Summary
To evaluate the utility of CEA and CA 15.3 for early diagnosis of recurrence, serial serum determinations of both antigens were performed in 1023 patients (follow-up: 1–10 years, mean 6.2 years) with primary breast cancer (CA 15.3 in 533 cases) and no evidence of residual disease (NED) after radical treatment (radical mastectomy or simple mastectomy and radiotherapy). 246 patients developed metastases during follow-up.
Results: CEA and CA 15.3 were elevated (> 10 ng/ml or > 60 U/ml, respectively) prior to diagnosis in 40% (98/246) and 41% (37/91) of the patients with recurrence, with a lead time of 4.9 ± 2.2 and 4.2 ± 2.3 months, respectively. When patients with locoregional recurrences were excluded, sensitivity improved to 46% (CEA) and 54% (CA 15.3), and to 64% with both tumor markers (CEA and/or CA 15.3). Higher levels of both CEA and CA 15.3 at diagnosis of recurrence, higher sensitivity in early diagnosis of relapse, and a higher lead time were found in ER+ (CEA) or PgR+ patients (CA 15.3) than in those that were negative for these receptors in the primary tumor (p < 0.001). Specificity of the tumor markers was 99% for both CEA (777 NED patients) and for CA 15.3 (444 NED patients), respectively. In conclusion, CEA and CA 15.3 are useful tools for early diagnosis of metastases, mainly in those patients with ER+ or PR+ tumors.
References
Fox MS: On the diagnosis and treatment of breast cancer. JAMA 241: 489–495, 1979
Skipper HE: Kinetics of mammary tumor cell growth and implications for therapy. Cancer 28: 1479–1487, 1971
Goldie JH, Coldman AJ: The genetic origin of drug resistance in neoplasms: Implication for systemic therapy. Cancer Res 44: 3643–3653, 1979
De Vita VT Jr: The relationship between tumor mass and resistance to chemotherapy. Cancer 51: 1209–1220, 1983
Minton JP, Hoenh JL, Gerber DM, Shelton J, Connally DP, Salwan F: Results of a 400-patient carcinoembryonic antigen second-look colorectal cancer study. Cancer 55: 1284–1290, 1985
Ahlemann LM, Staab HJ, Anderer FA: Serial CEA determinations as an aid in postoperative therapy management of patients with early breast cancer. Biomedicine 32: 194–199, 1980
Chatal JF, Chupin G, Ricolleau G, Tellier JL, Le Movel A, Fumoleau P: Use of serial carcinoembrionic antigen assays in detecting relapses in breast cancer involving high risk of metastasis. Eur J Cancer 17: 233–238, 1981
Coombes R, Powles T, Gazet J, Ford HT, McKinna A, Abbott Met al.: Screening for metastases in breast cancer: an assessment of biochemical and physical methods. Cancer 48: 310–315, 1981
Steward DM, Nixon D, Zamchech N, Aisenberg A: Carcinoembryonic antigen in breast carcinoma patients: serial levels and disease progression. Cancer 33: 1246–1252, 1974
Tormey DC, Waalkes TP, Snyder JJ, Simon RM: Biological markers in breast carcinoma. Clinical correlations with carcinoembryonic antigen. Cancer 39: 2397–2404, 1977
Ballesta AM, Molina R, Balague A: Use of serum phosphohexose isomerase and CEA determinations in clinical management of breast cancer. In: Peeters H (eds) Protides of the Biological Fluids. Pergamon Press, Oxford, 1984, pp 533–536
Molina R, Ballesta AM, Prats M, Zanon G, Balague A: Usefulness of the determinations of phosphohexose isomerase and carcinoembryonic antigen in early detection of metastases of breast cancer. In: Peeters H (eds) Protides of the Biological Fluids. Pergamon Press, Oxford, 1984, pp 571–574
Kufe D, Inghirami G, Abe M, Mayes D, Justi-Wheeler H, Schlom J: Differential reactivity of a novel monoclonal antibody (DF-3) with human malignant versus benign breast tumor. Hybridoma 3: 223–232, 1984
Hilkens J, Kroezen V, Bonfrer JMG, Bruning PF, Hilghers J, van Eijkeren J: A sandwich-radioimmunoassay for a new antigen (Mam-6) present in the sera of patients with metastasized carcinomas. In: Peeters H (ed) Protides of the Biological Fluids. Pergamon Press, Oxford, 1984, pp 651–653
