CEA和CYFRA21-1在原发性肺癌诊断中的应用价值分析

目的:评价血清癌胚抗原(carcinoembryonic antigen,CEA)和细胞角蛋白19的片段(CYFRA21-1)水平对原发性肺癌的诊断价值。方法:回顾性分析2012年5月~2013年5月我科收治的329例肺癌患者和192例肺部良性病变患者的临床资料。结果:肺癌患者血清CEA或CYFRA21-1水平随着肺癌的分期呈现逐渐上升的趋势(P0.001,P0.01)。以血清CEA≥3.4μg/L作为诊断条件诊断肺癌的灵敏度、特异度和阳性预计值预计值分别为67%、62%和75.2%;以血清CYFRA-21≥5.0 ug/L作为诊断条件诊断原发性肺癌的灵敏度、特异度和阳性预计值预计值分别为48%、87%和86.3%;以血清CEA≥3.4 ug/L和CYFRA-21≥5.0 ug/L共同作为诊断条件推断原发性肺癌的灵敏度、特异度和阳性预计值预计值分别为48%、87%和86.3%;良性肺部疾病患者中血清CEA和CYFRA-21水平同时升高者只有2%。结论:血清CEA≥3.4 ug/L和CYFRA-21≥5.0 ug/L同时升高对肺癌有具有重要的诊断价值,可有效的鉴别原发性肺癌与其它良性病变。     

非小细胞肺癌患者血清CYFRA21-1、VEGF及CEA的表达及与临床病理特征的相关性研究

目的:研究非小细胞肺癌(NSCLC)患者血清细胞角蛋白19片段(CYFRA21-1)、血管内皮生长因子(VEGF)、癌胚抗原(CEA)的表达及与临床病理特征的相关性。方法:选取2015年12月至2016年4月在我院接受治疗的NSCLC患者120例作为观察组,另选取同期在我院接受治疗的肺部良性病变患者50例作为良性对照组,比较两组患者血清中CYFRA21-1、VEGF及CEA的表达,分析观察组患者血清中CYFRA21-1、VEGF及CEA的表达与临床病理特征之间的关系,采用Pearson相关系数分析观察组患者血清中CYFRA21-1、VEGF、CEA的相关性。结果:观察组患者血清中的CYFRA21-1、VEGF及CEA水平均高于良性对照组(P0.05)。鳞状细胞癌患者血清中CYFRA21-1水平高于腺癌患者,CEA水平低于腺癌患者(P0.05),鳞状细胞癌患者和腺癌患者血清中VEGF水平比较无统计学差异(P0.05)。TNM分期为III-IV期的观察组患者血清中CYFRA21-1、VEGF及CEA水平均明显高于I-II期患者,有统计学差异(P0.05)。经Pearson相关系数分析显示,观察组患者血清中CYFRA21-1与VEGF、CEA呈正相关(r=0.512,0.423,P=0.000,0.000),VEGF与CEA呈正相关(r=0.452,P=0.000)。结论:NSCLC患者血清中CYFRA21-1、VEGF及CEA呈高表达,且CYFRA21-1、CEA与病理类型和TNM分期有关,VEGF与TNM分期有关,且三种指标存在一定的相关性。     

Serum level of cytokeratin 19 fragment (CYFRA 21-1) indicates tumour stage and prognosis of squamous cell carcinoma of the oesophagus

To determine the clinical efficacy of serum concentration of cytokeratin 19 fragment (CYFRA 21-1), sera from 66 patients with oesophageal squamous cell carcinoma were examined, and 54 surgically resected specimens were immunohistochemically stained for cytokeratin 19 (CK-19). The patients with positive CK-19 staining in the tissues of their carcinomas had significantly higher serum CYFRA 21-1 levels compared with those with negative CK-19 staining. When the cut-off value was defined as 2.0 ng/mL, CYFRA 21-1 had a higher positive ratio than that of either squamous cell carcinoma antigen (SCC-Ag) or carcinoembryonic antigen (CEA). Serum CYFRA 21-1 level increased significantly along with the clinical stages. In addition, serum CYFRA 21-1 level served as a prognostic factor for patients with oesophageal carcinoma after surgery, whilst SSC-Ag and CEA is not connected with the outcome. These findings suggest that the serum CYFRA 21-1 probably originated from the tumour tissue is an important marker for determining the stage and outcome of oesophageal carcinoma.     

