Preoperative values of CA 15-3 and CEA as prognostic factors in breast cancer: A multivariate analysis

The role of circulating tumor markers in providing prognostic information h as not been widely studied. In the current study, serum levels of the carbo hydrate antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) were dete rmined preoperatively in 364 breast cancer patients with no clinical signs of metastasis. The prognostic relevance of these markers for recurrence (17 5/ 364) and death of disease (104/175) was determined by Cox multivariate a nalysis, including the comparison with classical prognostic factors. High l evels of both tumor markers were associated with aneuploid tumors with high S-phase fraction and high ornithine decarboxylase activity. CA 15-3 was hi ghly associated with the number of positive lymph nodes and peritumoral lym phatic or blood vessel invasion. No significant associations were found bet ween CEA or CA 15-3 levels and histologic grade, necrosis and steroid recep tor status. In univariate analysis, preoperative values, using optimum cuto ff values of CA 15-3 (40 U/ml) and CEA (6 ng/ml), were statistically signif icant for relapse-free survival and overall survival. In multivariate analy sis, only node status, DNA ploidy and ornithine decarboxylase activity were independent predictors for relapse-free survival; the estrogen receptor st atus was a predictor of overall survival. In node-negative patients, ornith ine decarboxylase activity was the only factor selected for relapse-free su rvival. In node-positive patients, the number of lymph nodes and DNA ploidy were the only variables selected for relapse-free survival or overall surv ival. Estrogen receptor and ornithine decarboxylase, activity were excluded for relapse-free survival, but were significant prognostic factors for ove rall survival. Copyright (C) 2001 S. Karger AG, Basel.