Prognostic value of combination of Cyfra 21-1, CEA and NSE in patients with advanced non-small cell lung cancer

Objective: To assess the value of Cyfra 21-1, carcino-embryonic antigen (CEA) and neuron-specific enolase (NSE) combined, all three together as prognostic factors in advanced stage non-small cell lung cancer (NSCLC) patients. Patients and methods: Serum samples from untreated NSCLC patients were prospectively collected. All assays were performed using commercial kits blind to clinical information. Serum levels of CEA, NSE and Cyfra 21-1 higher than 10, 13 and 3.5 ng/ml, respectively, were considered as elevated. Results: 264 patients (men, 87%), with Performans Status (PS) of 0/1 in 80% and stage IV disease in 65% were studied. Cyfra 21-1, CEA and NSE were elevated in 52.5%, 41.8% and 33.2% of patients, respectively. Median survival was 9 months (range, 1-77). Cyfra 21-1, age, PS, stage as well as the combination of the three markers together correlated with prognosis in univariate analysis. Multivariate analysis demonstrated that age ≥65 years (HR=1.3 [1.02-1.70], p=0.03), PS 2 (HR=4.3 [3.13-6.11], p<0.0001), Cyfra 21-1≥3.5ng/ml (HR=1.3 [1.06-1.78], p=0.01) and the combination of the three markers (HR=1.06 [1.009-1.13], p=0.02) remained prognostic determinants. Conclusion: Combining Cyfra 21-1, NSE and CEA correlated with prognosis in a significant and independent manner.