Preoperative values of CA 15-3 and CEA as prognostic factors in breast cancer: a multivariate analysis.
The role of circulating tumor markers in providing prognostic information has not been widely studied. In the current study, serum levels of the carbohydrate antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) were determined preoperatively in 364 breast cancer patients with no clinical signs of metastasis. The prognostic relevance of these markers for recurrence (175/364) and death of disease (104/175) was determined by Cox multivariate analysis, including the comparison with classical prognostic factors. High levels of both tumor markers were associated with aneuploid tumors with high S-phase fraction and high ornithine decarboxylase activity. CA 15-3 was highly associated with the number of positive lymph nodes and peritumoral lymphatic or blood vessel invasion. No significant associations were found between CEA or CA 15-3 levels and histologic grade, necrosis and steroid receptor status. In univariate analysis, preoperative values, using optimum cutoff values of CA 15-3 (40 U/ml) and CEA (6 ng/ml), were statistically significant for relapse-free survival and overall survival. In multivariate analysis, only node status, DNA ploidy and ornithine decarboxylase activity were independent predictors for relapse-free survival; the estrogen receptor status was a predictor of overall survival. In node-negative patients, ornithine decarboxylase activity was the only factor selected for relapse-free survival. In node-positive patients, the number of lymph nodes and DNA ploidy were the only variables selected for relapse-free survival or overall survival. Estrogen receptor and ornithine decarboxylase activity were excluded for relapse-free survival, but were significant prognostic factors for overall survival.
Cañizares
F
F
Department of Clinical Chemistry, University Hospital Virgen de la Arrixaca, Murcia, Spain. fcanizares@hvax.insalud.es
Sola
J
J
Pérez
M
M
Tovar
I
I
De Las Heras
M
M
Salinas
J
J
Peñafiel
R
R
Martínez
P
P
D000328:Adult; D000368:Aged; D000782:Aneuploidy; D014408:Biomarkers, Tumor / Q000097:blood; D001943:Breast Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D002453:Cell Cycle; D004273:DNA, Neoplasm / Q000032:analysis / Q000235:genetics; D004171:Diploidy; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008207:Lymphatic Metastasis; D008593:Menopause; D008875:Middle Aged; D018396:Mucin-1 / Q000097:blood*; D015999:Multivariate Analysis; D009336:Necrosis; D009955:Ornithine Decarboxylase / Q000032:analysis; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012008:Recurrence; D012189:Retrospective Studies; D015996:Survival Rate
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D004273:DNA, Neoplasm; D018396:Mucin-1; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D009955:Ornithine Decarboxylase