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Liu H, Zhang Z, Huang Y, Wei W, Ning S, Li J, Liang X, Liu K, Zhang L. Plasma HSP90AA1 Predicts the Risk of Breast Cancer Onset and Distant Metastasis. Front Cell Dev Biol 2021; 9:639596. [PMID: 34109171 PMCID: PMC8181396 DOI: 10.3389/fcell.2021.639596] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/03/2021] [Indexed: 12/24/2022] Open
Abstract
Aim We aimed to develop and validate a comprehensive nomogram containing pre-treatment plasma HSP90AA1 to predict the risk of breast cancer onset and metastasis. Methods We assessed the expression of HSP90s in breast cancer patients using an online database. To verify the results, 677 patients diagnosed with breast cancer and 146 patients with benign breast disease between 2014 and 2019 were selected from our hospital and were divided into cancer risk and metastasis risk cohorts. We focused on HSP90AA1 to elucidate the risks of onset and metastasis in the cohorts. Results Expression levels of HSP90AA1, HSP90AA2, HSP90AB1, HSP90B1, and TRAP1 were linked to disease progression. Survival analysis using the GEPIA and OncoLnc databases indicated that the upregulation of HSP90AA1 and HSP90AB1 was related to poor overall survival. In the cancer risk cohort, carcinoembryonic antigen (CEA), carbohydrate antigen 153 (CA153), HSP90AA1, T cells%, natural killer cells%, B cells%, neutrophil count, monocyte count, and d-dimer were incorporated into the nomogram. A high Harrell's concordance index (C-index) value of 0.771 [95% confidence interval (CI), 0.725-0.817] could still be reached in the interval validation. In the metastasis risk cohort, predictors contained in the prediction nomogram included the use of CEA, CA153, HSP90AA1, carbohydrate antigen 125 (CA125), natural killer cells%, B cells%, platelet count, monocyte count, and d-dimer. The C-index was 0.844 (95% CI, 0.801-0.887) and it was well-calibrated. HSP90AA1 raised net clinical benefit of breast cancer onset and metastasis risk prediction nomogram in a range of risk thresholds (5-92%) and (1-90%). Conclusion Our study revealed that pretreatment plasma HSP90AA1 combined with other markers could conveniently predict the risk of breast cancer onset and metastasis.
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Affiliation(s)
- Haizhou Liu
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Zihan Zhang
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Yi Huang
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Wene Wei
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Shufang Ning
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Jilin Li
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Xinqiang Liang
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
| | - Kaisheng Liu
- Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Litu Zhang
- Department of Research, Affiliated Tumor Hospital, Guangxi Medical University, Nanning, China
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Cheung KL, Pinder SE, Paish C, Sadozye AH, Chan SY, Evans AJ, Blamey RW, Robertson JF. The Role of Blood Tumor Marker Measurement (Using a Biochemical Index Score and C-Erbb2) in Directing Chemotherapy in Metastatic Breast Cancer. Int J Biol Markers 2018; 15:203-9. [PMID: 11012094 DOI: 10.1177/172460080001500310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The role of blood tumor markers in monitoring response in advanced breast cancer is established in endocrine therapy and standard chemotherapy. This study examines marker levels in patients receiving new chemotherapy regimens. Thirty patients were recruited into two multicenter trials in which docetaxel-based regimens were used in 15 patients. The other 15 received doxorubicin-based regimens. Biochemical response calculated from a score using CA15.3, CEA and ESR was compared with UICC response. Marker changes at 2, 4 and 5 months correlated with UICC response at 3, 41/2 and 6 months, respectively (p < 0.03). Eleven patients achieved both clinical/radiological and biochemical response at the end of treatment; markers had not yet returned to below cutoffs in seven, suggesting a possible advantage to continue chemotherapy. No patient showed a biochemical response whilst judged clinically/radiologically progressive. Nineteen patients had progressed either clinically/radiologically or biochemically at six months; of these, eight showed progression assessed earlier by markers so that a median of four cycles of chemotherapy could have been saved. Measurements of serum c-erbB2 showed a correlation with tissue c-erbB2 staining in the primary tumor (p < 0.003). Among the patients with positive tissue staining, sequential changes in serum c-erbB2 completely paralleled initial response.
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Affiliation(s)
- K L Cheung
- Department of Surgery, City Hospital, Nottingham, UK.
