Evaluation of Tumor Markers in the Follow-Up of Breast Cancer Patients after Treatment

乳癌病患治療後腫瘤指數之評估

湯人仰(Jen-Yang Tang) ； 連熙隆(Shi-Long Lian) ； 章順仁(Shun-Jen Chang) ； 黃旼儀(Ming-Yii Huang) ； 何耀輝(Yu-Hui Ho)

《放射治療與腫瘤學》 6卷4期 (1999/12) Pp. 273-283

https://doi.org/10.6316/TRO/199906(4)273

摘要

目的：本篇研究針對接受過手術、放射線治療、化學治療以及賀爾蒙治療的乳癌患者，偵測其血液中之CEA、TPA以及CA153濃度，探討單獨或複合使用時與早期檢測復發的關係。
材料與方法：我們從332位乳癌患者（平均追蹤48.9個月）取得系列CEA、TPA以及CA153的血液濃度值。在追蹤過程中，有195個復發的事件；我們比較了腫瘤指數臨界值、20%以及30%動態變化等三種方法，對於預測癌症復發的優劣點。
結果：由臨界值的比較所獲得的敏感性及專一性分別為：CEA (27.91%, 94.38%)、TPA(63.37% 5313%)以及CA153 (31.40 %, 92.50%)。而藉由20%連續動態變化的方法所取得的敏感性及專一性則為：CEA (59.30%,18.75%)、TPA (55.23%, 38.13%)、以及CA153 (17.44%, 99.38%)。
結論：在本篇實驗中，轉移的地點被分類成臟器、骨頭以及局部復發等三大類。腫瘤指數的敏感性和復發地點有很好的關連性：一般來說對於局部復發的敏感性較差但對於臟器處則較好。當使用臨界值的方法時，CA153比CEA有更高的敏感性；但是若改用連續動態數值時，則兩者剛好相反。對於單一腫瘤指數TPA來說，使用臨界值的方法對於所有的轉移處而言都有最好的敏感度，但若改用連續動態數值，則在臟器轉移處，CEA有最高的敏感性。腫瘤指數異常升高通常預測了治癒後的再發現象，而當複合使用CEA、TPA和CA153時，則有助於提高預測的敏感性。

關鍵字

CEA ； TPA ； CA153 ； 腫瘤相關抗原 ； 乳癌 ； 腫瘤指數

並列摘要

Purpose: This study evaluates the usefulness of serial CEA, TPA, CA153 and combined modalities in serum levels for screening recurrence in patients with primary breast cancer after surgery, chemotherapy, radiotherapy and hormone therapy.
Materials and Methods: CEA, TPA, and CA153 serial serum determinations were performed on 332 patients (median follow-up: 48.9 months) with primary breast cancer. Within the group, there were 195 clinically diagnosed episodes of relapse during follow- up. Comparison among groups by cut-off value, and dynamic changes of 20% and 30% were done.
Results: The sensitivity and specificity, determined for circulating tumor markers by cutoff levels were (for CEA)27.91%, 94.38%; (TPA) 63.37%, 53.13%; and (CM 53) 31.40%, 92.50%, respectively. Utilizing 20% dynamic change methods, CEA, TPA and CA1S3 showed sensitivities of 59.30%, 55.23% and 17.44%, and specificities of 18.75%, 38.13% and 99.38%, respectively.
Conclusions: In this study, metastatic patients were classified into three categories of sites: viscera, bones and locoregional. Tumor marker sensitivity was clearly related to the site of recurrence; the lowest sensitivity was found in locoregional relapse and the highest was in patients with visceral metastasis, CA153 was more sensitive than CEA in monitoring breast cancer recurrence under cut-off methods but the results were reversed when serum concentration was evaluated by dynamic changes. For single markers, TPA presented the best sensitivity in all fields under cut-off methods, but was surpassed by CEA under dynamic changes for the detection of visceral metastasis. Unlike the other categories, when serum TPA values were determined by dynamic changes, the highest sensitivity was obtained for visceral metastasis detection. Significant elevation predicted new recurrence or tumor regrowth after complete remission. The combined use of CEA, TPA, and CA153 increased the overall sensitivity.

並列關鍵字

CEA ； TPA ； CA153 ； Tumor-associated antigen ； Breast cancer ； Tumor markers