title: Carcinoembryonic antigen and cytokeratin-19 fragments for assessment of therapy response in non-small cell lung cancer: a systematic review and meta-analysis.
abstract: BACKGROUND
  This meta-analysis evaluated whether pretherapy serum levels of carcinoembryonic antigen (CEA) and cytokeratin-19 fragments (CYFRA 21-1) are predictive of response to therapy in non-small cell lung cancer (NSCLC) and whether changes in these markers during vs pretherapy are indicative of response.
  
  
  METHODS
  Original peer-reviewed studies enrolling adults with untreated advanced NSCLC were identified using PubMed. Two reviewers independently extracted data from eligible studies and assessed study heterogeneity and the risk of study bias.
  
  
  RESULTS
  Fourteen studies were eligible; 11 had objective response as an end point and three evaluated clinical benefit (i.e., response and stable disease). Study bias was relatively low. Both markers showed comparable modest predictive value across studies, with baseline CYFRA 21-1 numerically better in predicting treatment benefit. A good performance in identifying objective response during treatment was seen (AUC 0.724 (95% CI 0.667-0.785) for CYFRA 21-1 and 0.728 (95% CI, 0.599-0.871) for CEA). A decline in CYFRA 21-1 levels during treatment was highly indicative for objective response (sensitivity 79.1% (95% CI 71.5-85.1)).
  
  
  CONCLUSIONS
  Comprehensive analysis of study heterogeneity and bias provides a high level of evidence for the clinical utility of CEA and CYFRA 21-1 for the prediction and monitoring of response in NSCLC.
authors.affiliation: Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Sigmund-Freud-Str. 25, Bonn D-53105, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Holdenrieder
authors.affiliation: Roche Diagnostics GmbH, Nonnenwald 2, Penzberg 82377, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Wehnl
authors.affiliation: QuoData GmbH, Prellerstrasse 14, Dresden 01309, Germany.
authors.forename: Karina
authors.initials: K
authors.lastname: Hettwer
authors.affiliation: QuoData GmbH, Prellerstrasse 14, Dresden 01309, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Simon
authors.affiliation: QuoData GmbH, Prellerstrasse 14, Dresden 01309, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Uhlig
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA.
authors.forename: Farshid
authors.initials: F
authors.lastname: Dayyani
mesh_terms: D000328:Adult; D000951:Antigens, Neoplasm / Q000378:metabolism*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D006801:Humans; D053539:Keratin-19 / Q000378:metabolism*; D008175:Lung Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D011379:Prognosis
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D053539:Keratin-19; C102012:antigen CYFRA21.1