P53抗体联合CYFRA21-1和CEA在非小细胞肺癌中的应用

目的：研究血清P53抗体在非小细胞肺癌临床病理特征之间的关系,并结合血清中的癌胚抗原、角质蛋白21-1以指导对临床上肺癌复发和转移的分析,用来选择合理的治疗方案。方法：正常组30例,肺良性疾病组10例,肺癌组45例,肺癌全组分别于手术前1天、术后10、30、60和90天时抽取清晨空腹静脉血2ml,23例肺癌病例于手术后120天,15例病例于手术后180天抽取清晨空腹静脉血2ml,肺良性疾病组分别于手术前1天、抽取清晨空腹静脉血2ml。正常组清晨空腹采集静脉血2ml。采用酶联免疫吸附法（ELISA）检测血清P53抗体和角质蛋白21-1,采用荧光酶标免疫法检测血清癌胚抗原。结果：血清P53抗体、CYFRA21-1和CEA在正常人组、良性疾病组、肺癌组术前阳性率的比较三种肿瘤标志物阳性率经X2检验,在肺癌组分别与正常人组和良性病例组有显著性差异（P〈0.05）,良性病例组和正常人组之间无显著行差异（P〉0.05）。并与手术后复发与转移相关。结论：联合检测癌胚抗原、角质蛋白21-1及血清P53抗体水平有助于肺部良恶性疾病的诊断;手术前后动态测定肺癌患者血清P53抗体和角质蛋白21-1的变化规律,有助于判断疗效,监测预后和指导肺癌术后的综合治疗。     

血清肿瘤标志物在肺癌辅助诊断中的应用

目的探讨血清肿瘤标志物在肺癌诊断中的临床价值。方法收集40例健康人、45例肺部良性疾病患者和90例肺癌患者,采用电化学发光分析检测患者血清中肿瘤标志物细胞角蛋白19(CYFRA21-1)、鳞状细胞癌相关抗原(SCC)和癌胚抗原(CEA),以及胃泌素释放肽前体(pro-GRP)和神经元特异性烯醇化酶(NSE)的含量。结果健康人组和肺部良性疾病患者组血清NSE、pro-GRP、CYFRA21-1、SCC和CEA水平较肺癌患者组水平低,差异有统计学意义(P0.01)。NSE和pro-GRP在小细胞肺癌患者中的水平均明显高于其他类型的肺癌患者(P0.01),CYFRA21-1和SCC在鳞癌患者中的含量比其他类型肺癌患者高(P0.01)。联合检测此5种血清肿瘤标志物敏感性高于单独的肿瘤标志物(P0.01)。结论联合检测NSE、pro-GRP、CYFRA21-1、SCC和CEA可以提高肺癌诊断的灵敏度。     

多种血清肿瘤标志物联合检测对肺癌诊断的临床意义分析

目的:探讨CA125、CYFRA21-1、CEA、NSE、AFP联合检测对肺癌的诊、诊断的敏感度以及特异性。方法:对我院收治的确诊为肺癌的患者选取120例作为A组,同期选择肺部良性病变患者61例作为B组,以及50例健康体检患者作为C组,将三组研究对象分别进行CA125、CYFRA21-1、CEA、NSE、AFP的检测。结果:A组患者CA125、CYFRA21-1、CEA、NSE、AFP的血清中含量明显高于B组以及C组(P<0.05);五种标记物联合检测的敏感度明显高于单一标志物的敏感度(P<0.05),但其特异性有明显的降低(P<0.05)。结论:采用CA125、CYFRA21-1、CEA、NSE、AFP联合检测,对肺癌的早期诊断以及治疗预后有较好的指导作用。     

CYFRA21-1 can predict the sensitivity to chemoradiotherapy of non-small-cell lung carcinoma

Background: The increasing panel of systemic therapies enables the individual management of lung cancer patients, even in advanced stages. However, predictive tools indicating the efficacy of chemoradiotherapy (CRT) are badly needed.

Aims: To determine the tumour markers for predicting the therapeutic effect in non-small-cell lung carcinoma (NSCLC) patients treated with CRT.

