-Original-

Prognostic Implications of Postoperative Serum CYFRA Levels in Upper Tract Urothelial Carcinoma

Yuki Endo¹, Jun Akatsuka¹, Hayato Takeda¹, Masato Yanagi¹, Yuka Toyama¹, Kotaro Obayashi¹, Hikaru Mikami¹, Shunsuke Ikuma², Hiroya Hasegawa¹, Mami Takadate¹, Honami Inoue¹, Tsutomu Hamasaki³, Go Kimura¹ and Yukihiro Kondo¹

¹Department of Urology, Nippon Medical School, Tokyo, Japan
²Department of Urology, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
³Departiment of Urology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan

Background: Current guidelines lack recommendations for serum tumor markers in patients with upper tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). This study assessed the potential of the postoperative serum C-terminus of cytokeratin 19 (CYFRA21-1, CYFRA) level, hereafter referred to as poCY, as a predictor of early progression in patients treated with RNU.
Methods: Overall, 117 patients were categorized into the high group (HG) or low group (LG) based on a poCY cutoff level of 3.5 ng/mL after excluding those who did not meet the inclusion criteria. Kaplan-Meier curves and log-rank tests were used to measure cancer-specific survival (CSS) and progression-free survival (PFS) rates. Multivariate analysis was performed using the Cox proportional hazards model.
Results: During a median follow-up of 34 months, the 5-year CSS and PFS rates were 79% and 66%, respectively. The HG had a significantly worse CSS and 2-year PFS than the LG. Multivariate analyses identified poCY and lymph node involvement (LNI) as independent prognostic factors. Regarding the 2-year PFS, poCY, LNI, and resection margin status (RM) emerged as independent prognostic factors.
Conclusions: poCY, LNI, and RM predicted early progression following RNU in patients with UTUC. Patients with elevated poCY may benefit from adjuvant chemotherapy, irrespective of their pathological findings.

J Nippon Med Sch 2025; 92: 321-330

Keywords
radical nephroureterectomy, biomarker, postoperative progression, urothelial carcinoma, CYFRA

Correspondence to
Yuki Endo, MD, Department of Urology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
y-endo1@nms.ac.jp

Received, November 8, 2024
Accepted, March 26, 2025