肿瘤标志物CA15-3、CA125、癌胚抗原与分子亚型的乳腺癌生存率：一项队列研究
Tumor markers CA15-3, CA125, CEA and breast cancer survival by molecular subtype: a cohort study.
作者信息
Li Junxian, Liu Luyang, Feng Ziwei, Wang Xin, Huang Yubei, Dai Hongji, Zhang Liwen, Song Fangfang, Wang Dezheng, Zhang Pengyu, Ma Baoshan, Li Haixin, Zheng Hong, Song Fengju, Chen Kexin
机构信息
Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060, People's Republic of China.
Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, People's Republic of China.
出版信息
Breast Cancer. 2020 Jul;27(4):621-630. doi: 10.1007/s12282-020-01058-3. Epub 2020 Feb 10.
BACKGROUND
The burden of breast cancer has grown rapidly in China during recent decades. However, the association between tumor markers (CA15-3, CA125, and CEA) and breast cancer survival among certain molecular subtypes is unclear; we described this association in a large, population-based study.
METHODS
We conducted a cohort study including 10,836 women according to the Tianjin Breast Cancer Cases Cohort. Demographic and epidemiologic data were collected by a structured face-to-face questionnaire. Clinico-pathological parameters were abstracted from medical records, and follow-up information was obtained once a year by telephone. The primary endpoints were breast cancer-specific survival (BCSS) and disease-free survival (DFS). We utilized the Cox proportional hazard model to calculate hazard ratios (HRs) and 95% confidence intervals (CI).
RESULTS
Among all patients, elevated CA15-3 and CEA exhibited consistently and statistically significant reduced BCSS compared with normal ones (CA15-3: HR 1.54, 95% CI 1.01-2.34; CEA: HR 2.45, 95% CI 1.40-4.30). Similar patterns of association were observed for DFS (CA15-3: HR 2.09, 95% CI 1.44-3.02; CEA: HR 2.71, 95% CI 1.71-4.27). Moreover, in luminal A subtype, high CA15-3 and CEA levels were associated with decreased BCSS (CA15-3: HR 4.47, 95% CI 2.04-9.81; CEA: HR 3.79, 95% CI 1.68-8.55) and DFS (CA15-3: HR 4.06, 95% CI 2.29-7.18, CEA: HR 3.41, 95% CI 1.75-6.64). In basal-like subtype, elevated CEA conferred reduction for BCSS (HR 5.13, 95% CI 1.65-15.9). However, no association was observed between CA125 and breast cancer outcome.
CONCLUSIONS
Preoperative CA15-3 and CEA levels differ in breast cancer molecular subtypes and yield strong prognostic information in Chinese women with breast cancer. Measuring CA15-3 and CEA levels before surgery may have the potential in predicting breast cancer survival and offering patients' personalized treatment strategy among luminal A and basal-like subtypes.
背景
近几十年来，中国乳腺癌负担迅速增加。然而，某些分子亚型中肿瘤标志物（CA15-3、CA125和CEA）与乳腺癌生存之间的关联尚不清楚；我们在一项基于人群的大型研究中描述了这种关联。
方法
我们根据天津乳腺癌病例队列进行了一项队列研究，纳入10836名女性。通过结构化面对面问卷收集人口统计学和流行病学数据。从病历中提取临床病理参数，每年通过电话获取随访信息。主要终点为乳腺癌特异性生存（BCSS）和无病生存（DFS）。我们使用Cox比例风险模型计算风险比（HRs）和95%置信区间（CI）。
结果
在所有患者中，与CA15-3和CEA水平正常者相比，其水平升高与BCSS显著降低相关（CA15-3：HR 1.54，95%CI 1.01-2.34；CEA：HR 2.45，95%CI 1.40-4.30）。DFS也观察到类似的关联模式（CA15-3：HR 2.09，95%CI 1.44-3.02；CEA：HR 2.71，95%CI 1.71-4.27）。此外，在腔面A型亚型中，高CA15-3和CEA水平与BCSS降低相关（CA15-3：HR 4.47，95%CI 2.04-9.81；CEA：HR 3.79，95%CI 1.68-8.55）和DFS降低相关（CA15-3：HR 4.06，95%CI 2.29-7.18，CEA：HR 3.41，95%CI 1.75-6.64）。在基底样亚型中，CEA升高与BCSS降低相关（HR 5.13，95%CI 1.65-15.9）。然而，未观察到CA125与乳腺癌预后之间的关联。
结论
术前CA15-3和CEA水平在乳腺癌分子亚型中存在差异，可为中国乳腺癌女性提供强有力的预后信息。术前检测CA15-3和CEA水平可能有助于预测乳腺癌生存，并为腔面A型和基底样亚型患者提供个性化治疗策略。
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