İlhan HACIBEKİROĞLU, Ebru SARI, Gökşen İnanç İMAMOĞLU, Uğur ERSOY, Dilşen ÇOLAK, Semiha URVAY, Tuba HACIBEKIROĞLU, Mustafa ALTINBAŞ

Meme Kanseri Hastalarında Tümör Belirteçleriyle Evre ve Prognostik Faktörler Arasındaki İlişki

Amaç: Meme kanseri hastalarında tümör belirteçleri, prognozun belirlenmesinde, metastazların erken saptanmasındave tedaviye yanıtın değerlendirilmesinde, görüntüleme tetkiklerinin yanında yardımcı olur. Yapılan çalışmalarda,erken evre meme kanserinde, preoperatif ölçülen Karsinoembriyonik antijen(CEA) ve Kanser antijen 15-3 (CA15-3)düzeylerinin, prognostik ve prediktif değer taşığı gösterilmiştir. Çalışmamızda, preoperatif ölçülen tümör belirteçleri(CEA, CA 15-3) ile prognostik faktörler arasındaki ilişki araştırılmıştır.Yöntem ve Gereçler: Preoperatif tümör belirteci düzeyleri mevcut, opere Evre I-III meme kanseri, 114 hastaçalışmaya dahil edildi. Hastaların yaş, soygeçmişte kanser öyküsü, menopoz statüsü, histolojik tip, tümör büyüklüğü,aksiller lenf nodu metastazı, histolojik grad, lenfovasküler invazyon varlığı, östrojen reseptörü(ER), progesteronreseptörü(PR), insan epitelyal büyüme faktörü reseptörü-2(Her2) durumu, immünohistokimya (İHK) ile belirlenenmoleküler subtip klasifikasyonu ve patolojik evre ile pre-operatif ölçülen CEA, CA 15-3 yüksekliği arasındaki ilişkibelirlenmeye çalışıldı. Bulgular: Çalışmamızda hastaların %19.3ü Evre I, %47,4ü Evre II, %33.3ü Evre III olarak evrelendirildi. Hastaların%8.8inde CA 15-3 düzeyi yüksek ve %27.4ünde CEA düzeyi yüksek saptandı. Preoperatif CEA yüksekliği ile prog- nostik faktörler arasında anlamlı ilişki saptanmadı. Preoperatif CA 15-3 yüksekliği ile tümör boyutu, nodal tutulumve patolojik evre arasında anlamlı ilişki saptanırken, yaş, Her2, ER, menopoz statüsü, lenfovasküler invazyon, gradve meme subtipleri arasında anlamlı ilişki saptanmadı. Sonuç: Çalışmamızda, preoperatif ölçülen CEA düzeyinin prognostik faktörlerle anlamlı ilişkisi saptanmazken, pr- eoperatif olarak ölçülen CA 15-3 düzeyinin, tümör büyüklüğü.

The Relatıonship of Tumor Markers Between Stage And Prognostic Factors In Breast Cancer Patients

Objective: Tumor markers are usefull in prediction of prognosis, early detection of metastasis and treatment re- sponce evaluation besides imaging techniques in breast cancer patients. Studies have shown that; in early stage breastcancer, preoperative Carcinoembryonic Antijen(CEA) and Cancer Antigen 15-3(CA15-3) levels have prognostic andpredictive value. In our study we investigated the relationship between preoperative tumor markers (CEA and CA15- 3) and other prognostic factors. Material and Methods: 114 operated stage I-III breast cancer patients whose preoperative tumor markers have beenrecorded are included to the study. We tried to find out the relationship between preoperative CEA and CA15-3 levelswith the patient s age, and family history of cancer, menopausal status, tumor s histologic type, grade, size, axillarylymph node status, lymphovascular invasion, Estrogen receptor(ER), Progesterone receptor(PR), Human epidermalgrowth factor receptor-2(Her2) status, immunohistochemical molecular subtype and pathological staging. Results: In our study, 19.3 % of the patients were stage I, 47.4 % were stage II, 33.3% were stage III. 8.8 % of thepatients had high levels of CA15-3 while 27.4 % had high levels of CEA. We couldn t find any relationship betweenpreoperative CEA levels and other prognostic factors. We found out a statistically significant relationship betweenpreoperative CA15-3 level and tumor size, nodal status, and pathological stage but there wasn t any significant re- lationship between CA15-3 level and age, Her2, ER, menoposal status, lymphovascular invasion, grade, molecularsubtypes. Conclusion: In our study, preoperative CEA levels did not have any relationship with prognostic factors but wefound out that preoperative CA15-3 levels can be used in predicting tumor size, nodal status and pathological staging.

