Diagnostic and Prognostic Value of Serum Cyfra 21–1 Levels in Patients with Pancreatic Cancer

Background : This study was conducted to evaluate serum cytokeratin 19-fragments (CYFRA 21–1), in addition to serum carbohydrate antigen 19–9 (CA 19–9), as a novel biomarker for the diagnosis and prognosis of pancreatic cancer. Methods: We performed a retrospective review of medical records of the patients whose serum CYFRA 21–1 and CA 19–9 levels were estimated in a single institute from March 2011 to February 2014. The sensitivity and specificity of CYFRA 21–1 and CA 19–9 for pancreatic cancer were assessed, and the overall survival of the patients was evaluated with respect to elevation of the CYFRA 21–1 levels. Results: Records of 57 patients diagnosed with pancreatic cancer and 110 healthy individuals (control group) were collected. CYFRA 21–1 had a sensitivity of 80.7%, specificity of 80%, positive predictive value of 67.6%, and negative predictive value of 88.9%, at a cut-off value of 1.93 ng/ml determined by a receiver operating characteristics (ROC) analysis. The area under ROC (AUC-ROC) curves of CYFRA 21–1 and CA 19–9 were 0.83 [95% confidence interval (CI), 0.764–0.884) and 0.874 (95% CI, 0.814–0.921), respectively without any statistically significant difference (p = 0.333). No correlation was observed between the CYFRA 21–1 levels and the serum total bilirubin levels. For overall survival, a CYFRA 21–1 level of ≥ 5 ng/ml indicated a poor prognosis among patients with pancreatic cancers (median survival, 4.4 vs. 9.5 months, p = 0.000). CYFRA 21–1 level was also found to be an independent prognostic factor in the multivariate analysis [hazard ratio, 2.277 (95% CI, 1.137–4.559), p = 0.020]. Conclusion : CYFRA 21–1 can be a valuable biomarker for the diagnosis and prognostic prediction of pancreatic cancer.