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3
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Dai D, Chen B, Tang H, Wang B, Zhao Z, Xie X, Wei W. Nomograms for Predicting the Prognostic Value of Pre-Therapeutic CA15-3 and CEA Serum Levels in TNBC Patients. PLoS One 2016; 11:e0161902. [PMID: 27561099 PMCID: PMC4999206 DOI: 10.1371/journal.pone.0161902] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022] Open
Abstract
Previous studies have indicated that carcinoembryonic antigen (CEA) and cancer antigen 15–3 (CA15-3) levels are both independent prognostic factors in breast cancer. However, the utility of CEA and CA15-3 levels as conventional cancer biomarkers in patients with triple-negative breast cancer (TNBC) remains controversial. The current study was performed to explore the predictive value of pre-therapeutic serum CEA and CA15-3 levels, and nomograms were developed including these serum cancer biomarkers to improve the prognostic evaluation of TNBC patients. Pre-therapeutic CA15-3 and CEA concentrations were measured in 247 patients with stage I–IV TNBC. Kaplan-Meier analysis showed that TNBC patients with high levels of both CEA and CA15-3 had shorter overall survival (OS) and disease-free survival (DFS) rates than those in the low-level groups (p<0.05). Multivariate analysis suggested that pre-therapeutic CA15-3 and CEA levels are independent predictive elements for OS (p = 0.022 and p = 0.040, respectively) and DFS (p = 0.023 and p = 0.028, respectively). In addition, novel nomograms were established and validated to provide personal forecasts of OS and DFS for patients with TNBC. These novel nomograms may help physicians to select the optimal treatment plans to ensure the best outcomes for TNBC patients.
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Affiliation(s)
- Danian Dai
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bo Chen
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hailin Tang
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bin Wang
- Institute of Life Science, Chongqing Medical University, Chongqing, China
| | - Zhiping Zhao
- Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoming Xie
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail: (WW); (XX)
| | - Weidong Wei
- Department of Breast Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail: (WW); (XX)
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Nicolini A, Ferrari P, Rossi G. Mucins and Cytokeratins as Serum Tumor Markers in Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 867:197-225. [PMID: 26530368 DOI: 10.1007/978-94-017-7215-0_13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Structural and functional characteristics of mucins and cytokeratins are shortly described. Thereafter, those commonly used in breast cancer as serum tumor markers are considered. First CA15.3, MCA, CA549, CA27.29 mucins and CYFRA21.1, TPA, TPS cytokeratins alone or in association have been examined in different stages and conditions. Then their usefulness in monitoring disease-free breast cancer patients is evaluated. The central role of the established cut-off and critical change, the "early" treatment of recurrent disease and the potential benefit in survival are other issues that have been highlighted and discussed. The successive sections and subsections deal with the monitoring of advanced disease. In them, the current recommendations and the principal findings on using the above mentioned mucins and cytokeratins have been reported. A computer program for interpreting consecutive measurements of serum tumor markers also has been illustrated. The final part of the chapter is devoted to mucins and cytokeratins as markers of circulating and disseminated tumor cells and their usefulness for prognosis.
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Affiliation(s)
- Andrea Nicolini
- Department of Oncology, Transplantations and New Technologies in Medicine, University of Pisa, Pisa, Italy.
| | - Paola Ferrari
- Department of Oncology, Transplantations and New Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Rossi
- Unit of Epidemiology and Biostatistics, National Council of Research, Pisa, Italy
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5
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Bahrami-Ahmadi A, Makarian F, Mortazavizadeh MR, Yazdi MF, Chamani M. Symptomatic metastasis prediction with serial measurements of CA 15.3 in primary breast cancer patients. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:850-4. [PMID: 23826012 PMCID: PMC3697210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 08/03/2012] [Accepted: 08/05/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND CA 15.3 is elevated in most patients with distant metastatic breast cancer who had prognostic information. The present study was performed to estimate predictive ability of CA 15.3 in assessment of symptomatic metastasis in patients with breast cancer. MATERIALS AND METHODS During five years, 159 primary breast cancer patients were evaluated. A total of 2226 determination of serum CA 15.3 (14 per patient) were performed. We performed contemporary clinical examinations with CA 15.3 measurements at the time of diagnosis, end of chemotherapy, every three months in the first two years and every six months in the second two years of follow-up period. Imaging studies were performed if clinical or laboratory examinations (abnormal serum levels of CA 15.3) suspected symptomatic metastasis. Metastasis in participants was confirmed by imaging study in symptomatic patients. RESULTS There was no significant increase in CA 15.3 tumor markers during chemotherapy (P = 0.08). There was a significant relationship between CA 15.3 positive results and metastasis situation (P = 0.00). Mean of maximum CA 15.3 level in metastatic patients (52.72±27.09) was significantly higher than non-metastatic patients (27.58±13.46; P = 0.00). CA 15.3 abnormality (OR, 1.07; 95% CI: 1.04-1.11; P value, 0.01) and abnormal lymph nodes remained as predictor of metastasis (OR: 1.16; 95% CI: 1.05-1.28; P value < 0.0001). CONCLUSION CA 15.3 is one of the predicting factors for symptomatic metastasis.
