title: Serum CYFRA 21-1 in Biliary Tract Cancers: A Reliable Biomarker for Gallbladder Carcinoma and Intrahepatic Cholangiocarcinoma.
abstract: BACKGROUND
  Biliary tract cancers encompass gallbladder carcinoma, and intrahepatic, perihilar and distal cholangiocarcinoma. Upregulated serum CYFRA 21-1 has been reported in intrahepatic cholangiocarcinoma.
  
  
  OBJECTIVE
  The present study aimed to explore the clinical significance of serum CYFRA 21-1 in all biliary tract cancer subtypes.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Serum CYFRA 21-1 represents a reliable biomarker for gallbladder carcinoma and intrahepatic cholangiocarcinoma.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Peiwen
authors.initials: P
authors.lastname: Liang
authors.forename: Wenjie
authors.initials: W
authors.lastname: Hu
authors.forename: Kunsong
authors.initials: K
authors.lastname: Zhang
authors.forename: Shunli
authors.initials: S
authors.lastname: Shen
authors.forename: Jiancong
authors.initials: J
authors.lastname: Chen
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Zhang
authors.forename: Bin
authors.initials: B
authors.lastname: Chen
authors.forename: Yuyan
authors.initials: Y
authors.lastname: Han
authors.forename: Fanyin
authors.initials: F
authors.lastname: Meng
authors.forename: Sharon
authors.initials: S
authors.lastname: DeMorrow
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Yin
authors.forename: Jiaming
authors.initials: J
authors.lastname: Lai
authors.forename: Lijian
authors.initials: L
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D019540:Area Under Curve; D001650:Bile Duct Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005706:Gallbladder Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D053539:Keratin-19 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D053539:Keratin-19; C102012:antigen CYFRA21.1