title: Prognostic impact of serum CYFRA 21-1 in patients with advanced lung adenocarcinoma: a retrospective study.
abstract: BACKGROUND
  Serum CYFRA 21-1 is one of the most important serum markers in the diagnosis of non-small cell lung cancer (NSCLC), especially squamous-cell carcinoma. However, it remains unknown whether pretreatment serum CYFRA 21-1 values (PCV) may also have prognostic implications in patients with advanced lung adenocarcinoma.
  
  
  METHODS
  We retrospectively reviewed the data of 284 patients (pts) who were diagnosed as having advanced lung adenocarcinoma and had received initial therapy.
  
  
  RESULTS
  Of the study subjects, 121 pts (43%) had activating epidermal growth factor receptor (EGFR) mutations (Mt+), while the remaining 163 pts (57%) had wild-type EGFR (Mt-). Univariate analysis identified gender (male/ female), ECOG performance status (PS) (0-1/ ≥2), PCV (<2.2 ng/ml/ ≥2.2 ng/ml), EGFR mutation status (Mt+/ Mt-), pretreatment serum CEA values (<5.0 ng/ml/ ≥5.0 ng/ml), smoking history (yes/ no) and EGFR-TKI treatment (yes/ no) as prognostic factors (p = .008, p < .0001, p < .0001, p < .0001, p = .036, p = .0012, p < .0001 respectively). Cox's multivariate regression analysis identified PCV < 2.2ng/ml as the only factor significantly associated with prolonged survival (p < .0001, hazard ratio: 0.43, 95% CI 0.31-0.59), after adjustments for PS (p < .0001), EGFR mutation status (p = .0069), date of start of initial therapy (p = .07), gender (p = .75), serum CEA level (p = .63), smoking history (p = .39) and EGFR-TKI treatment (p = .20). Furthermore, pts with Mt+ and PCV of <2.2 ng/ml had a more favorable prognosis than those with Mt+ and PCV of ≥2.2 ng/ml (MST: 67.0 vs. 21.0 months, p < .0001), and patients with Mt- and PCV of <2.2 ng/ml had a more favorable prognosis than those with Mt- and PCV of ≥2.2 ng/ml (MST: 24.1 vs. 10.2 months, p < .0001).
  
  
  CONCLUSIONS
  PCV may be a potential independent prognostic factor in both Mt+ and Mt- patients with advanced lung adenocarcinoma.
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka 411-8777, Japan. a.ono@scchr.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Ono
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Akamatsu
authors.forename: Takehito
authors.initials: T
authors.lastname: Shukuya
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Taira
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kenmotsu
authors.forename: Tateaki
authors.initials: T
authors.lastname: Naito
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Murakami
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakajima
authors.forename: Masahiro
authors.initials: M
authors.lastname: Endo
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Yamamoto
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000235:genetics / Q000401:mortality; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood*; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D053539:Keratin-19 / Q000097:blood*; D008175:Lung Neoplasms / Q000097:blood* / Q000235:genetics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D053539:Keratin-19; C102012:antigen CYFRA21.1; D066246:ErbB Receptors