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Affiliation(s)
| | - Fariborz Makarian
- Department of Clinical Oncology, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Fariborz Makarian, Department of Clinical Oncology, Isfahan University of Medical Sciences and Health Services, Isfahan, Iran. E-mail:
| | | | - Mohammad F. Yazdi
- Department of Clinical Oncology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehdi Chamani
- Department of Clinical Psychiatry, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
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6
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Park HK, Seov UH. MUC1 from the Mucin Family as Potential Tools in Breast Cancer Immunotherapy. J Breast Cancer 2009. [DOI: 10.4048/jbc.2009.12.3.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Heung Kyu Park
- Department of Surgery, Gachon University of Medicine, Incheon, Korea
| | - U Hyoung Seov
- Department of Surgery, Gachon University of Medicine, Incheon, Korea
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7
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Karnon J, Kerr GR, Jack W, Papo NL, Cameron DA. Health care costs for the treatment of breast cancer recurrent events: estimates from a UK-based patient-level analysis. Br J Cancer 2007; 97:479-85. [PMID: 17653077 PMCID: PMC2360350 DOI: 10.1038/sj.bjc.6603887] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cost pressures and the need to demonstrate cost-effectiveness of new interventions require consideration of the costs of treating disease. This study presents analyses of resource use data covering 199 postmenopausal women who experienced a breast cancer recurrent event between 1991 and 2004 and were treated at the Western General Hospital, Edinburgh. Aggregate (5-year) treatment costs for alternative recurrent events were estimated, as well as the annual costs incurred by patients experiencing contralateral, locoregional, or distant recurrence, who remained alive without further recurrence for a year. The 95% confidence intervals for the 5-year costs of recurrence ranged from pounds 10,000 to pounds 37,000 for locoregional recurrence, and pounds 14,500- pounds 20,000 for distant recurrence. No evidence of significant variations in these costs across time periods between 1991 and 2004 was identified. Annual costs for patients remaining in the same health state showed high initial costs for contralateral and locoregional recurrence, with low costs in subsequent years, while costs associated with distant recurrence declined at a slower rate and plateaued at 4-5 years post-diagnosis. The cost estimates presented in this paper not only inform the magnitude of the resource consequences of breast cancer recurrences, but they are also better suited to informing cost-effectiveness analyses, which have a far greater role in allocating health-care resources.
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Affiliation(s)
- J Karnon
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
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8
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Donnelly P, Hiller L, Bathers S, Bowden S, Coleman R. Questioning specialists' attitudes to breast cancer follow-up in primary care. Ann Oncol 2007; 18:1467-76. [PMID: 17525086 DOI: 10.1093/annonc/mdm193] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND National Institute for Clinical Excellence (NICE) guidelines recommend discharging asymptomatic breast care patients 3 years after diagnosis. A role for General Practitioners (GPs) and breast care nurses is proposed, together with skills training, but it remains unclear for how long breast cancer patients should be followed up, what tests should be done, and who should be conducting the follow-up. We therefore surveyed Breast Cancer Specialists. DESIGN A 20-point questionnaire was sent to 562 Specialists registered in the Cancer Research Clinical Trials Unit database, with questions on case-load, perceptions of follow-up, local policy and opinions on greater primary care involvement. RESULTS The most commonly acknowledged purpose of follow-up was detection of treatment-related morbidity. Eighty four percent of respondents adhered to a locally developed protocol with only 9% conforming to NICE guidelines. The median follow-up was 5 years. Significant factors predicting delayed discharge were younger age (P < or = 0.0001); poorer Nottingham Prognostic Index (P = 0.003); treatment factors (P = 0.002); and patient risk factors (P = 0.003). Centres with higher case-loads (>200/year) were more likely to discharge earlier. Reduced workload was perceived as the main benefit of discharge, while lack of GP oncological experience and loss of outcome data were concerns. CONCLUSIONS Specialists favour a risk adjusted discharge strategy and increased oncology infrastructure in primary care.
