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An individual reference limit of the serum CEA–TPA–CA 15-3 tumor marker panel in the surveillance of asymptomatic women following surgery for primary breast cancer

Authors Nicolini A, Carpi A, Ferrari P, Morganti R, Mazzotti V, Barak V, Duffy MJ

Received 18 June 2018

Accepted for publication 25 September 2018

Published 13 December 2018 Volume 2018:10 Pages 6879—6886

DOI https://doi.org/10.2147/CMAR.S177522

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Professor Nakshatri


Andrea Nicolini,1 Angelo Carpi,2 Paola Ferrari,1 Riccardo Morganti,3 Valentina Mazzotti,3 Vivian Barak,4 Michael J Duffy5

1Department of Oncology, Transplantations and New Technologies in Medicine, University of Pisa, Pisa, Italy; 2Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; 3Section of Statistics, University Hospital of Pisa, Pisa, Italy; 4Immunology Lab for Tumor Diagnosis, Hadassah University, Jerusalem, Israel; 5Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, University College Dublin, Dublin, Ireland

Purpose: The purpose of this study was to evaluate the combined measurement of serum CEA, TPA, and CA 15-3, using an individual reference limit (IRL), for predicting distant metastases in asymptomatic women following a diagnosis of primary breast cancer.
Methods:
A total of 231 patients were followed up for a mean of 5.5±1.6 years. An IRL for defining critical changes (CCs) in marker levels was used as a warning signal of pending distant metastases.
Results: Sensitivity, specificity, and accuracy of the combined CEA–TPA–CA 15-3 marker panel for predicting patient outcome were 95.2%, 97.8%, and 97.9%, respectively. In all, 19 (8.3%) patients relapsed with a mean lead time to radiological evidence of metastases of 11.7±13.8 months.
Conclusion: We concluded that the combined measurement of CA 15-3, CEA, and TPA using an IRL for determining the CC in markers levels is an accurate strategy for predicting outcome during postoperative monitoring of asymptomatic breast cancer patients. Whether the early prediction of metastasis and subsequent administration of therapy impacts on patient outcome should now be the objective of a prospective clinical trial. The marker panel described here could serve as the basis for such a trial.

Keywords: breast cancer, postoperative monitoring, serum tumor markers, individual reference limit, early detection of relapses

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