al-Jarallah M A, Behbehani A E, el-Nass S A, Temim L, Ebraheem A K, Ali M A, Szymendera J J
Department of Surgery, Kuwait Cancer Control Center, Shuwaikh.
Eur J Surg Oncol. 1993 Feb;19(1):74-9.
Serum CA-15.3 and CEA levels were longitudinally determined in 307 patients with breast carcinoma during postsurgical follow-up and/or therapy. Of 120 patients with no apparent disease, the specificity of marker levels fluctuating within the normal range (true-negative) was 98% for CA-15.3 alone (P = 0.004) and about 88% for CEA alone or for the tests combined. However, the false-negative levels in patients with progressive cancer reduced the predictive value of the tandem to around 76%, i.e. normal levels of both markers correctly predicted uneventful postsurgical course in only three fourths of the patients. Of 187 patients with active disease, the sensitivity of raised or increasing marker levels was around 70% for CA-15.3 alone or CEA alone, and 82% for the tests combined (P = 0.006). The 11% false-positive rate of CEA in patients with no apparent disease decreased the predictive value of a positive test from 98% for CA-15.3 alone (P = 0.006) to 91% for CEA alone or the tandem. Serum CA-15.3 or CEA paralleled the site of relapse: at least one marker was found elevated in 60% of patients with locoregional disease or with metastases to the lungs or bones exclusively, and in 90% of those with metastases to the lungs and bones or to the liver. A concurrent decrease of both marker levels reflected response to therapy while an increase of at least one marker level reflected treatment failure. It may be concluded that the marker tandem was better than either marker alone for follow-up aimed at detection of relapse, and that the tests were approximately 80% accurate for follow-up and/or monitoring therapy.
在307例乳腺癌患者术后随访和/或治疗期间，纵向测定血清CA-15.3和CEA水平。在120例无明显疾病的患者中，单独CA-15.3标记物水平在正常范围内波动（真阴性）的特异性为98%（P = 0.004），单独CEA或联合检测的特异性约为88%。然而，进展期癌症患者的假阴性水平将串联检测的预测价值降低至约76%，即两种标记物水平正常仅能正确预测四分之三患者术后病程平稳。在187例有活动性疾病的患者中，单独CA-15.3或CEA标记物水平升高或上升的敏感性约为70%，联合检测的敏感性为82%（P = 0.006）。无明显疾病患者中CEA 11%的假阳性率使阳性检测的预测价值从单独CA-15.3的98%（P = 0.006）降至单独CEA或串联检测的91%。血清CA-15.3或CEA与复发部位相关：在60%仅出现局部区域疾病或肺或骨转移的患者中，以及在90%出现肺和骨或肝转移的患者中，至少发现一种标记物升高。两种标记物水平同时下降反映对治疗有反应，而至少一种标记物水平升高反映治疗失败。可以得出结论，对于旨在检测复发的随访，标记物串联检测比单独使用任何一种标记物更好，并且这些检测对于随访和/或监测治疗的准确性约为80%。