PDF

___

1. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Can- cer J Clin. 2010;60(5):277-300.
2. Autier P, Boniol M, La Vecchia C, ve diğ. Disparities in breast can- cer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ. 2010;341:c3620.
3. Diamandis EP. Tumor markers: Past, present, and future. In: Dia- mandis EP, Fritsche EP H Jr, Lilja H, Chan D, Schwartz M, edi- tors. Tumor markers: Physiology, pathobiology, technology, and clinical applications. Washington DC: AACC Press; 2002. pp. 38.
4. Duffy MJ. CA 15-3 and related mucins as circulating markers in breast cancer. Ann Clin Biochem 1999;36:57986.
5. Gion M, Boracchi P, Dittadi R, Biganzoli E, Peloso L, Mione R, et al. Prognostic role of serum CA 15.3 in 362 node-negative breast cancer. An old player for a new game. Eur J Cancer 2002;38:11818.
6. Duffy MJ, Duggan C, Keane R, Hill ADK, McDermott E, Crown J, et al. High preoperative CA 15-3 concentrations predict adverse outcome in node-negative and node-positive breast cancer: study of 600 patients with histologically confirmed breast cancer. Clin Chem 2004;50:55963.
7. Shering S, Sherry F, McDermott E, O'Higgins N, Duffy MJ. Preo- perative CA 15-3 concentrations predict outcome in breast cancer. Cancer 1998;83:25217
8. Nguyen PL, Taghian AG, Katz MS, ve diğ. Breast Cancer Subt- ype Approximated by Estrogen Receptor, Progesterone Recep- tor, and HER-2 Is Associated With Local and Distant Recurrence After Breast-Conserving Therapy. Journal of Clinical Oncology. 2008;26(14):2373 -2378
9. Jemal A, Bray F, Center MM, ve diğ. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90.
10. Gokce T, Akçay C, Karadogan I. A long-term survival pattern for breast cancer treated in a single institution. Indian Journal of Can- cer. 2011;48(2):187.
11. Li CI, Uribe DJ, Daling JR. Clinical characteristics of different histologic types of breast cancer. Br J Cancer. 2005;93(9):1046- 1052.
12. Agrawal AK, Jelen M, Rudnicki J, Grzebieniak Z, Zyśko D, Kie- lan W, Słonina J, Marek G. The importance of preoperative eleva- ted serum levels of CEA and CA15-3 in patients with breast cancer in predicting its histological type. Folia Histochem Cytobiol. 2010 Jan 1;48(1):26-9.
13. Duffy MJ. Biochemical markers in breast cancer: which ones are clinically useful? Clin Biochem 2001; 34: 347-52.
14. Rosselli del Turco M, Palli D, Cariddi A, Ciatto S, Pacini P, Dis- tante V. Intensive diagnostic follow-up after treatment of primary breast cancer. A randomized trial. National Research Council Pro- ject on Breast Cancer follow-up. JAMA 1994;271:15937.
15. Molina R, Barak V, D.A. van, Duffy MJ, Einarsson R, Gion M, et al. Tumor markers in breast cancer - European Group on Tumor Markers recommendations. Tumour Biol 2005;26:28193.
16. Park BW, Oh JW, Kim JH, Park SH, Kim KS, Kim JH, Lee KS.Preoperative CA 15-3 and CEA serum levels as predictor for breast cancer outcomes. Ann Oncol. 2008 Apr;19(4):675-81. Epub 2007 Nov 23
17. Lee JS, Park S, Park JM, Cho JH, Kim SI, Park BW. Elevated le- vels of preoperative CA 15-3 and CEA serum levels have indepen- dently poor prognostic significance in breast cancer. Ann Oncol. 2012 Dec 9
18. Aksu G,Duman C,Gurbuz Y,Ercin C,Canturk Z,Utkan Z,Dulger M. Correlation between c-erbB2 expression, lymphovasculer in- vasion and other biological and clinical prognostic factors and pre- operative tumor markers in patients with early-stage and locally advenced breast cancer. J Buon 2011 Jan-Mar;16(1):52-7
19. Yerushalmi R, Tyldesley S, Kennecke H, Speers C, Woods R, Knight B, Gelmon KA. Tumor markers in metastatic breast cancer subtypes: frequency of elevation and correlation with outcome. Ann Oncol. 2012 Feb;23(2):338-45.
20. Anonymous. Clinical practice guidelines for the use of tumor markers in breast and colorectal cancer. Adopted on May 17,1996 by the American Society of Clinical Oncology. J Clin Oncol 1996;14:284377.