Methods: The serum levels of cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), neurone-specific enolase (NSE) and carcinoembryonic antigen (CEA) were measured before CRT by enzyme-linked immunosorbent assays, while the tumour responses were assessed according to the World Health Organization (WHO) response criteria. The relationships between pretreatment expression of CYFRA21-1, NSE, CEA and the effectiveness of CRT were analysed.

Results: The complete response (CR) rate of the primary tumours estimated by computed tomography in patients with high levels of CYFRA21-1 was 2.9% (2/68) while in cases with low CYFRA21-1 it was 20.3% (12/59) (p?=?0.005). The effective rates (CR+PR) in CYFRA21-1 high and low groups were 52.9% (36/68) and 72.9% (43/59), respectively (p?=?0.022).

Conclusions: CYFRA21-1 may be a reliable surrogate marker of CRT efficacy in patients with NSCLC.     

CYFRA21-1 and CEA are useful markers for predicting the sensitivity to chemoradiotherapy of esophageal squamous cell carcinoma

Background: Chemoradiotherapy (CRT) is currently performed for patients with advanced esophageal carcinoma. Sensitivity of tumours to CRT differs from one case to another and may be influenced by the expression of biological molecules. The aim of this study was to identify biological markers which could predict sensitivities of esophageal squamous cell carcinoma (ESCC) to CRT.

Methods: A total of 84 patients with stage I–IV ESCC were evaluated. The cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) and carcinoembryonic antigen (CEA) levels were measured before CRT by enzyme-linked immunosorbent assays in patients with primary ESCCs using 3.4?ng ml^?1 and 3.3?ng ml^?1, respectively, as cut-off values. The relationships between pretreatment expression of CYFRA 21-1 and CEA and the effectiveness of CRT were analysed.

Results: The complete response (CR) rates of the primary tumours estimated by computed tomography in patients with high levels of CYFRA21-1 and CEA were 10% (3/30) and 4.2% (1/24), while in cases with low CYFRA21-1 and CEA the CR rates were 50% (27/54) and 48.3% (29/60), respectively (p?=?0.002 and 0.003). The effective rates (CR+PR) in CYFRA21-1 high and low groups were 60% (18/30) and 96.3% (52/54), while in CEA high and low groups they were 58.3% (14/24) and 93.3% (56/60), respectively (p?=?0.013 and 0.013).

Conclusion: CYFRA21-1 and CEA may be helpful in predicting the responsiveness in ESCC of primary lesions to CRT, although the results should be confirmed in larger, more homogeneous studies.     

血清肿瘤标志物检测对晚期非小细胞肺癌靶向治疗的预后分析

目的：探究检测血清肿瘤标志物对预测晚期非小细胞肺癌靶向治疗预后的影响。方法：选取2010年4月至2012年12我院收治的晚期非小细胞肺癌患者70例,均予以吉非替尼进行治疗,检测治疗前及治疗后2个月肿瘤标志物癌胚抗原CEA、角蛋白19的可溶性片段（CYFRA21—1）、癌抗原125（CA125）的表达水平,观察其表达水平与患者疗效之间的关系。结果：治疗后,患者完全缓解1例,部分缓解37例,疾病稳定19例,疾病进展13例,有效率为54．3％。治疗后,治疗有效的患者CEA、CA125明显比治疗前降低,结果具有统计学意义（P〈0．05）;而疾病稳定、疾病进展的患者治疗后CEA、CA125与治疗前比却无明显差异（P〉0．05）。治疗有效与疾病稳定的患者治疗后CYFRA21．1有明显降低,但与治疗前比却无明显差异（P〉0．05）;而疾病进展患者的CYFRA21—1却明显升高,与治疗前比有显著差异（P〈0．05）。而治疗前,治疗有效的患者血清中CEA、CA125比疾病稳定、疾病进展的患者明显较高,结果具有统计学意义（P〈0．05）;疾病稳定患者的CEA、CA125与疾病进展患者的相比,治疗有效的患者CYFRA21-1与疾病稳定、疾病进展的相比,结果均不具有统计学意义（P〉0．05）。结论：治疗前CEA、CA125浓度较高则治疗效果不错．治疗后效果较好则CEA、CA125浓度较低,效果不好则CYFRA21-1浓度较高。利用血清肿瘤标志物可显著反映肿瘤靶向药物治疗的预后情况,为临床判断其治疗效果提供依据。     

