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Intensive post-operative follow-up of breast cancer patients with tumour markers: CEA, TPA or CA15 3 vs MCA and MCA-CA15 3 vs CEA-TPA-CA15 3 panel in the early detection of distant metastases Nicolini A; Tartarelli G; Carpi A; Metelli MR; Ferrari P; Anselmi L; Conte M; Berti P; Miccoli PBMC Cancer 2006[Nov]; 6 (ä): 269BACKGROUND: In breast cancer current guidelines do not recommend the routine use of serum tumour markers. Differently, we observed that CEA-TPA-CA15.3 (carcinoembryonic (CEA) tissue polypeptide (TPA) and cancer associated 115D8/DF3 (CA15.3) antigens) panel permits early detection and treatment for most relapsing patients. As high sensitivity and specificity and different cut-off values have been reported for mucin-like carcinoma associated antigen (MCA), we compared MCA with the above mentioned tumour markers and MCA-CA15.3 with the CEA-TPA-CA15.3 panel. METHODS: In 289 breast cancer patients submitted to an intensive post-operative follow-up with tumour markers, we compared MCA (cut-off values, > or = 11 and > or = 15 U/mL) with CEA or CA15.3 or TPA for detection of relapse. In addition, we compared the MCA-CA15.3 and CEA-TPA-CA15.3 tumour marker panels. RESULTS: Distant metastases occurred 19 times in 18 (6.7%) of the 268 patients who were disease-free at the beginning of the study. MCA sensitivity with both cut-off values was higher than that of CEA or TPA or CA15.3 (68% vs 10%, 26%, 32% and 53% vs 16%, 42%, 32% respectively). With cut-off > or = 11 U/mL, MCA showed the lowest specificity (42%); with cut-off > or = 15 U/mL, MCA specificity was similar to TPA (73% vs 72%) and lower than that of CEA and CA15.3 (96% and 97% respectively). With > or = 15 U/mL MCA cut-off, MCA sensitivity increased from 53% to 58% after its association with CA15.3. Sensitivity of CEA-TPA-CA15.3 panel was 74% (14 of 19 recurrences). Eight of the 14 recurrences early detected with CEA-TPA-CA15.3 presented as a single lesion (oligometastatic disease) (5) or were confined to bony skeleton (3) (26% and 16% respectively of the 19 relapses). With > or = 11 U/mL MCA cut-off, MCA-CA15.3 association showed higher sensitivity but lower specificity, accuracy and positive predictive value than the CEA-TPA-CA15.3 panel. CONCLUSION: At both the evaluated cut-off values serum MCA sensitivity is higher than that of CEA, TPA or CA15.3 but its specificity is similar to or lower than that of TPA. Overall, CEA-TPA-CA15.3 panel is more accurate than MCA-CA15.3 association and can "early" detect a few relapsed patients with limited metastatic disease and more favourable prognosis. These findings further support the need for prospective randomised clinical trial to assess whether an intensive post-operative follow-up with an appropriate use of serum tumour markers can significantly improve clinical outcome of early detected relapsing patients.|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Antigens, Tumor-Associated, Carbohydrate/*blood[MESH]|Biomarkers, Tumor/*blood[MESH]|Bone Neoplasms/blood/diagnosis/*secondary[MESH]|Breast Neoplasms/*blood/diagnosis/*surgery[MESH]|Carcinoembryonic Antigen/*blood[MESH]|Early Diagnosis[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Middle Aged[MESH]|Mucin-1/*blood[MESH]|Postoperative Care/methods[MESH]|Sensitivity and Specificity[MESH]|Tissue Polypeptide Antigen/*blood[MESH] |