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Affiliation(s)
- P Donnelly
- Breast Care Directorate, South Devon Healthcare NHS Foundation Trust, Torquay, UK.
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9
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Kurebayashi J, Nomura T, Hirono M, Okubo S, Udagawa K, Shiiki S, Ikeda M, Nakashima K, Tanaka K, Sonoo H. Combined measurement of serum sialyl Lewis X with serum CA15-3 in breast cancer patients. Jpn J Clin Oncol 2006; 36:150-3. [PMID: 16520359 DOI: 10.1093/jjco/hyi235] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Serum CA15-3 has been one of the most reliable tumor markers used in monitoring breast cancer patients; however, its sensitivity in detecting metastases is limited. To increase its sensitivity, the combined measurement of other tumor markers with CA15-3 was investigated. METHODS Serum CA15-3, carcinoembryonic antigen (CEA) and sialyl Lewis X (CSLEX) were simultaneously measured in a prospective series of 455 postoperative breast cancer patients with or without metastasis. The diagnostic parameters sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting metastases were compared. The correlation of values between pairs of tumor markers was analyzed. The efficacy of combined measurement of two different tumor markers was also evaluated. RESULTS The sensitivity for detecting metastases was 61.5, 56.9 and 52.3%; specificity was 97.2, 93.6 and 96.2%; PPV was 78.4, 59.7 and 69.4%; NPV was 93.8, 92.9 and 92.4%; and accuracy was 92.1, 88.8 and 89.9% for CA15-3, CEA and CSLEX, respectively. The values for CA15-3 were significantly correlated with those for CEA (P < 0.001) but not those for CSLEX. The combined measurement of CSLEX and CA15-3 increased the sensitivity by 17.0% but that of CEA and CA15-3 increased the sensitivity by only 10.8%. All diagnostic parameters for the combined measurement of CSLEX and CA15-3 were higher than those for the combined measurement of CEA and CA15-3. CONCLUSIONS These findings suggest that CSLEX may be more useful than CEA in combination with CA15-3 in monitoring breast cancer patients. The results of this study suggest that CSLEX may be more useful than CEA in combination with CA15-3 in monitoring breast cancer patients.
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Affiliation(s)
- Junichi Kurebayashi
- Department of Breast & Thyroid Surgery, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan.
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10
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Kurebayashi J, Nishimura R, Tanaka K, Kohno N, Kurosumi M, Moriya T, Ogawa Y, Taguchi T. Significance of serum tumor markers in monitoring advanced breast cancer patients treated with systemic therapy: a prospective study. Breast Cancer 2005; 11:389-95. [PMID: 15604995 DOI: 10.1007/bf02968047] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The significance of serum tumor markers in monitoring advanced breast cancer patients is still controversial. To clarify this issue, the Tumor Marker Study Group of the Japanese Breast Cancer Society conducted a prospective study. METHODS Patients with advanced breast cancer who were treated with systemic therapy between January and December 2002 were recruited from five collaborative institutes in Japan. The patients were monitored every four weeks using three serum tumor markers, CEA, CA 15-3 and NCC-ST-439 during the therapy. RESULTS Findings from 108 eligible patients were analyzed. The pretreatment positivity rates were 51.9% for CEA, 50% for CA 15-3, and 34.3% for NCC-ST-439. The changes in each marker level at 8 and 12 weeks but not at 4 weeks after the start of therapy seemed to correlate with the response to therapy in pretreatment marker-positive patients but not in negative patients. The Cox proportional hazard model revealed a greater than 20% reduction in CEA, CA 15-3 or NCC-ST-439 levels at 4, 8 and/or 12 weeks after the start of therapy to be an independent predictive factor for longer time-to-progression (TTP) in pretreatment marker-positive patients. CONCLUSION This prospective study supported the findings obtained from our previous retrospective study that in pretreatment marker-positive patients 1) the changes in serum tumor marker levels after the start of therapy correlate with the response to therapy; and 2) a greater than 20% reduction in the tumor marker levels was a favorable predictive factor for TTP during systemic therapy. When the pretreatment serum level of these markers is over the respective cut-off value, sequential measurement of them may be useful for evaluating the efficacy of treatment as well as monitoring the outcome of patients with advanced breast cancer.
