晚期乳腺癌治疗后单纯血清肿瘤标志物升高二线治疗的价值

The intervention studies of merely elevated serum tumor markers in advanced breast cancer posttreatment

目的：探讨晚期乳腺癌患者经一线姑息化疗有效后，随诊仅出现肿瘤标志物升高时早期给予二线治疗的临床价值。方法：选取在我院就诊影像学检查有转移病灶，同时伴有肿瘤标志物癌胚抗原（CEA）和（或）糖类抗原15－3（CA－153）升高，经一线姑息化疗有效后，随诊过程中单纯出现肿瘤标志物再次升高的晚期乳腺癌患者42例。根据是否给予二线治疗分为治疗组（20例）和观察组（22例）。主要观察自单纯出现肿瘤标志物升高至影像学出现疾病进展时间（PFSmarker）。结果：晚期乳腺癌一线治疗后，血CEA 及CA－153仍呈下降趋势，随诊过程中单纯出现CEA和（或）CA－153升高时给予二线治疗可以使其再次下降，而观察组则持续升高直至影像学出现肿瘤进展。治疗组PFSmarker为13．65（6～24）个月，观察组为8．18（3～15）个月，两组差异有统计学意义（P ＜0．05），治疗组明显长于观察组。结论：晚期乳腺癌患者一线治疗有效后，随诊中仅出现肿瘤标志物再次升高，早期给予二线治疗可延缓疾病进展，改善生存。

Objective To evaluate the clinical value of early intervention of second-line treatment for advanced breast cancer patients who experienced elevated tumor marker without any evidence for progress on imaging after effective first-line treatment. Methods We recruited 42 metastatic breast cancer patients experiencing elevated tumor marker （CEA or CA-153） meanwhile, who had merely increased tumor markers again in regular review after effective first-line treatment. Patients were divided into two groups： 20 patients in treatment group were given second-line treatment （palliative chemotherapy）; 22 patients in observation group insisted on regular follow-up without any changing of treatment strategy. We mainly evaluated PFSmarker , which was defined as the time between tumor markers increase and disease progression. Results CEA and CA-153 in patients with advanced breast cancer showed a tendency to decrease after first-line chemotherapy , which can be reduced again by second-line treatment while increased in regular review , and the observation group continued to rise until disease progressed. The PFSmarker in treatment group was 13.65 （6 ~ 24） months while that of the observation group was 8.18 （3 ~ 15） months. The difference of PFS between these two groups was statistically significant （P 〈 0.05） and the median time to disease progression in treatment group was significantly longer than that in observation group. Conclusions Early intervention of second-line treatment for advanced breast cancer patients who only experienced elevated tumor marker after effective first-line treatment could slow down disease progression and improve the quality of life.