1. Serum cytokeratin 19 fragment 21-1 and carcinoembryonic antigen combination assay as a biomarker of tumour progression and treatment response in extramammary Paget’s disease
Yoshio Nakamura1, Keiji Tanese1, Ikuko Hirai1, Masayuki Amagai1, Yutaka Kawakami2, Takeru Funakoshi1
1Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
2Division of Cellular Signaling Institute for Advanced Medical Research, Keio University School of Medicine Journal reference
British Journal of Dermatology. DOI: /bjd.17789

2. Research Team
Keiji Tanese, M.D., Ph.D.
Takeru Funakoshi, M.D., Ph.D.

3. Yoshio Nakamura, M.D., Ph.D.
Ikuko Hirai, M.D., Ph.D.

4. Introduction What’s already known?
Serum carcinoembryonic antigen (CEA) and cytokine 19 fragment (CYFRA 21-1) levels have been shown to be elevated in extramammary Paget’s disease (EMPD).
Elevation of serum CEA levels are associated with tumour progression of EMPD.
A single small study reported that serum CYFRA 21-1 levels are elevated in EMPD patients with lymph node metastasis.

5. Objective
EPMD is a rare intraepithelial adenocarcinoma affecting the genitals and axillary regions.
As metastasis of these tumours is itself rare, solid disease management strategies have not been established.
Serum CEA and CYFRA 21-1 levels have been identified as candidate biomarkers for tumour progression in EMPD.
However, due to the rareness of the disease, neither the accuracy of, nor correlation between, these markers have been examined in EMPD patients, yet.

6. Methods
Serum CEA and CYFRA 21-1 levels were examined in 30 EMPD patients treated at Keio University Hospital.
Both assays were performed at the time of diagnosis, during the postoperative observation period, and systemic treatment in those with confirmed metastasis.
Serum levels were then correlated with tumour progression status and treatment responses.

7. Results
In all primary localised patients, CEA and CYFRA were within normal levels.
In metastatic patients, CEA and CYFRA was elevated in 79% and 63%, respectively.
**P＝0.001

8. Results
Changes in CEA and CYFRA levels were statistically independent.
Using a combined view, either CEA or CYFRA were found to be elevated in 95% of the metastatic patients.
CEA
elevated
normal
CYFRA21-1 9 3 6 1
X2 test p =0.157

9. Results
In addition, both of the markers correlated well, with the treatment responses in all metastatic patients.
Changes in serum CEA and CYFRA 21-1 levels in metastatic EMPD patients.

10. Discussion
This study revealed that CEA and CYFRA combination assay may improve the sensitivity of detecting metastatic EMPD, as well as demonstrating the utility of this method for monitoring treatment responses in metastatic patients.
Evaluation of both CEA and CYFRA is a useful method for the management of advanced EMPD patients.

11. Conclusions What does this study add?
Serum CEA and CYFRA 21-1 analyses of nineteen metastatic EMPD cases were positive in 78.9% and 63.2%, respectively.
Elevation of CEA and CYFRA 21-1 were statistically independent.
CEA and CYFRA 21-1 combination assays were positive in 94.7% of metastatic EMPD cases.
Combination assays are useful for monitoring treatment response in metastatic EMPDs, particularly those with elevation of either marker.

12. Call for correspondence
Why not join the debate on this article through our correspondence section?
Rapid responses should not exceed 350 words, four references and one figure
Further details can be found here