Increased CYFRA 21-1, CEA and NSE are Prognostic of Poor Outcome for Locally Advanced Squamous Cell Carcinoma in Lung: A Nomogram and Recursive Partitioning Risk Stratification Analysis

OBJECTIVES: This study aimed to: (1) assess the prognostic significance of serum tumor markers in locally advanced squamous cell carcinoma in lung (LA-SCCL); (2) generate a nomogram to predict the overall survival (OS) and (3) identify a prognostic stratification to assist the therapeutic decision-making. METHODS: LA-SCCL patients receiving definitive radiotherapy and baseline tumor marker measurement were eligible for this retrospective study. Cox proportional hazards regression was used to determine independent factors associated with various survival indexes and a nomogram was created to estimate the 5-year OS probability for individual patient. The identified prognostic factors were recruited into a recursive partitioning analysis (RPA) for OS to stratify patients with distinct outcome. RESULTS: A total of 224 patients were eligible for analysis. Increased cytokeratin-19 fragment (CYFRA 21-1) was independently associated with inferior OS, progression free survival (PFS) and a borderline decreased local-regional progression free survival (LRPFS). Elevated carcino-embryonic antigen (CEA) served as an unfavorable determinant for OS and increased neuron-specific enolase (NSE) was predictive of poor distant metastasis free survival (DMFS). A nomogram integrating KPS, TNM stage, CEA and CYFRA 21-1 was created, resulting in a c-index of 0.62. RPA identified 4 prognostic classifications, with median OS of 27.6, 19.9, 17.3 and 10.9?months for low, intermediate, high and very-high risk groups, respectively. CONCLUSIONS: Baseline tumor marker panel including CYFRA 21-1, CEA and NSE can be prognostic of outcome for LA-SCCL receiving definitive radiotherapy. The RPA identified four prognostic subgroups, which could assist personalized therapy and clinical trial design in LA-SCCL.     

肺癌患者血清CEA、CYFRA21-1和NSE的检测及临床意义

目的探讨外周血癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)和神经元特异性烯醇化酶(NSE)的检测对肺癌的诊断、病理分型和疗效判断的临床用价值。方法采用化学发光法检测了62例肺癌患者、54例良性肺部疾病患者、36例健康人、40例肺癌患者手术前后血清CEA、CYFRA21-1和NSE的水平。结果肺癌患者手术前血清CEA、CYFRA21-1和NSE的含量明显高于良性肺部疾病组及正常对照组(P0.01)。鳞癌组、腺癌组和小细胞癌组之间肿瘤标志物CEA、CYFRA21-1和NSE水平差异有统计学意义。CEA阳性率以腺癌组最高(84%),CYFRA21-1阳性率以鳞癌组最高(85.2%),NSE阳性率以小细胞癌组最高(80.0%)。手术治疗后未复发转移组CEA、CYFRA21-1和NSE水平低于术前,而复发转移组与术前比变化不显著(P0.05)。结论血清CEA、CYFRA21-1和NSE的检测对不同病理类型肺癌患者的诊断、病情检测及疗效判断有较好的临床参考价值。     

NSE、CEA 和CYFRA21-1 测定对胸腔积液的诊断价值

目的:探讨神经元烯醇化酶(NSE)、癌胚抗原(CEA)和细胞角蛋白19(CYFRA21-1)测定对胸腔积液的诊断价值。方法:选择我院2009年4月～2011年9月收治的胸腔积液患者89例作为研究对象,按照胸腔积液性质分为两组,良性组47例,恶性组42例,对两组的NSE、CEA和CYFRA21-1测定结果进行比较分析。结果:恶性组患者血清和胸腔积液中NSE、CEA和CYFRA21-1水平均明显高于良性组,组间差异有统计学意义(P<0.05);NSE、CEA和CYFRA21-1联合检测对恶性胸腔积液的敏感性均明显高于单独NSE、CEA和CYFRA21-1检测,差异有统计学意义(P<0.05)。结论:NSE、CEA和CYFRA21-1测定对胸腔积液具有临床诊断价值,且三者联合检测能够明显提高诊断敏感性。     

