Tampellini Marco, Berruti Alfredo, Bitossi Raffaella, Gorzegno Gabriella, Alabiso Irene, Bottini Alberto, Farris Antonio, Donadio Michela, Sarobba Maria Giuseppa, Manzin Enrica, Durando Antonio, Defabiani Enza, De Matteis Andrea, Ardine Mara, Castiglione Federico, Danese Saverio, Bertone Elena, Alabiso Oscar, Massobrio Marco, Dogliotti Luigi
Medical Oncology, University of Turin, Ospedale San Luigi, Orbassano, Torino, Italy.
Breast Cancer Res Treat. 2006 Aug;98(3):241-8. doi: 10.1007/s10549-005-9155-y. Epub 2006 May 3.
Tumor response to first-line chemotherapy in advanced breast cancer offers prognostic information and may be used as a surrogate marker for evaluating treatment efficacy. With this study we wanted to determine whether changes in circulating serum CA 15-3 levels during chemotherapy provided additional information for prognostic prediction. Serum CA 15-3 was measured at baseline and after 3 and 6 months during anthracycline-based first-line chemotherapy in 526 patients with advanced breast cancer prospectively enrolled in five phase II-III trials. Changes in marker levels were correlated with disease response, time to progression and overall survival. In all, 336 patients attained a disease response. A significant relationship was found between disease response and CA 15-3 variations, although many individual discrepancies were also observed. At the 6-month time point, the median time to progression was 15.3 months in patients with normal marker levels throughout the study, 11.7 months in those with a CA15-3 reduction >25%, 9.6 months in those with elevated baseline CA 15-3 levels which did not change during therapy and 8.6 months in those with increased marker levels (p < 0.001). The median survival was 42.3, 29.7, 28.5, and 24.8 months, respectively (p < 0.002). The prognostic role of changes in CA 15-3 levels was maintained in the patient subset attaining disease response or stabilization to treatment (p < 0.001) and after adjusting for clinical response and major prognostic parameters in the multivariate analysis (p < 0.001). In conclusion, monitoring serum CA 15-3 levels during first-line chemotherapy in advanced breast cancer patients provides prognostic information independently from tumor response.
晚期乳腺癌对一线化疗的反应可提供预后信息，并可用作评估治疗效果的替代标志物。通过本研究，我们想确定化疗期间循环血清CA 15-3水平的变化是否能为预后预测提供更多信息。在五项II-III期试验中前瞻性纳入的526例晚期乳腺癌患者中，在基于蒽环类药物的一线化疗的基线期、3个月和6个月后测量血清CA 15-3。标志物水平的变化与疾病反应、进展时间和总生存期相关。共有336例患者获得疾病反应。尽管也观察到许多个体差异，但发现疾病反应与CA 15-3变化之间存在显著关系。在6个月时间点，在整个研究中标志物水平正常的患者中，进展的中位时间为15.3个月，CA15-3降低>25%的患者为11.7个月，基线CA 15-3水平升高但在治疗期间未变化的患者为9.6个月，标志物水平升高的患者为8.6个月（p<0.001）。中位生存期分别为42.3、29.7、28.5和24.8个月（p<0.002）。CA 15-3水平变化的预后作用在获得疾病反应或病情稳定的患者亚组中得以维持（p<0.001），并且在多变量分析中调整临床反应和主要预后参数后也得以维持（p<0.001）。总之，在晚期乳腺癌患者一线化疗期间监测血清CA 15-3水平可独立于肿瘤反应提供预后信息。
