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Abstract
Several serum markers have been proposed either for diagnosis or follow-up
of women with breast cancer such as CEA, CA15-3 and more recently
MCA. In this retrospective analysis we evaluated the correlation between
breast cancer and serum markers and their changes related to surgical
treatment, with a minimum 5-year postoperative follow-up.
We evaluated retrospectively 66 women who underwent curative
surgery for primary breast cancer. Patients with a pT value > 2 (calculated
as a mean of the two maximum diameters) and all M+ were excluded, as
well as patients with a discontinuous follow-up. Mean age was 61 years
(median 61, range 31-87); 52 (78.8%) were older than 50 years. Patients
were further divided into 3 groups: Group 1 (pTlpN0), Group 2 (pT2pN0)
and Group 3 (pT2pN+). Mean pts age in the 3 groups was respectively: 53,
65 and 63 years. Preoperative CEA serum levels (normal values 0-10 ng/
mL) were available in all patients, and CA 15.3 levels (normal values
&31 kU/L) only in 45 (68.1%). Markers were measured in the same
Laboratory with high sensibility techniques. Further blood samples were
collected at least at 6 months and 1, 2, 3 and 5 years after operation. Mean
follow-up for the 62 alive patients was 88 months (median 78, range
60-138 months) and overall survival rate was 94.0%. Three patients
died respectively 26, 52 and 54 months after operation of metastatic disease;
another patient died of acute miocardial infarction 13 months after
surgery. Student\u2019s t-test was used for statistical significance study.
CEA mean serum concentration was 8.58\ub17.31 ng/mL (median 7.0,
range 1-19) in Group 1; 5.55\ub15.44 (median 4.0, range 1-24) in Group 2;
6.28\ub16.66 (median 3.0, range 1-22) in Group 3. Preoperative CA 15-3
was available respectively in 16/19, 16/29 and 1308 patients in each
group. Mean CA 15.3 value was 34.06\ub118.90 kU/L (median 34.0, range
12-82) in Group 1; 27.0\ub112.15 (median 26.50, range 8-53) in Group 2;
27.38 f 19.90 (median 27.38, range 7-81) in Group 3. No statistically significant
difference was found among the 3 groups. Preoperative increased
CEA serum levels was found in 14 (21.2%) patients and respectively in
709, l/29, 6/18 patients in each group; increased basal CA 15-3 serum
levels was found in 14 (31.1%) patients and respectively in 7/16,4/16, 3/13
patients. CEA serum level at 6 months were 2.63\ub12.06 in Group 1; 2.72
f 1.77 in group 2; 4.22\ub13.28 in Group 3 and mean CA 15-3 levels were
respectively 22.19\ub112.61, 19.19\ub14.93 and 15.46\ub19.50. Five years after
operation, 62 patients were still alive. In these patients CEA levels were:
2.58\ub11.89 (Group l), 3.07\ub13.26 (Group 2), 2.29\ub11.07 (Group 3) and
CA 15.3 levels were: 23.18\ub117.80 (Group l), 19.84 f 6.41 (Group 2),
16.77\ub15.37 (Group 3). Only in Group 1, a statistically significant difference
in CEA and CA 15.3 levels (0 vs. 6 months and 0 vs. 5 years) was
found. Ten (15.1%) patients showed relapse of malignancy during follow-up
and mean relapse time was 40.3 months. In 7/10 and 3/10 patients
respectively, CA 15-3 and CEA serum levels were increased at l-6 months
before recurrence.
Serum markers are not useful in diagnosis of breast cancer. In our 5 year
long follow-up in a smaller group of ten pts who showed recurrence,
elevation of serum CA 15.3 and CEA occurred respectively in seven and
three pts with a mean of four months before evidence of relapse, while in
the group of pts who had no evidence of recurrence (N=56) only in three cases
was there an increase of serum CEA and CA 15.3 was discovered, in one
case CEA and CA 15.3 increase was due to alcohol abuse and returned to
normal. We conclude that serum markers CA 15.3 and CEA are useful
during follow-up for the early detection of recurrences