International Journal of Reproductive BioMedicine · Published 2026-07-14 · DOI 10.18502/ijrm.v24i5.21293
Nicko Pisceski Kusika Saputra, Samsulhadi Samsulhadi, Hendy Hendarto, Ashon Saádi, Widodo J Pudjirahardjo, I Wayan Arsana, Relly Yanuari, Sri Ratna Dwiningsih, Suri Dwi Lesmana
Background: Endometriosis is one of the most common gynecological conditions, and the gold standard for its diagnosis is laparoscopy. Cytokeratin fragment 21-1 (CYFRA 21-1) has emerged as a potential biomarker candidate due to its strong association with endometriosis. The mechanisms underlying the cleavage of cytokeratin-19 into CYFRA 21-1 remain unclear. Tumor necrosis factor alpha (TNF-α) may play a regulatory role in this process. Objective: This study aimed to analyze the correlation between intraperitoneal TNF-α levels and CYFRA 21-1 expression levels in women with endometriosis. Materials and Methods: This was an analytical study with a cross-sectional study design, involving 38 women diagnosed with endometriosis and 35 non-endometriosis women as controls. Both CYFRA 21-1 and TNF-α concentrations were measured using the Enzyme-Linked Immunosorbent Assay method. Urine creatinine was measured using the Electrochemiluminescence Immunoassay method, while clinical data were collected through medical records. Results: The mean intraperitoneal TNF-α level was significantly higher in the endometriosis group compared to controls (p < 0.001). A significant positive correlation was found between intraperitoneal TNF-α concentrations and CYFRA 21-1 levels (p < 0.001; r 0,662 [95% CI: 0.426–0.814]), indicating a strong association. Furthermore, a strong positive correlation was observed between the urinary CYFRA 21-1 to creatinine ratio and intraperitoneal TNF-α levels, particularly during the proliferative phase of the menstrual cycle. Conclusion: These findings suggest that TNF-α may influence CYFRA 21-1 expression in a cycle phase-dependent manner, supporting the potential role of CYFRA 21-1 as a non-invasive biomarker for endometriosis, particularly during the proliferative phase.
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Saputra, N., Samsulhadi, S., Hendarto, H., et al. (2026). The role of tumor necrosis factor alpha in regulating CYFRA 21-1 as a potential biomarker for endometriosis: A cross-sectional study. International Journal of Reproductive BioMedicine. https://doi.org/10.18502/ijrm.v24i5.21293