Nicolini A, Carpi A, Ferrari P, Anselmi L, Spinelli C, Conte M, Miccoli P
Department of Internal Medicine, University of Pisa, Pisa, Italy.
Br J Cancer. 2000 Dec;83(11):1412-7. doi: 10.1054/bjoc.2000.1477.
The aim of this retrospective study was to assess the value of a serum tumour marker panel in selecting from among the patients with equivocal chest X-ray (CXR) or liver echography (LE) those with thoracic or liver metastases respectively. Between January 1984 and December 1999, 467 (341 non-relapsed and 126 metastatic) breast cancer patients were followed-up postoperatively. Among the 126 metastatic patients 36 showed thoracic (19 patients) or liver (17 patients) metastases, alone or in conjunction with other organs as the first evidence of distant spread. We focused on this series of 377 patients including 341 non-relapsed plus 36 with liver or thoracic metastases. The patients were followed-up after mastectomy with serial determinations of a panel of CEA-TPA-CA15.3 tumour markers, bone scintigraphy, CXR and LE. Up to December 1999, equivocal CXR occurred in 23 (6.1%) patients of whom 11 (47.8%) developed thoracic metastases; 14 (3.7%) patients showed an equivocal LE of whom 5 developed liver metastases. In the 37 patients with equivocal CXR or equivocal LE prolonged clinical and imaging follow-up over 41 +/- 36 months (mean +/- SD, range 3-163) was used to ascertain the presence or absence of thoracic or liver metastases. In the 23 patients with equivocal CXR the negative and positive predictive values of the tumour marker panel to predict thoracic metastases were 92% and 100% respectively. In the 14 patients with equivocal LE the negative and positive predictive values of the tumour marker panel for prediction of liver metastases were 90% and 100% respectively. This study shows that in breast cancer patients the CEA-TPA-CA15.3 tumour marker panel has a high value for selecting those patients at high risk of developing clinically evident pulmonary or liver metastases from amongst those subjects with equivocal CXR or equivocal LE.
这项回顾性研究的目的是评估血清肿瘤标志物组合在从胸部X线（CXR）或肝脏超声检查（LE）结果不明确的患者中分别筛选出有胸部或肝脏转移的患者方面的价值。1984年1月至1999年12月期间，对467例（341例未复发和126例转移）乳腺癌患者进行了术后随访。在126例转移患者中，36例出现胸部（19例患者）或肝脏（17例患者）转移，单独或与其他器官一起作为远处转移的首个证据。我们关注这377例患者，包括341例未复发患者以及36例有肝脏或胸部转移的患者。患者在乳房切除术后进行随访，连续测定CEA-TPA-CA15.3肿瘤标志物组合、骨闪烁显像、CXR和LE。截至1999年12月，23例（6.1%）患者CXR结果不明确，其中11例（47.8%）发生了胸部转移；14例（3.7%）患者LE结果不明确，其中5例发生了肝脏转移。对于37例CXR或LE结果不明确的患者，采用长达41±36个月（平均±标准差，范围3 - 163个月）的延长临床和影像学随访来确定是否存在胸部或肝脏转移。在23例CXR结果不明确的患者中，肿瘤标志物组合预测胸部转移的阴性和阳性预测值分别为92%和100%。在14例LE结果不明确的患者中，肿瘤标志物组合预测肝脏转移的阴性和阳性预测值分别为90%和100%。本研究表明，在乳腺癌患者中，CEA-TPA-CA15.3肿瘤标志物组合对于从CXR或LE结果不明确的患者中筛选出有发生临床明显肺或肝转移高风险的患者具有很高的价值。
