Shering S G, Sherry F, McDermott E W, O'Higgins N J, Duffy M J
Department of Surgery, University Hospital of Wales, Heath Park, Cardiff.
Cancer. 1998 Dec 15;83(12):2521-7.
CA 15-3 is a breast-associated mucin that is elevated in the majority of breast carcinoma patients with distant metastases. Currently, the main application of this marker is in monitoring and detecting recurrences in patients with diagnosed breast carcinoma.
Preoperative serum concentrations (prior to excision of the primary tumor) of CA 15-3 were measured in 368 patients undergoing potentially curative surgical treatment for early breast carcinoma. These results were compared with prospectively recorded clinicopathologic characteristics and patient outcome data.
A weak but significant positive association was found between CA 15-3 concentrations and both tumor stage and the number of involved axillary lymph nodes but not between CA 15-3 concentrations and estrogen receptor status. Patients with high concentrations of CA 15-3 had a significantly worse prognosis than patients with low concentrations. Using an optimum cutoff value of 30.38 U/mL, the probability of disease free survival at 5 years was 44% in patients with high CA 15-3 levels compared with 65% in patients with low CA 15-3 levels (P = 0.002, Mantel-Cox log rank test). The corresponding probabilities for overall survival were 67% and 83%, respectively (P < 0.001). The association of preoperative CA 15-3 levels with outcome was maintained in multivariate survival analysis and was not explained by the association between CA 15-3 and tumor size or lymph node burden. The relation between CA 15-3 and outcome also was found within some patient subgroups identified by traditional prognostic factors (axillary lymph node positive patients, patients with primary tumors >2 cm in greatest dimension, and patients with estrogen receptor positive tumors).
Preoperative serum concentrations of CA 15-3 appear to have a significant relation to outcome in patients with early breast carcinoma and may have a role in the rational selection of patients for appropriate adjuvant treatments. To the authors' knowledge, CA 15-3 thus is one of the first circulating markers shown to be an independent prognostic indicator in patients with breast carcinoma.
CA 15 - 3是一种与乳腺癌相关的粘蛋白，在大多数发生远处转移的乳腺癌患者中水平升高。目前，该标志物的主要应用是监测和检测已确诊乳腺癌患者的复发情况。
对368例接受早期乳腺癌潜在根治性手术治疗的患者，在术前（原发肿瘤切除前）测定血清CA 15 - 3浓度。将这些结果与前瞻性记录的临床病理特征及患者预后数据进行比较。
发现CA 15 - 3浓度与肿瘤分期及腋窝淋巴结受累数目之间存在微弱但显著的正相关，而与雌激素受体状态无关。CA 15 - 3浓度高的患者预后明显比浓度低的患者差。采用30.38 U/mL的最佳临界值，CA 15 - 3水平高的患者5年无病生存率为44%，而CA 15 - 3水平低的患者为65%（P = 0.002，Mantel - Cox对数秩检验）。总生存率的相应概率分别为67%和83%（P < 0.001）。术前CA 15 - 3水平与预后的关联在多因素生存分析中得以维持，且不能用CA 15 - 3与肿瘤大小或淋巴结负荷之间的关联来解释。在由传统预后因素确定的一些患者亚组（腋窝淋巴结阳性患者、最大径>2 cm的原发肿瘤患者以及雌激素受体阳性肿瘤患者）中也发现了CA 15 - 3与预后的关系。
早期乳腺癌患者术前血清CA 15 - 3浓度似乎与预后密切相关，可能在合理选择合适辅助治疗的患者方面发挥作用。据作者所知，CA 15 - 3因此是首批被证明为乳腺癌患者独立预后指标的循环标志物之一。
