Abstract
BackgroundMetastatic breast cancer (MBC) prognosis is highly variable, depending on various factors such as the biological subtype, the performance status, disease extension…. A better evaluation of a patient’s prognostic factors could allow for a more accurate choice of treatments. The role of serum tumor markers remains, however, unclear in this population. Considering the recent interest in phenotypic changes and tumor heterogeneity during breast cancer progression, additional tumor markers could be interesting in this setting.MethodsTwo hundred fifty MBC patients treated at the Montpellier Cancer Institute (2008–2015) were retrospectively selected, based on the availability of frozen serum samples. The usual MBC clinical and pathological variables were collected, altogether with Cancer Antigen 15-3 (CA15-3), Carcinoembryonic Antigen (CEA), HER2 extra-cellular domain (ECD), Neuron Specific Enolase (NSE), S100ß protein and Matrix Metalloproteinase 9 (MMP-9) serum levels in order to determine their prognostic value.ResultsWith a median follow-up of 40.8 months, median overall survival was 16.2 months (95 % CI 12.4–20.6). In multivariate analysis, the performance status, brain or subcutaneous metastases, the number of previous metastatic chemotherapy lines and the tumor biological subtype were independent prognostic factors. Elevated CA 15-3 (HR = 1.95, IC 95 % 1.31–2.93, p = 0.001), HER2 ECD (regardless of tumor HER2 status, HR = 2.51, IC 95 % 1.53–4.12, p < 0.001) and S100ß (HR = 1.93, IC 95 % 1.05–3.54, p = 0.033) serum levels were independently associated with a poor outcome.ConclusionsSerum CA 15-3, HER2 ECD and S100ß could represent useful independent prognostic factors in MBC. Of particular interest is the independent value of serum HER2 ECD levels, regardless of the tumor HER2 status, possibly linked to metastatic tumor heterogeneity.
Highlights
Metastatic breast cancer (MBC) prognosis is highly variable, depending on various factors such as the biological subtype, the performance status, disease extension
The primary objective was to evaluate the prognostic value of six serum biomarkers in patients with MBC
The tumor was considered human epidermal growth factor 2 (HER2)-positive if the primary tumor was scored 3+ by IHC or if the HER2 gene was amplified by fluorescence or chromogenic in situ hybridization (FISH/CISH) for IHC 2+ cases
Summary
Metastatic breast cancer (MBC) prognosis is highly variable, depending on various factors such as the biological subtype, the performance status, disease extension. MBC prognosis is highly variable depending on various factors, with survivals ranging from a few months to decades. The median OS for HER2 (Human epidermal growth factor receptor 2)-positive/HR-positive tumors and triple negative tumors were 34.4 and 8.8 months, respectively, in a series of 815 MBC patients [5]. Given this important variability in terms of outcomes, a better evaluation of a given patient’s prognostic factors could allow for a more accurate choice of the therapeutic strategy
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