The Association of Carcinoembryonic Antigen and Cytokeratin-19 Fragments 21-1 Levels with One-Year Survival of Advanced Non-Small Cell Lung Carcinoma at Cipto Mangunkusumo Hospital: A Retrospective Cohort Study

Cleopas Martin Rumende, Galuh Chandra Kirana Sugianto, Ikhwan Rinaldi, Muhadi Muhadi


Background: non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. Therefore, research into its prognostic factor is very important for better patient management. However, there have been no studies looking for the association of CYFRA 21-1 and CEA with survival of NSCLC in Indonesia, and no cut-off value for them as standardized prognostic factors. This study aims to know the association of CEA and CYFRA 21-1 with one-year survival of advanced stage NSCLC in RSCM and determining their cut-off point as a prognostic factor. Methods: a retrospective cohort study of 111 subjects with advanced stage NSCLC aged > 18 years who were diagnosed from January 2012 to May 2018, resulted in a set of data which includes an initial score of CEA and CYFRA 21-1 at diagnosis, along with their confounding factors, namely performance status (PS), type of histology, therapy, and stadium. All data were taken from the RSCM Medical Record Unit. Results: the CEA area under the curve (AUC) was less than 50% (AUC=0.446) and not significant, whereas AUC CYFRA 21-1=0.741 (0.636–0.847) with p <0.001 was significant in this analysis. CYFRA 21-1 cut-off point was > 10.9 ng / mL with a sensitivity of 69.5% and specificity of 65.5%. The variables that met the proportional hazard assumption were CYFRA 21-1, PS, histology, and therapy. CYFRA 21-1 > 10.9 ng/mL had HR 1.744 (HR=1.744; p=0.028); ECOG 3-4 PS had HR 2.434 (HR=2.434; p=0.026); non-adenocarcinoma histology had HR 1.929 (HR=1.929; p=0.029); and the non-chemotherapy group had HR 2.633 (HR=2.633; p=2.633; p=0.015). Conclusion: from both tumour markers, only CYFRA 21-1 was proven to be significant to NSCLC survival. CYFRA 21-1 cut-off value as a prognostic factor was > 10.9 ng/mL.


lung cancer; non-small cell lung carcinoma; advanced stage; one-year survival; CEA; CYFRA 21-1


Sutandyo N, Suratman E, Mulawarman AJ. Epidemiological data and survival of lung. 2007. [diunduh pada tanggal 18 Agustus 2018]. [Available at 26)00192.pdf].

Kementrian Kesehatan RI Pusat Data dan Informasi Kesehatan. Stop Kanker. infodatin-Kanker. 2015. [diunduh pada tanggal 18 Agustus 2018]. [Available at resources/ download/ pusdatin/infodatin /infodatin-kanker.pdf].

Sharma S. Tumor markers in clinical practice: General principles and guidelines. Indian J Med Paediatr Oncol. 2009;30(1):1.

Ballman K V. Biomarker: Predictive or prognostic? J Clin Oncol. 2015;33(33):3968–71.

Duffy MJ. Tumor markers in clinical practice: A review focusing on common solid cancers. Med Princ Pract. 2012;22(1):4–11.

Liu L, Teng J, Zhang L, et al. The combination of the tumor markers suggests the histological diagnosis of lung cancer. Biomed Res Int. 2017;2017.

Pang LI, Wang J, Jiang Y, Chen L. Decreased levels of serum cytokeratin 19 fragment CYFRA 21 ‑ 1 predict objective response to chemotherapy in patients with non-small cell lung cancer. Experimental and therapeutic medicine. 2013;355–60.

Barlési F, Gimenez C, Torre JP, et al. Prognostic value of combination of Cyfra 21-1, CEA and NSE in patients with advanced nonsmall cell lung cancer. Respir Med. 2004;98(4):357–62.

Emad A Abd AFS. Prognostic Value of CYFRA 21-1 and Carcinoembryonic Antigen in Non-Small Cell Lung Cancer. J Clin Cell Immunol. 2015;06(02).

Youlden DR, Cramb SM, Baade PD. The international epidemiology of lung cancer: Geographical distribution and secular trends. J Thorac Oncol. 2008;3(8):819–31.

Groot PM De, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl Lung Cancer Res. 2018;1982(7):220–33.

Hei Y. Survival by histologic subtype in stage IV nonsmall cell lung cancer. Surveillance, Epidemiology and End Results Program. 2011;139–48.

Cho BC. Prognostic and predictive value of CEA and CYFRA 21-1 levels in advanced non-small cell lung cancer patients treated with gefitinib or erlotinib. Exp Ther Med. 2011;685–93.

Hanagiri T, Sugaya M, Takenaka M, et al. Lung cancer preoperative CYFRA 21-1 and CEA as prognostic factors in patients with stage I non-small cell lung cancer. Lung Cancer. 2011;74(1):112–7.

Lin X, Wang X, Sun D, Li Z, Bai Y. High serum CEA and CYFRA21-1 levels after a two-cycle adjuvant chemotherapy for NSCLC: possible poor prognostic factors. Cancer Biol Med. 2012;270–3.

Fiala O, Pesek M, Finek J, Benesova L, Minarik M, Bortlicek Z, et al. Predictive role of CEA and CYFRA 21-1 in patients with advanced-stage NSCLC treated with erlotinib. Anticancer Res. 2014;34(6):3205–10.

Edelman MJ, Hodgson L, Rosenblatt PY, et al. CYFRA 21-1 as a prognostic and predictive marker in advanced non-small-cell lung cancer in a prospective trial: CALGB 150304. J Thorac Oncol. 2012;7(4):649– 54.

Pallis AG, Dziadziuszko R, O’Brien M. Chemotherapy of advanced non-small-cell lung cancer: current landscape. Clin Investig (Lond). 2013;3(3):265–79.

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