2004P - The combination of high levels of serum cytokeratin fragment 21-1 and VI-RADS≧4 has diagnostic and prognostic value in high-stage bladder cancer

Background

The aim of this study was to determine whether the combination of serum Cytokeratin fragment 21-1 (sCYFRA) and Vesical Imaging Reporting and Data System (VI-RADS) scores has diagnostic and prognostic value in high-stage bladder cancer.

Methods

We performed 537 transurethral resections of bladder tumors at our hospital between January 2019 and August 2023, who underwent preoperative Magnetic resonance imaging (MRI) and measured post operative sCYFRA into this study. We first evaluated all patients by the VI-RADS. The correlation between sCYFRA, C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) levels and clinicopathological features in the VI-RADS≥4 group was compared. Cut-off values were determined using ROC analysis. We also analyzed overall survival (OS) at each cut-off value.

Results

A total of 134 cases were examined. The diagnostic performance of VI-RADS was 87% for sensitivity and 89% for specificity, with an area under the curve (AUC) of 0.86. In the VI-RADS ≧ 4 group, in multivariate analysis, the levels of sCYFRA were most significantly higher than other variables in lymph nodes (p<0.001) and distant metastasis (p<0.001). The ROC curve showed AUCs of 0.924 and 0.896 for predicting lymph node metastasis and distant metastasis with sCYFRA in VI-RADS≥4 group. The cut-off value for sCYFRA was set at 2.0 ng/dL. The median follow-up was 13(1-56) months. Overall, 21 (15.6 %) patients developed tumor progression, and 18 (13.4 %) patients died. The AUC of sCYFRA predicting 1-year OS was 0.803 and 3-year OS was 0.802 in VI-RADS≥4 group. In all cases, multivariate COX analysis showed that the sCYFRA ≥2.0 ng/dL group was the most significant risk factor for OS (HR = 8.92, P < 0.001). In the VI-RADS≥4 group, patients with sCYFRA≥2.0 ng/dL was only risk factors for OS (HR = 5.19, P = 0.008). In the VI-RADS<4 group, levels of sCYFRA showed no difference in OS.

Conclusions

This study suggests that high levels of sCYFRA in VI-RADS ≥ 4 group could predict high-stage and poor prognosis of bladder cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.