CEA及CA 15-3预测氟维司群对乳腺癌疗效的临床价值

The clinical value of CEA and CA 15-3 in predicting the curative effect of fulvestrant in breast cancer treatment

目的探讨癌胚抗原(CEA)及糖链抗原(CA 15-3)在氟维司群对乳腺癌疗效中的预测作用。方法纳入乳腺癌患者32例。将患者分为临床获益组(CB:8例PR,13例SD)与非获益组(non-CB:11例PD)。分析其在治疗初、第3个月、第6个月及治疗后的CEA及CA 15-3水平。根据肿瘤指标评判标准以25%为阈值将患者分为疾病进展组、缓解组和稳定组,并计算评判疗效的灵敏度和特异度。此外,调整阈值并重新计算相应的灵敏度及特异度。分析各组的客观缓解率(ORR)及临床获益率(CBR)差异。观察各组中患者的CEA及CA15-3在治疗期间的连续变化特征。结果 CEA评判non-CB及CB灵敏度为36%和48%、特异度为76%和73%。CA 15-3评判non-CB及CB灵敏度为18%和67%、特异度为86%和73%。CEA评判non-CB最佳灵敏度为46%(阈值10%),CA 15-3评判CB的最佳特异度为82%(阈值30%)。CA 15-3评判疾病稳定组和降低组间的CBR存在显著差异(P=0.011)。疾病缓解组中PR患者的CEA及CA 15-3呈现连续下降趋势。结论利用CEA及CA 15-3水平变化或能预测氟维司群治疗乳腺癌患者的临床获益情况。

Objective To investigate the predictive significance of CEA and CA 15 -3 in the fulvestrant treatment for breast cancer. Methods Thirty - two patients with breast cancer were recruited. The patients were grouped into clinical benefit group （CB, n =21 ） and clinical nonbenefit group （non -CB, n = 11 ）. The levels of CEA and CA 15 -3 before treatment, at the third month, at the sixth months and after the whole treatment were analyzed. The patients were then grouped into disease progression group, disease response group and disease stable group based upon the judgement criteria of CEA and CA 15 - 3 with a threshold of 25%. The sensitivities and specificities of CEA and CA 15 - 3 were calculated with the threshold of 25% as well as adjusted thresholds. The ORR and CBR in each group were compared. The continuous variation of CEA and CA 15 - 3 in the period of the fulvestrant treatment were analyzed. Results CEA had the sensitivities of 36% and 48% , and specificities of 76% and 73% in predicting non - CB and CB, respectively. The sensitivity and specificity of CA 15 -3 were 18% and 86% in predicting non -CB, respectively; and 67% and 73% in predicting CB, respectively. CEA had its best sensitivity of 46% in predicting non -CB with the threshold of 10%. However, CA 15 -3 had its best specificity of 82% in predicting CB with the threshold of 30%. The CBR of the disease stable group was significantly different from that of the disease response group （P = 0. 001 ）. The CEA and CA 15 -3 of patients in the disease response group continuously declined during treatment. Conclusion The changes of CEA and CA 15 -3 are useful in predicting patients with breast cancer to obtain clinical benefit from the fulvestrant treatment.