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Affiliation(s)
- Junichi Kurebayashi
- Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
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Molina R, Barak V, van Dalen A, Duffy MJ, Einarsson R, Gion M, Goike H, Lamerz R, Nap M, Sölétormos G, Stieber P. Tumor Markers in Breast Cancer – European Group on Tumor Markers Recommendations. Tumour Biol 2005; 26:281-93. [PMID: 16254457 DOI: 10.1159/000089260] [Citation(s) in RCA: 226] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Accepted: 08/04/2005] [Indexed: 11/19/2022] Open
Abstract
Recommendations are presented for the routine clinical use of serum and tissue-based markers in the diagnosis and management of patients with breast cancer. Their low sensitivity and specificity preclude the use of serum markers such as the MUC-1 mucin glycoproteins (CA 15.3, BR 27.29) and carcinoembryonic antigen in the diagnosis of early breast cancer. However, serial measurement of these markers can result in the early detection of recurrent disease as well as indicate the efficacy of therapy. Of the tissue-based markers, measurement of estrogen and progesterone receptors is mandatory in the selection of patients for treatment with hormone therapy, while HER-2 is essential in selecting patients with advanced breast cancer for treatment with Herceptin (trastuzumab). Urokinase plasminogen activator and plasminogen activator inhibitor 1 are recently validated prognostic markers for lymph node-negative breast cancer patients and thus may be of value in selecting node-negative patients that do not require adjuvant chemotherapy.
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Affiliation(s)
- Rafael Molina
- Laboratory of Biochemistry, Hospital Clinic, Medical School, Barcelona, Spain.
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12
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Kurebayashi J, Yamamoto Y, Tanaka K, Kohno N, Kurosumi M, Moriya T, Nishimura R, Ogawa Y, Taguchi T. Significance of serum carcinoembryonic antigen and CA 15-3 in monitoring advanced breast cancer patients treated with systemic therapy: a large-scale retrospective study. Breast Cancer 2003; 10:38-44. [PMID: 12525762 DOI: 10.1007/bf02967624] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The significance of serum carcinoembryonic antigen (CEA) and CA 15-3 in monitoring advanced breast cancer is still controversial. To clarify this issue, the Tumor Marker Study Group of the Japanese Breast Cancer Society conducted a large-scaled retrospective study. METHODS The findings from four clinical trials and seven institutes of 528 patients with advanced breast cancer were collected. Three-hundred forty-eight patients, in whom both serum CEA and CA 15-3 were measured during therapy, were selected for analysis. RESULTS The pretreatment positivity rate of CA 15-3 was significantly higher than that of CEA (p<0.0001). Time-to-progression (TTP) in CEA- and CA 15-3-positive patients was significantly shorter than TTP in negative patients. The changes in either marker level correlated well with response to therapy in marker-positive patients but not in negative patients. TTP in the marker-positive patients with a greater than 20%-reduction in either marker level during therapy was significantly longer than that in positive patients without such a reduction (p<0.01 for CEA and CA 15-3). CONCLUSION CA 15-3 is more useful for monitoring advanced breast cancer than CEA and a greater than 20%-reduction in marker levels suggests longer TTP in pretreatment marker-positive patients.
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13
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Whitlock JP, Evans AJ, Jackson L, Chan SY, Robertson JF. Imaging of metastatic breast cancer: distribution and radiological assessment at presentation. Clin Oncol (R Coll Radiol) 2002; 13:181-6. [PMID: 11527292 DOI: 10.1053/clon.2001.9250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This prospective study was performed to document the distribution of sites of disease in breast cancer patients with newly diagnosed metastatic disease, and to identify those with assessable or measurable disease by International Union Against Cancer (UICC) criteria. Data were collected on a consecutive series of 100 patients presenting with metastatic breast cancer. Imaging findings recorded included whether patients had assessable or measurable disease and which potentially assessable sites were rendered unassessable by radiotherapy. Radiologically diagnosable complications were recorded. Skeletal metastases comprised the majority, with 67 patients having skeletal involvement, although of these only 33 (49%) had assessable disease and 24 (36%) measurable disease. Sixteen (24%) patients had radiographically occult metastases. Liver ultrasound examination showed metastatic disease in 32 patients, of whom 28 (88%) had measurable lesions and 12% diffuse disease. Chest radiographs demonstrated metastatic disease in 42 patients, with assessable disease in 39 (93%) and measurable disease in 18 (43%). In total, 80 patients had radiologically assessable disease, with five rendered unassessable by the administration of radiotherapy to the only assessable site. Therefore, of the 100 patients, 75% (95% confidence interval (CI) 65-83) had radiologically assessable disease, with 55% (95% 45-65 CI) having measurable lesions by UICC criteria.
