Elevated preoperative serum level of tumor markers CEA and CA 15–3 in breast cancer patients

Abstract

621 Background: Serological tumor markers: Cancer Antigen 15–3 (CA 15–3), Carcinoembryonic Antigen (CEA), have been investigated as useful markers for monitoring of response to treatment and for predicting outcome in breast cancer patients. Methods: A total of 820 breast cancer patients, treated over the period April 1999 through December 2003, had preoperative CA15–3 and CEA concentrations measured. The stage of the primary tumor ranged from 0 to IV. The median age of the patients was 47years (range 20–88 years old). The concentration of markers was investigated with regard to clinico-pathological parameters and patients outcome by both univariate and multivariate analysis. We determined the range of normality by the mean + 2 standard deviations of the markers distribution in populations of healthy females, who took an annual health screening program. Survival curves for disease free survival and death from disease were estimated by the method of Kaplan-Meier method and differences between groups in survival were tested using the log-rank test. All statistical analyses were carried out using SPSS statistics software (ver 10.5). Results: Among 820 patients, elevated preoperative level of CA15–3 and CEA was identified in 100 (12.2%) and 83 (10.1%) patients, respectively. Tumor size (>5cm), lymph node metastases (≥4), advanced stage (stage III and IV) were associated with significantly higher level of both preoperative CA15–3 and CEA. Elevated preoperative values of CA15–3 and CEA were associated with poor disease free survival (DFS, p=0.0019, p=0.0001, respectively) and distant relapse-free survival (DRFS, p=0.011, p=0.0034), but the level was marginal for overall survival (OS, p=0.0848, p=0.0895). By Cox’s multivariate analysis, younger age (<35 years), larger tumor size(>2cm), axillary node metastases, negative ER expression, elevated preoperative values of CA15–3 and CEA were independent prognostic factors for DFS and DRFS. Conclusions: High level of preoperative CA 15–3 and CEA might reflect a tumor burden, and is associated with advanced disease condition and disease-free survival. Measuring preoperative levels of CA 15–3 and CEA might be helpful for predicting the outcome and for planning the adjuvant therapy in breast cancer patients. No significant financial relationships to disclose.