Synonyms: Soluble fragments of cytokeratin 19, tumor marker CYFRA 21-1
Scientific editor: M. Merkusheva, PSPbGMU them. Acad. Pavlov, general medicine.
October, 2018.
The test system Cyfra 21-1 to identify the blood soluble cytokeratin 19 fragments used in the diagnosis, monitoring and predicting treatment non-small cell lung cancer (NSCLC) and certain other malignancies neoplasms.
In the absence of tumor and organ specificity of the study is not recommended for screening for lung cancer, if the patient is predisposed to cancer (high risk), or it has no pronounced clinical symptoms.
Analysis of Cyfra 21-1 can not substitute for other diagnostic methods (clinical, instrumental, histological) in the primary diagnosis. However, when a definitive diagnosis, if it is impossible for some reason to do a biopsy, this study is expedient to conduct.
Basic information
Cytokeratins - the elements that form the frame epithelial cell (cytoskeleton). Normally, they do not enter the bloodstream and only in the destruction of the epithelium found in laboratory studies. In total there are 25 varieties of cytokeratin. Cyfra 21-1 - a fragment of the 19th, which is detected in some types of cancer (large cell, squamous cell, and so on.).
Increasing the Cyfra 21-1 concentration in serum is typical for most non-small cell lung cancer. But because of his lung tumor histological structure meet the most diverse, the experts recommend to conduct a comprehensive examination, including at least 3 types tumor markers:
- REA (Cancer embryonic antigen),
- NSE (Neuron specific enolase)
- and Cyfra 21-1.
The following table shows the most appropriate inspection schemes for different kinds tumors
Histology Tumor structure |
primary token | sensitivity test | |
| small cell carcinoma | Cyfra 21-1 NSE |
52,3% | |
| non-small cell carcinoma | adenocarcinoma | Cyfra 21-1 REA |
63,2% |
| squamous | Cyfra 21-1 | 72 – 75% | |
| large- | Cyfra 21-1 REA |
72 – 75% | |
| unknown | Cyfra 21-1 NSE REA |
62 – 65% |
The concentration of Cyfra 21-1 increases in proportion to the stage of the malignant process that is widely used to predict disease outcome and patient survival. Accordingly, a moderate increase Cyfra 21-1 values may indicate as a progressive (rising slowly) during the pathology and different embodiments of the tumor.
If the tumor marker level at diagnosis was upgraded, then this information can be used as a "reference point" in the program of the patient in the future. The decline in Cyfra 21-1 after surgery reflects the degree of success of the surgical intervention and the fact of the presence / absence of residual cancerous tissue.
Preservation suspected tumor residues if Cyfra 21-1 reducing rate is too slow, or the value has not reached the reference. Against this background, once again increasing the concentration of tumor marker indicative of disease recurrence. But the most important thing is that this feature is detected long (more than 12 months) before the actual start of the growth of the tumor itself, ie when clinical symptoms of cancer recurrence has not yet manifested itself. And it can be a serious reason for referral to an early X-ray examination.
No less important is the analysis on Cyfra 21-1 for monitoring invasive bladder cancer, if at the time of diagnosis was increased concentration of the tumor marker. Together with the analysis on the CA 19-9 and carcinoembryonic antigen (CEA), CYFRA 21-1 study can be used to diagnose, assess prognosis and treatment monitoring of colon cancer.
Determination of Cyfra 21-1 in patients with severe chest trauma can predict the development of acute respiratory distress syndrome and pneumonia, and in time to prevent these complications1.
testimony
- Primary diagnosis of lung cancer (comprehensive survey);
- Evaluating the effectiveness of the treatment of lung cancer;
- Predicting outcome NSCLC patient survival rate;
- Monitoring of invasive bladder cancer;
- Suspicion of cancer and other forms of localization;
- Diagnosis, prognosis and assessment of the control of treatment of colon cancer, breast cancer;
- Definition of tactics of treatment of metastatic differentiated thyroid cancer;
- The symptoms of lung cancer (cough, coughing up blood, shortness of breath, signs of tumor compression of surrounding structures (hoarseness, difficulty swallowing).
- When the symptoms of colon cancer: anemia, rectal bleeding, abdominal pain, constipation or diarrhea;
- Preoperative assessment of Cyfra 21-1 in malignant tumors of the thymus to evaluate process step, the tumor histotype and predict relapse2;
- Analysis Cyfra 21-1 are used to detect cervical cancer relapse3.
Interpret the results of the analysis on the Cyfra 21-1 experts:
- oncologist,
- pulmonologist,
- endocrinologist,
- gastroenterologist,
- surgeon.
Standards for Cyfra 21-1
Important! Norms vary depending on the reagents and equipment used in a particular laboratory. Therefore, when interpreting the results it is necessary to use standards adopted precisely in the lab where to be tested. It is also necessary to pay attention to the units.
- 0 - 2.08 ng / ml (Invitro Laboratory).
- 0 - 3.3 ng / ml (Helix Laboratory).
Increase Cyfra 21-1
Important! Interpretation of the results is always carried out comprehensively. An accurate diagnosis on the basis of only one analysis impossible.
- Lung cancer;
- Bladder cancer;
- Other tumor localization (cervix, esophagus, thyroid, head and neck, colon);
- Recurrence of cervical cancer;
- Papillary thyroid carcinoma;
- Metastatic cancer (tumor distant metastases, e.g., breast to other organs and tissues).
- adenocarcinoma of the colon;
- Metastasis of breast cancer, the sensitivity of 65% (together with analyzes on CEA and CA 15-3 sensitivity 90%).
That can affect the outcome
Cyfra 21-1 concentration increases on the background:
- renal insufficiency, hemodialysis;
- diabetic nephropathy (diabetes complication);
- pulmonary lesions and pleural tissue (fibrosis, tuberculosis, pleuritis, COPD);
- liver diseases (hepatitis, cirrhosis);
- inflammations of the serous lining of the heart (pericarditis).
low values
- Norm;
- The high efficiency of the surgical treatment of lung cancer;
- The course of treatment with cytostatics (anticancer drug).
Training
The biomaterial for research: serum of venous blood.
Method biomaterial sampling: the antecubital vein venipuncture.
The recommended duration of treatment: the morning, from 8.00 to 11.00.
Mandatory requirement: strict fasting (8-10 hours after an overnight fast). Possible to perform analysis at a different time of day, but only after 4 hchasovogo abstinence from food.
sources:
- 1. Negrin LL. Club cell protein 16 and cytokeratin fragment 21-1 as early predictors of pulmonary complications in polytraumatized patients with severe chest trauma. - PLoS One. 2017.
- 2. Zhang X. Correlation between Serum Cytokeratin 19 Fragment and the Clinicopathological Features and Prognosis of Thymic Epithelial Tumors. - Zhongguo Fei Ai Za Zhi. 2018.
- 3. Kainz C. Cytokeratin subunit 19 measured by CYFRA 21-1 assay in follow-up of cervical cancer. - Gynecol Oncol. 1995.
- 4. A.A.Kishkun, prof. Manual for the laboratory diagnosis methods - GEOTAR-Media, 2007.