槐耳颗粒联合GP方案治疗晚期非小细胞肺癌的疗效及对Th1/Th2免疫平衡和血清肿瘤标志物的影响

摘要 目的：观察晚期非小细胞肺癌（NSCLC）采用吉西他滨+顺铂（GP方案）联合槐耳颗粒治疗的疗效及对Th1/Th2免疫平衡和血清肿瘤标志物的影响。方法：选取2020年01月~2022年02月期间来成都市第六人民医院接受治疗的晚期NSCLC患者80例。采用双色球法将患者分为对照组（40例,GP方案治疗）和研究组（40例,槐耳颗粒联合GP方案治疗）。对比两组临床疗效、血清肿瘤标志物[糖类抗原125（CA125）、癌胚抗原（CEA）、细胞角蛋白19片段21-1（CYFRA21-1）]、Th1/Th2免疫平衡和不良反应。结果：研究组客观缓解率、疾病控制率高于对照组（P<0.05）。两组不良反应发生率组间对比无差异（P>0.05）。研究组治疗后卡式评分（KPS）、Th1、Th1/Th2高于对照组（P<0.05）,Th2低于对照组（P<0.05）。治疗后研究组血清CA125、CYFRA21-1、CEA水平较对照组低（P<0.05）。结论：槐耳颗粒联合GP方案治疗晚期NSCLC,可有效降低血清CA125、CEA、CYFRA21-1水平,改善Th1/Th2免疫平衡,安全可靠。     

CYFRA21-1、MMP-3及CEA 和细胞学联合检查对恶性胸腔积液的诊断价值分析

摘要 目的：探讨细胞角蛋白19片段（CYFRA21-1）、基质金属蛋白酶-3（MMP-3）及癌胚抗原（CEA） 和细胞学联合检查对恶性胸腔积液的诊断价值。方法：选择2020年1月至2023年1月我院接诊的100例胸腔积液患者进行研究,并根据病理结果分为实验组47例（病理检查结果恶性）,对照组53例（病理检查结果良性）,分析血清CYFRA21-1、MMP-3及CEA 和细胞学水平变化情况及其的诊断价值。结果：实验组患者血清血清CYFRA21-1、MMP-3及CEA水平显著高于对照组,差异显著（P＜0.05）;实验组患者CYFRA21-1、MMP-3及CEA 和细胞学阳性率均显著高于对照组,差异显著（P＜0.05）;CYFRA21-1诊断恶性胸腔积液的AUC为0.989,95%CI为0.977~1.000;MMP-3诊断恶性胸腔积液的AUC为0.979,95%CI为0.964~0.994;CEA 诊断恶性胸腔积液的AUC为0.982,95%CI为0.967~0.997;细胞学诊断恶性胸腔积液的AUC为0.823,95%CI为0.766~0.879,联合检测时AUC为0.995,95%CI为0.990~1.000,较单独检测曲线下面积比较显著差异;且特异度、准确度均较单独检测更高。结论：CYFRA21-1、MMP-3及CEA 和细胞学联合检查可有效提高诊断恶性胸腔积液的准确性,临床应用价值高。     

Early CYFRA 21-1 variation predicts tumor response to chemotherapy and survival in locally advanced non-small cell lung cancer patients

We have evaluated CYFRA 21-1 serum level variations as an indicator of tumor response and survival in 44 consecutive patients with locally advanced non-small cell lung cancer (NSCLC) treated with induction chemotherapy (IC). Irrespective of the initial CYFRA 21-1 serum concentration, a more than 65% decrease in the serum level after the first chemotherapy course was significantly predictive of an objective tumor response (p = 0.0022). In addition, a more than 80% decrease in this level significantly predicted a better disease-free survival (p = 0.039). In patients with initial CYFRA 21-1 serum levels > 3.3 ng/mL (n = 29), a more than 80% decrease after the first IC course was the most significant predictor of overall survival (p = 0.025) in a Cox analysis including initial staging, tumor response and surgery. We conclude that early monitoring of CYFRA 21-1 serum levels may be a useful prognostic tool for tumor response and survival in stage III NSCLC patients treated by induction chemotherapy.     

