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.
Aims
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.
Conclusion
Serum CYFRA 21-1 represents a reliable biomarker for gallbladder carcinoma and intrahepatic cholangiocarcinoma.
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Acknowledgments
The authors thank Prof. Dong Wang and Dr. Dubo Chen (Department of Clinical Laboratory, the First Affiliated Hospital of Sun Yat-sen University) for providing advice and technical assistance in measuring biomarkers. We also thank Prof. Yuantao Hao (Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University) for careful review and statistical advice. This work was supported by the National Natural Science Foundation of China (81201919), the Science and Technology Planning Project of Guangdong Province (2012B050600016) and the Medical Scientific Research Foundation of Guangdong Province (B2012087).
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10620_2014_3472_MOESM1_ESM.jpg
Supplementary material 1 Distributions of serum CYFRA 21-1 in TNM stage of each biliary tract cancers subtype. Data are presented as median (horizontal line) and interquartile range. Analysis of serum CYFRA 21-1 in different TNM stage of biliary tract cancers (BTCs) and all subtypes revealed significant difference (Kruskal–Wallis test, P < 0.001). (1a) biliary tract cancers (BTCs); (1b) intrahepatic cholangiocarcinoma (ICC); (1c) gallbladder carcinoma (GBC); (1d) perihilar cholangiocarcinoma (Perihilar-CC); (1e) distal cholangiocarcinoma (Distal-CC) (JPEG 267 kb)
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Huang, L., Chen, W., Liang, P. et al. Serum CYFRA 21-1 in Biliary Tract Cancers: A Reliable Biomarker for Gallbladder Carcinoma and Intrahepatic Cholangiocarcinoma. Dig Dis Sci 60, 1273–1283 (2015). https://doi.org/10.1007/s10620-014-3472-0
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DOI: https://doi.org/10.1007/s10620-014-3472-0