Prognostic Significance of CYFRA21-1, CEA and Hemoglobin in Patients with Esophageal Squamous Cancer Undergoing Concurrent Chemoradiotherapy


Purpose: To evaluate the prognostic value of serum CYFRA21-1, CEA and hemoglobin levels regardinglong-term survival of patients with esophageal squamous cell carcinoma (ESCC) treated with concurrentchemoradiotherapy (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 CRTwere retrospectively investigated and related to outcome in 113 patients receiving 5-fluorouracil and cisplatincombined with radiotherapy for ESCC. The Kaplan-Meier method was used to analyze prognosis, the log-rankto compare groups, the Cox proportional hazards model for multivariate analysis, and ROC curve analysis forassessment of predictive performance of biologic markers.
Results: The median survival time was 20.1 monthsand the 1-, 2-, 3-, 5- year overall survival rates were 66.4%, 43.4%, 31.9% and 15.0%, respectively. Univariateanalysis 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 CEAlevel were independent predictors of prognosis. By ROC curve, CYFRA21-1 and hemoglobin showed betterpredictive performance for OS than CEA (AUC= 0.791, 0.704, 0.545; P=0.000, 0.000, 0.409).
Conclusions: Ofall clinicopathological and molecular factors, T stage, N stage, hemoglobin, CYFRA21-1 and CEA level wereindependent 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.