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

Abstract

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.