Esteban J M, Felder B, Ahn C, Simpson J F, Battifora H, Shively J E
Division of Pathology, City of Hope National Medical Center, Duarte, California.
Cancer. 1994 Sep 1;74(5):1575-83. doi: 10.1002/1097-0142(19940901)74:5<1575::aid-cncr2820740513>3.0.co;2-w.
Expression of carcinoembryonic antigen (CEA) has been reported in 10-95% of breast cancer. Its value as a predictor of disease progression is controversial.
The expression of CEA in 202 Stages I and II breast carcinomas was assessed by immunohistochemistry, and the results were correlated with various histologic and clinical parameters to establish CEA's biologic relevance. The mean follow-up of the patients was 6.5 years. The monoclonal antibody used does not cross-react with other molecules in the CEA gene family.
One hundred, thirteen (56%) tumors expressed CEA in more than 15% of the cells. Expression of CEA was associated with positive estrogen receptor (ER) status (P = 0.003). Univariate Cox regression analysis showed that, whereas disease free survival (DFS) and overall survival (OS) were not associated significantly with CEA expression, tumor size, nuclear grade, ER status, lymph node metastases, and stage were. When ER status was stratified to CEA expression, patients who were ER negative and had CEA-negative tumors had a 3.9 times higher risk (P = 0.032) of death than did the patients with CEA-positive tumors. Cox regression analysis revealed that ER was the only parameter with significant interacting effect with CEA. Multivariate, stepwise Cox regression analysis showed that CEA expression, tumor size, and nuclear grade were the only significant independent predictors of DFS, and nuclear grade and lymph node metastasis the only significant predictors of OS in the ER-positive group. The only significant independent predictor of DFS and OS in the ER-negative group was CEA. When CEA expression was stratified to ER status, patients whose tumors lacked CEA and ER had threefold higher risk of disease relapse (P = 0.002) and a 5.3-fold higher risk of death (P = 0.0001) than those with ER-positive and CEA-negative tumors. Multivariate analysis showed that the association between CEA and ER was enhanced further after compensating for other parameters with independent predictive value.
The association between CEA and ER was the most important independent predictor of a subgroup of patients (CEA-negative, ER-positive) with the most favorable prognosis. The results imply that the association of several tumor markers may provide tumor profiles with superior predictive value than a single parameter.
据报道，10% - 95%的乳腺癌中存在癌胚抗原（CEA）表达。其作为疾病进展预测指标的价值存在争议。
采用免疫组织化学方法评估202例Ⅰ期和Ⅱ期乳腺癌中CEA的表达情况，并将结果与各种组织学和临床参数相关联，以确定CEA的生物学相关性。患者的平均随访时间为6.5年。所使用的单克隆抗体与CEA基因家族中的其他分子无交叉反应。
113例（56%）肿瘤中，超过15%的细胞表达CEA。CEA的表达与雌激素受体（ER）阳性状态相关（P = 0.003）。单因素Cox回归分析显示，无病生存期（DFS）和总生存期（OS）与CEA表达无显著相关性，而与肿瘤大小、核分级、ER状态、淋巴结转移和分期相关。当根据ER状态对CEA表达进行分层时，ER阴性且CEA阴性肿瘤的患者死亡风险比CEA阳性肿瘤的患者高3.9倍（P = 0.032）。Cox回归分析显示，ER是与CEA具有显著交互作用的唯一参数。多因素逐步Cox回归分析显示，在ER阳性组中，CEA表达、肿瘤大小和核分级是DFS的唯一显著独立预测因素，核分级和淋巴结转移是OS的唯一显著预测因素。在ER阴性组中，DFS和OS的唯一显著独立预测因素是CEA。当根据ER状态对CEA表达进行分层时，肿瘤缺乏CEA和ER的患者疾病复发风险比ER阳性且CEA阴性肿瘤的患者高3倍（P = 0.002），死亡风险高5.3倍（P = 0.0001）。多因素分析显示，在补偿了其他具有独立预测价值的参数后，CEA与ER之间的关联进一步增强。
CEA与ER之间的关联是预后最良好的亚组患者（CEA阴性、ER阳性）最重要的独立预测因素。结果表明，几种肿瘤标志物的联合应用可能比单一参数提供更具预测价值的肿瘤特征。
