3种肿瘤标志物在不可测量病灶的晚期乳腺癌患者血清中的水平变化及其临床意义

摘要

Objective To study the usefulness of changes in serum levels of the tumor markers CEA,CA125,and CA153 for assessing the efficacy of chemotherapy in patients with metastatic breast cancer without measurable disease. Methods Electronic medical records were retrospectively reviewed for 81 patients with metastatic breast cancer but without measurable disease treated between January 2008 and June 2013.Serum levels of CEA,CA125,and CA153 were measured with electrochemiluminescence before and after chemotherapy,and the levels were correlated with survival. Results Patients were grouped according to whether they presented normal levels of all three serum markers before chemotherapy(negative group,n=44)or they presented elevated levels of at least one marker before chemotherapy(positive group,n=37).Median progression-free survival(PFS)was significantly longer in the negative group (19 months)than in the positive group (9.8 months,P=0.007).The positive and negative groups had similar overall survival (51.9 vs 37.7 months,P=0.06).Median PFS in patients in whom at least one tumor marker declined by one degree during chemotherapy (10.2 months)was longer than that in patients in whom at least one marker declined by two degrees(5.2 months,P=0.008). Conclusions Elevated levels of serum CEA,CA125 or CA153 correlate with shorter PFS in metastatic breast cancer patients without measurable disease.A decline of two or more degrees in the levels of any one of these tumor markers is a significant predictor of PFS benefit.%目的：研究血清中CEA、CA125及CA153的水平及其变化在不可测量病灶的晚期乳腺癌患者化疗中的应用价值。方法回顾性收集在我院化疗的不可测量病灶的晚期乳腺癌患者的临床资料及化疗前后血清中CEA、CA125及CA153的检测结果，分析3种肿瘤标志物的水平及其变化与患者生存时间的相关性。结果纳入的81例患者中，54.32%（44/81）的患者3种肿瘤标志物处于正常水平（标志物阴性组），45.68%（37/81）的患者有1种或1种以上的标志物高于正常水平（标志物阳性组），标志物阴性组患者中位的无进展生存期（PFS）为19.0个月，显著长于标志物阳性组的9.8个月（P=0.007）；两组患者的总生存期（OS）差异无统计学意义（51.9个月 vs 37.7个月，P=0.06）。化疗后任一标志物下降Ⅱ度以上者的中位PFS显著长于下降玉度者（10.2个月vs 5.2个月，P=0.008）。结论化疗前血清中CEA、CA125及CA153升高的不可测量病灶晚期乳腺癌的无进展生存期较短，化疗后任一标志物下降Ⅱ度以上可预测该类患者无进展生存期的获益情况。