1258 Pronostic value of CYFRA 21.1 variation in lung cancer

We have investigated the usefulness of CYFRA 21-1 as indicator of therapy effectiveness and prognostic in lung cancer. Forty-two patients with primary lung cancer were selected on the basis of a high CYFRA 21-1 serum level (> 3.3 ng/ml) on diagnosis time. All cases were histologically proven: 6 small cell carcinomas, 17 squamous cell, 11 adenocarcinomas and 8 undifferentiated. Serial monitoring of CYFRA 21 was performed during modalities of first therapy (chemotherapy 36, irradiation 3, surgery 3 cases). The serial values were analysed according to response to treatment and overall survival. Thirty five of 42 patients had a significant decrease (SDS) (> 50% or return to normal) of CYFRA 21 serum level and 27 returned to normal values (NV). Twenty-two (62%) of SDS patients, and 18 of NV patients (66%) had a clinical response to therapy, making CYFRA 21 a moderate indicator in terms of specificity. Clinical response, however, was always associated with a SDS of CYFRA 21. Eleven clinical relapses were observed, that were reflected by a positive CYFRA 21 in 8 (72%) cases at the time of radiological or clinical relapse. In three patients CYFRA 21 values preceded the clinical detection by one month. Survival data were available for 36 patients. A statistically significant difference ( P  = 0.01) was found in survival depending on return to normal of CYFRA 21 during therapy or not (42 and 27 weeks respectively). Initial CYFRA value was not correlated with survival. We conclude that serial monitoring of CYFRA 21 serum levels may be a useful prognostic tool of response and longer survival in lung cancer patients.