Serum and biliary cytokeratin fragment CYFRA 21-1, as a marker of resectability for extrahepatic cholangiocarcinoma

ABSTRACT

Serum levels of CEA and CA 19.9 are occasionally elevated in cases of cholangiocarcinoma [CC]. They, however, have low sensitivity and specificity, which makes the diagnosis of CC difficult, and better tumor markers are needed. CYFRA 21-1, a cytokeratin fragment, is being evaluated as a tumor marker with diagnostic potential for small cell lung carcinoma. The resectability of CC is difficult to assess accurately pre-operatively using available laboratory and imaging techniques. The aim of the present study was to assess the diagnostic value of CYFRA 21-1, CA 19.9, and CEA in serum and bile of patients with extrahepatic CC. and to evaluate whether any of these markers can be used to assess resectabilily. Fifty patients with extrahepatic obstructive jaundice were included in this study. Group 1 30 patients with histologically proven CC had serum and bile samples measured for CYFRA 21-1, CA 19.9; and CEA. Group II 20 patients with calcular obstructive jaundice had serum and bile samples obtained during endoscopic removal of stones to control for the effect of biliary obstruction on CYFRA 21-1, CA 19.9, and CEA. Sixteen patients in whom imaging studies showed resectability were explored and operative findings were correlated to tumor markers. CEA and CA 19.9 were measured using enzyme immnunoassay [EIA,], and CYFRA 21-1 level was measured using electrochemiluminescence immunoassay [ECLIA] in serum and bile of the CC patients and the caicular obstructive jaundice controls. Patients with CC had significantly higher serum levels of CEA [24.5 +/- 6 vs 4 +/- 1.3 ng/ml. p<0.01] CA 19.9 [118.9 +/- 25.4 vs 31.2 +/- 8.4 U/ml, p< 0.01] and CYFRA 21-1 [8.3 +/- 2.7 vs 2.1 +/- 0.5 ng/ml, p<0.01] than patients with benign calcular cholestatic disorder, and bile concentration of the 3 markers was sign higher than serum concentrations. Among the 16 patients who underwent surgery, serum and biliary levels of CYFRA 21-1 were significantly higher with irresectable tumors. CYFRA 21-1 may be a useful marker for resectabilily saving many unnecessary operations. This, however, needs further larger studies to be documented