Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore.
Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore; SingHealth Duke-NUS Breast Centre, Singapore.
Breast. 2020 Aug;52:95-101. doi: 10.1016/j.breast.2020.05.005. Epub 2020 May 20.
Serum tumour markers, cancer antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) are not routinely recommended for detecting breast cancer recurrence and monitoring treatment. In this study, we aim to evaluate the diagnostic accuracy of absolute CA 15-3 and CEA levels and report on the clinical utility of tumour marker velocity in breast cancer surveillance.
67 consecutive patients over a 15-year period (1998-2012) with available serial serum CA 15-3 and CEA measurements at recurrence were matched to a control group of patients. Tumour marker velocity was derived from the average change in consecutive tumour marker values over time, expressed in unit/year. Logistic regression analysis was performed to investigate the association between tumour characteristics, tumour marker velocity and disease recurrence.
Using the Youden index values, the optimal cut-off values for absolute CA 15-3 and CEA corresponded to the normal assay reference range while tumour marker velocity values were derived to be 2.5U/mL/year and 1.2ng/mL/year respectively. CA 15-3 velocity > 2.5U/mL/year had the highest AUROC value of 0.85 than CEA velocity alone. When either tumour marker velocity exceeded threshold values, the sensitivity, specificity, negative predictive value and positive predictive value were 94.0%, 73.1%, 92.5%, and 77.8% respectively. In the multivariate logistic regression analysis, having both CA 15-3 and CEA velocity exceeding the cut-off values was shown to be a significant predictor for disease recurrence (p = 0.01).
These findings highlighted the clinical utility of serial tumour markers measurements and its velocity in breast cancer surveillance.
血清肿瘤标志物，癌抗原 15-3（CA 15-3）和癌胚抗原（CEA）通常不推荐用于检测乳腺癌复发和监测治疗。在本研究中，我们旨在评估绝对 CA 15-3 和 CEA 水平的诊断准确性，并报告肿瘤标志物速度在乳腺癌监测中的临床应用。
在 15 年期间（1998-2012 年），对 67 例连续出现可获得的复发性血清 CA 15-3 和 CEA 测量值的患者进行了研究，并与对照组患者进行了匹配。肿瘤标志物速度是从随时间推移连续肿瘤标志物值的平均变化得出的，以单位/年来表示。进行逻辑回归分析以研究肿瘤特征、肿瘤标志物速度与疾病复发之间的关系。
使用 Youden 指数值，绝对 CA 15-3 和 CEA 的最佳截断值对应于正常检测参考范围，而肿瘤标志物速度值则分别设定为 2.5U/mL/年和 1.2ng/mL/年。CA 15-3 速度>2.5U/mL/年的 AUROC 值最高，为 0.85，优于 CEA 速度单独使用。当任一肿瘤标志物速度超过阈值时，其敏感性、特异性、阴性预测值和阳性预测值分别为 94.0%、73.1%、92.5%和 77.8%。在多变量逻辑回归分析中，CA 15-3 和 CEA 速度均超过截止值被证明是疾病复发的显著预测因子（p=0.01）。
这些发现强调了连续肿瘤标志物测量及其速度在乳腺癌监测中的临床应用。