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Vinken A, Li Z, Balan D, Rittenhouse B, Wilike R, Nathwani D. Economic evaluation of linezolid, flucloxacillin and vancomycin in the empirical treatment of cellulitis in UK hospitals: a decision analytical model. J Hosp Infect 2001; 49 Suppl A:S13-24. [PMID: 11926436 DOI: 10.1016/s0195-6701(01)90030-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Standard antibiotic treatment of infections has become more difficult and costly due to treatment failure associated with the rise in bacterial resistance. New antibiotics that can overcome such resistant pathogens have the potential for great clinical and economic impact. Linezolid is a new antibiotic that is effective in the treatment of both antibiotic-susceptible and antibiotic-resistant Gram-positive bacterial infections, including those resistant to other available antibiotics. This breadth of activity is unique in existing antibiotics for Gram-positive bacteria and serves as the rationale for exploring the hypothesis that linezolid is an appropriate choice when considering empirical treatment of cellulitis in complicated or compromised patients in the nosocomial setting. A decision-modelling approach was used to compare the predicted first-line treatment efficacy and direct medical costs of linezolid with standard treatment of cellulitis among hospitalized patients. For the purposes of this analysis, standard care is defined along two main pathways: (1) initiating care with intravenous (iv) flucloxacillin, switching to vancomycin if the pathogen is found to be resistant to flucloxacillin, or maintaining flucloxacillin if the pathogen is found susceptible, or when culture and sensitivity analysis is inconclusive; or (2) initiating care with vancomycin, switching to iv flucloxacillin if the pathogen is found susceptible to flucloxacillin, maintaining vancomycin if the infection is found resistant, or when culture and sensitivity are inconclusive. For those patients taking iv flucloxacillin, a switch to oral flucloxacillin was allowed when clinically appropriate. We hypothesized that the cost of care of initiating treatment with linezolid would be less than that for both vancomycin and flucloxacillin in resistance risk ranges typically encountered in UK hospitals. In addition, while the registration trials showed equivalence of linezolid with the comparators in known or suspected methicillin-resistant Staphylococcus aureus (MRSA) and in known or suspected methicillin-susceptible Staphylococcus aureus (MSSA) (vancomycin and oxacillin) respectively, we hypothesized that first-line success rates would be higher in empiric treatment with linezolid. Efficacy data were obtained from recent clinical trials with linezolid and standard treatment, and medical resource utilization was obtained from an expert panel of clinicians who were questioned regarding resistant and susceptible infections separately. UK hospital direct medical costs of treatment were determined using standard costing techniques. Base case analyses assumed a residual 80% unknown pathogen rate after culture and susceptibility based on a physician survey and supported in the literature. The analysis in this model predicts that initiating empirical treatment of cellulitis with linezolid will (1) result in higher overall success rates than flucloxacillin for first-line treatment, regardless of resistance risk and (2) be less costly than initiating treatment with flucloxacillin when the likelihood of a patient being infected by a resistant pathogen is greater than 24.1%. Furthermore, initiating treatment with linezolid is predicted to result in higher overall success rates and be less costly than vancomycin across the entire spectrum of the patients' risk of being infected by a resistant pathogen.
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Affiliation(s)
- A Vinken
- The Lewin Group, Hoofddorp, The Netherlands
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Abstract
The aim of this paper was to estimate the future breast cancer and non-breast cancer costs associated with breast screening. The Nottingham prognostic index (NPI) was used to stratify patients into different prognostic groups and to predict the impact of breast screening on future costs. A Markov model was used to estimate breast cancer and non-breast costs for each prognostic group. Breast cancer costs were found to increase as the severity of prognosis increases. The opposite pattern was found for non-breast cancer costs. The total future costs (breast cancer and non-breast cancer costs) for each prognostic group was between pound10000 and pound11000. As a percentage of the costs of screening, the savings in future breast cancer costs were 20.9%. Inclusion of non-breast cancer costs cancelled out any potential savings in future breast cancer cost resulting from a better prognosis and resulted in an increase of 5.7% in future costs. Whether to include the latter type of cost remains a methodological issue of debate in economic evaluation.