Tobias R, Rothwell C, Wagner J, Green A, Liu YS: Development and evaluation of radioimmunoassay for the detection of a monoclonal antibody defined breast tumor associated antigen 115 D8/DF-3. Clin Chem 31: 986, 1985
Molina R, Ballesta AM, Casals E, Elena M, Balague A: A new tumor marker CA 15.3 defined by monoclonal antibodies. Initial clinical evaluation. In: Coli AC, Torre GC, Vecchione A, Zacutti A (eds) Marker Tumorali in Ginecologia. CIC Edizioni Internazionali, Rome, 1986, pp 455–472
Hayes DF, Zurawski VR, Kufe DW: Comparison of circulating CA 15.3 and carcinoembryonic antigen levels in patients with breast cancer. J Clin Oncol 38: 1542–1550, 1986
van Dalen A: Tumor markers in breast cancer. Ann Ch Cynaec 78: 54–64, 1989
Colomer R, Ruibal A, Salvador L: Circulating tumor marker levels in advanced breast carcinoma correlate with the extent of metastatic disease. Cancer 64: 1674–1681, 1989
Gold P, Shuster J, Freedman SD: Carcinoembryonic antigen (CEA) in clinical medicine. Historical perspectives, pitfalls and projections. Cancer 42: 1399–1405, 1978
Lowestein MS, Zammcheck N: Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease status. Cancer 42: 1412–1418, 1978
Colomer R, Ruibal A, Genolla J, Salvador L: Circulating CA 15.3 antigen levels in non-mammary malignancies. Br J Cancer 59: 283–286, 1989
Molina R, Ballesta AM, Rivera-Fillat F, Casals E, Gual J, Elena Met al.: Clinical usefulness of the simultaneous evaluation of serum levels of carcinoembryonic antigen (CEA) and estrogen receptor status in patients with breast cancer. In: Coli AC, Torre GC, Vecchione A, Zacutti A (eds) Marker Tumorali in Ginecologia. CIC Edizioni Internazionali, Rome, 1986, pp 473–490
Altman DG: Practical Statistics for Medical Research. Chapman-Hall, London, 1991
Nemoto T, Vana J, Bedwani RN, Baker HW, McGregor FH, Murphy GP: Management and survival of female breast cancer: results of a national survey by the American College of Surgeons. Cancer 45: 2917–2925, 1980
Fisher ER, Redmond C, Fisher B: Histologic grading of breast cancer. In: Sommers SC, Rosen PP (eds) Pathology Annual. Appleton-Century Crofts, New York, 1980, 239–251
Goldie JH: Mathematical models of drug resistance and chemotherapy effects. In: Ozols RF (ed) Drug Resistance in Cancer Therapy. Boston: Kluwer Acad Publishers, Boston, 1989, pp 13–26
Davidson NE, Lippman ME: Adjuvant therapy for breast cancer. In: Lippman ME, Lichter AS, Danforth DN (eds) Diagnosis and Management of Breast Cancer. WB Saunders, Philadelphia, 1988, pp 348–387
Falkson HC, Van Der Watt JJ, Portugal MA, Shoeman HS, Falkson G: Carcinoembryonic antigen in patients with breast cancer. Cancer 42: 1308–1313, 1978
Haagensen DE, Kister SJ, Vandervoorde JP, Gates JB, Smart EK, Hansen HJet al.: Evaluation of carcinoembryonic antigen as a plasma monitor for human breast carcinoma. Cancer 42: 1512–1519, 1978
Staab HJ, Ahlemann ML, Koch HL, Anderer FA: Serial carcinoembryonic antigen determinations in the management of patients with breast cancer. Oncodev Biol Med 1:151–160, 1980
Viebanh C, Besserer A, Opri F: Die Bedeutung des CEA für die Therapie und Nachsorge des Mammakarzinom. Tumor Diagnostic Ther 2: 39–45, 1981
Molina R, Ballesta AM, Rivera-Fillat F, Casals E, Balague A: Value of determination of CEA and PHI levels in breast tissue: correlation with steroid receptors. In: Peeters H (ed) Protides of the Biological Fluids. Pergamon Press, Oxford, 1985, pp 843–846
Silvestrini R, Sanfilippo O, Tedesco G: Kinetics of human mammary carcinoma and their correlation with the cancer and the host characteristics. Cancer 34: 1252–1258, 1974
Steel GG: Growth Kinetics of Tumor. Clarendon Press, Oxford, 1977
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Molina, R., Zanón, G., Filella, X. et al. Use of serial carcinoembryonic antigen and CA 15.3 assays in detecting relapses in breast cancer patients. Breast Cancer Res Tr 36, 41–48 (1995). https://doi.org/10.1007/BF00690183
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DOI: https://doi.org/10.1007/BF00690183