Postoperative CYFRA 21-1 and CEA as prognostic factors in patients with stage I pulmonary adenocarcinoma.

BACKGROUND: Patients with pathological stage I pulmonary adenocarcinoma have different postoperative prognosis. The aim of this study is to evaluate the prognostic significance of preoperative and postoperative serum levels of carcinoembryonic antigen (CEA) and CYFRA 21-1 in patients with pathological stage I pulmonary adenocarcinoma.

MATERIAL AND METHODS: We retrospectively reviewed the data of 123 patients who had undergone a complete resection for pathological stage I pulmonary adenocarcinoma between 2004 and 2014. The clinical data of each patient including age, gender, preoperative and postoperative serum CEA and CYFRA 21-1 levels, and pathologic stage, was collected for analysis.

RESULTS: The CYFRA 21-1 and CEA level was persistently normal in 80.5% and 77.2% of all patients with p-stage I ADC, respectively. The preoperative level was elevated and postoperative level declined to normal for CYFRA 21-1 and CEA were in 10.6% and 13.0% of all patients, respectively. The postoperative CYFRA 21-1 and CEA level were high in 8.9% and 9.8% of all patients, respectively. The postoperative 5-year survival rate of patients with normal, only preoperative high, and postoperative high CYFRA 21-1 level was 92.6%, 92.3% and 43.8%, respectively. There was a significant difference between postoperative high group and the other two groups (p = 0.002). The postoperative 5-year survival rate of patients with normal, only preoperative high, and postoperative high CEA level was 90.8%, 92.3%, and 70.1%, respectively. There was a significant difference between postoperative high group and the other two groups (p = 0.019). In univariate analysis, degree of differentiation, visceral pleural invasion, tumor size, and pTNM stage, was found to be significant independent prognostic factor (p = 0.014). Multivariate analysis showed that pTNM stage, postoperative CYFRA 21-1 high level, and postoperative CEA high level was related to the poor prognosis.

CONCLUSIONS: Patients of p-stage I ADC with postoperative high serum level of either CEA or CYFRA 21-1 had poor prognosis. Carefully followed-up might be necessary to rule out occult metastasis for these patients, and further clinical studies will be necessary to evaluate the efficacy of adjuvant chemotherapy or target therapy. Postoperative high serum level of CEA or CYFRA 21-1 might be a subtype of p-stage I ADC.