Value of CA 15-3 determination in the initial management of breast cancer patients.

نویسندگان

  • S Chourin
  • D Georgescu
  • C Gray
  • C Guillemet
  • A Loeb
  • C Veyret
  • J-P Basuyau
چکیده

CA 15-3 is the most frequently used tumour marker in invasive breast cancer. Despite poor prognosis associated with an initially high value, scientific societies have not yet recommended its determination in the initial evaluation as regards the extent of disease [1–6]. Nevertheless, some institutions, such as the Henri-Becquerel Center (HBC), routinely include CA 15-3 determination before treatment of patients with invasive breast cancer. As a nonconsensual approach required further in-depth evaluation, we were prompted to confirm the prognostic value of initial CA 15-3 concentration and to evaluate the impact of its determination on the therapeutic management of patients. During a 5-year period, all consecutive women referred to HBC for the initial management of invasive breast cancer had a CA 15-3 assay before treatment. The patients with previous history of another type of cancer were excluded. Patients studied were followed up according to the standard procedures of HBC, for at least 54 months. Two thousand and thirty-six patients were included, with 200 test results >30 kU/l. For each patient, criteria investigated were age, hormonal status, the breast (left or right) affected, histological classification and grade, tumour size (T), clinical lymph node invasion (N), presence or absence of hormone receptors and CA 15-3 concentration. Disease treatment and patient evolution data were also collected. All CA 15-3 determinations were carried out at HBC, using a primary tube of blood collected on heparin, with a Kryptor analyser (BRAHMS Hennigsdorf, Germany). The reproducibility (n = 350) was better than 6% for a concentration of 30 kU/l and 83 kU/l. The upper limit of the normal range is 30 kU/l. Statistical tests were carried out with SEM software (Fabrice Kwiatkowski, Centre Jean-Perrin, Clermont-Ferrand, France). Differences between groups were evaluated using least-squares difference tests for quantitative characters and chi-square tests for qualitative characters. Survival curves were calculated by the nonparametric Kaplan–Meier method. Univariate analysis was carried out with Mantel–Haentzel tests (two curves) or logrank tests (more than two curves). Cox models were used for multivariate analysis. A 5% threshold was considered significant. During a 5-year period, 2036 patients attending the HBC for the initial management of invasive breast cancer underwent pretreatment CA 15-3 determination. Initial CA 15-3 concentration was >30 kU/l in 200 patients (9.8%), with 75 who had metastases at diagnosis (M+). Significant differences between the M+ and M2 populations only concerned tumour size, clinical lymph node invasion and CA 15-3. Types of management and survival curves of patients with and without metastases were very different, therefore the M+ and M2 groups were assessed separately. An initial CA 15-3 concentration of >30 kU/l was associated with a poor prognosis: 75 of these patients (37.5%) had letters to the editor Annals of Oncology

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عنوان ژورنال:
  • Annals of oncology : official journal of the European Society for Medical Oncology

دوره 20 5  شماره 

صفحات  -

تاریخ انتشار 2009