肺癌肿瘤标志物的临床意义及研究进展

肺癌血清肿瘤标志物在肺癌的早期筛查、诊断、疗效评价、复发及预后预测等方面有重要的指导意义。本研究对目前临床常用的癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、细胞角蛋白19片段抗原（CYFRA21—1）、鳞状细胞癌相关抗原（SCC—Ag）、乳酸脱氢酶（LDH）5种肺癌相关血清肿瘤标志物的临床意义及研究进展进行综述。     

Diagnostic utility of CYFRA 21-1 and CEA assays in pericardial fluid for the recognition of neoplastic pericarditis

A positive cytology result in pericardial fluid is the gold standard for recognition of malignant pericardial effusion. Unfortunately, in 30-50% of patients with malignant pericardial effusion cytological examination of the pericardial fluid is negative. Tumor marker assessment in pericardial fluid may help to recognize malignant pericardial effusion. The aim of our study was to estimate the value of CYFRA 21-1 and CEA measurement in pericardial fluid for the recognition of malignant pericardial effusion. To our knowledge this is the first study on CYFRA 21-1 assessment in pericardial effusion. The examined group consisted of 50 patients with malignant pericardial effusion and 34 patients with non-malignant pericardial effusion. Median CEA concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 80 ng/mL (0-317) and 0.5 ng/mL (0-18.4), respectively (p<0.001). Median CYFRA 21-1 concentrations in malignant pericardial effusion and non-malignant pericardial effusion were 260 ng/mL (5.3-10080) and 22.4 ng/mL (1.87-317.6), respectively (p<0.001). The optimal cutoff value for CYFRA 21-1 in pericardial effusion was 100 ng/mL. CYFRA 21-1 >100 ng/mL or CEA >5 ng/mL were found in 14/15 patients with malignant pericardial effusion and negative pericardial fluid cytology. We therefore strongly recommend the use of CYFRA 21-1 and/or CEA in addition to pericardial fluid cytology for the recognition of malignant pericardial effusion.     

Preoperative CEA, NSE, SCC, TPA and CYFRA 21.1 serum levels as prognostic indicators in resected non-small cell lung cancer.

In 62 patients affected by resectable non-small cell lung cancer (NSCLC) submitted to radical surgery we evaluated the prognostic significance of CEA, NSE, SCC, TPA, and CYFRA 21.1 serum levels at diagnosis, as well as the predictive ability of these tumor markers with respect to histological type and pathological stage. The group was composed of 56 male and 6 female patients; the median age was 62 years (range 29-73 years). Thirty-four patients had a histological diagnosis of adenocarcinoma and 28 of squamous cell carcinoma; with regard to pathological stage, 32 patients had stage 1, 4 patients stage II and 23 patients stage IIIA disease. A good predictive ability with respect to histological type was obtained with SCC serum levels; as for pathological stage, TPA and CYFRA 21.1 were found to have moderate predictive ability. In this series of patients, at a median follow-up of 55 months after surgery, we found that both TPA and CYFRA 21.1 serum levels at diagnosis were reliable predictors of overall survival, high values of these markers being associated with a worse prognosis.     

Cytokeratins as serum markers in egyptian bladder cancer. A comparison of CYFRA 21-1, TPA and TPS

Cytokeratins (CKs) have been shown to be overexpressed in bladder cancer and to be valuable as tumor markers. The present study was designed to evaluate the single and combined use of three cytokeratin fragments, CYFRA 21-1, TPA, and TPS, in serum of Egyptian bladder cancer patients. The study subjects comprised 40 healthy controls, 30 patients with benign bladder diseases, and 60 patients with histologically confirmed primary bladder cancer. The cutoff was set at 95% specificity versus benign bladder diseases, resulting in cutoff values of 2.93 ng/mL for CYFRA 21-1, 158 U/L for TPA and 143.7 ng/mL for TPS. With 41% true positive results CYFRA 21-1 had a higher sensitivity than TPA (32%) and TPS (27%). Evaluation by histological findings revealed a highest sensitivity of CYFRA 21-1 (46%) in transitional cell carcinoma (TCC) followed by TPA (27%) and TPS (21%). Also in adenocarcinoma CYFRA 21-1 showed the highest sensitivity (38%) followed by TPA (32%) and TPS (28%). A high percentage (41.6%) of Egyptian bladder cancers is represented by squamous cell carcinoma (SCC). In this population TPS showed the highest sensitivity (69%), followed by CYFRA 21-1 (54%) and TPA (41 %). The sensitivity of each of the three markers increased with advancing tumor stage and increasing tumor grade. Combined use of two of the three markers did not raise the sensitivities obtained by single determination of CYFRA 21-1. The present study suggests that serum CYFRA 21-1 could be a marker of choice in bladder cancer.