level were independent predictors of prognosis for patients with ESCC treated with concurrent CRT. Among biomarkers, CYFRA21-1 and hemoglobin may have a better predictive potential than CEA for long-term outcomes.
authors.affiliation: Department of Radiation Oncology, Shandong Cancer Hospital, Jinan, China.
authors.forename: Hai-Qin
authors.initials: HQ
authors.lastname: Zhang
authors.forename: Ren-Ben
authors.initials: RB
authors.lastname: Wang
authors.forename: Hong-Jiang
authors.initials: HJ
authors.lastname: Yan
authors.forename: Wei
authors.initials: W
authors.lastname: Zhao
authors.forename: Kun-Li
authors.initials: KL
authors.lastname: Zhu
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Jiang
authors.forename: Xi-Gang
authors.initials: XG
authors.lastname: Hu
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Yu
mesh_terms: D000951:Antigens, Neoplasm / Q000097:blood*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood*; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000097:blood / Q000401:mortality / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D053539:Keratin-19 / Q000097:blood*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D006454:Hemoglobins; D053539:Keratin-19; C102012:antigen CYFRA21.1; D002945:Cisplatin; D005472:Fluorouracil