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Affiliation(s)
- K Johnston
- Health Economics Research Centre, University of Oxford, Institute of Health Sciences, Headington, OX3 7LF, Oxford, UK.
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Cheung KL, Evans AJ, Robertson JF. The use of blood tumour markers in the monitoring of metastatic breast cancer unassessable for response to systemic therapy. Breast Cancer Res Treat 2001; 67:273-8. [PMID: 11561773 DOI: 10.1023/a:1017909727019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The role of blood tumour markers is established in the monitoring of response to systemic therapy for patients with metastatic breast cancer assessable by UICC criteria. This paper examines the use of marker measurements (in the form of a previously devised biochemical index score comprising CA15.3, CEA and ESR) in patients with metastatic lesions unassessable for response by UICC criteria. Of 218 patients with metastatic breast cancer treated over a 2-year period in the Nottingham Breast Unit, 43 patients (20%) had unassessable disease and 36 of them with blood marker results available were studied. Eighty-six per cent of patients were biochemically assessable. All patients who achieved biochemical response remained unassessable by UICC criteria. Twenty-two patients progressed initially or subsequently (after an initial biochemical response), either biochemically or by UICC criteria. Biochemical assessment completely paralleled UICC assessment in all eight patients who progressed by both assessments. Biochemical progression occurred ahead of UICC assessment in four of them with a median lead-time of 4.5 months. Biochemical assessment by blood tumour markers is useful in patients with metastatic breast cancer unassessable for response to systemic therapy. These findings need to be confirmed in a larger patient series.
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Affiliation(s)
- K L Cheung
- Department of Surgery, City Hospital, Nottingham, United Kingdom.
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Cheung KL, Graves CR, Robertson JF. Tumour marker measurements in the diagnosis and monitoring of breast cancer. Cancer Treat Rev 2000; 26:91-102. [PMID: 10772967 DOI: 10.1053/ctrv.1999.0151] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Elevation of established blood tumour markers correlates with the stage of breast cancer. The major role of current blood markers is therefore in the diagnosis and monitoring of metastatic disease. A combination of markers is better than a single marker with the most widely adopted combination being CEA and one MUC1 mucin, commonly detected as either CA15.3 or CA27.29. Tumour marker measurement is now used as a complementary test in the diagnosis of symptomatic metastases. In the monitoring of therapeutic response to both endocrine and cytotoxic therapies in advanced disease, biochemical assessment using blood markers not only correlates with conventional UICC criteria but has a lot of advantages which make it a potentially superior way of assessment. In this regard, CA15.3, CEA and ESR are the best validated combination. Studies are ongoing to evaluate the use of sequential blood tumour marker measurements in the follow-up of patients after treatment for their primary breast cancer, in terms of both early detection and early therapeutic intervention. Further randomized studies are also required to ascertain that marker-directed therapy is superior to the current practice for metastatic disease. In line with clinical studies, intensive laboratory work is being carried out to optimize the use of blood markers in advanced disease as well as to exploit their use in screening and diagnosis of early primary breast cancer.
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Affiliation(s)
- K L Cheung
- Professorial Unit of Surgery, City Hospital, Nottingham, UK
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Robertson JF, Jaeger W, Syzmendera JJ, Selby C, Coleman R, Howell A, Winstanley J, Jonssen PE, Bombardieri E, Sainsbury JR, Gronberg H, Kumpulainen E, Blamey RW. The objective measurement of remission and progression in metastatic breast cancer by use of serum tumour markers. European Group for Serum Tumour Markers in Breast Cancer. Eur J Cancer 1999; 35:47-53. [PMID: 10211087 DOI: 10.1016/s0959-8049(98)00297-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An established biochemical index for monitoring therapy in patients with metastatic breast cancer was tested prospectively in a multicentre study. The index uses two serum tumour markers--carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA15-3) along with erythrocyte sedimentation rate (ESR). 67 patients treated by either endocrine or chemotherapy had CA15-3, CEA and ESR measured at diagnosis of metastases and sequentially during therapy. Two markers, CA15-3 and CEA, were measured on a further 16 patients giving a total of 83 patients who were assessable for CA15-3 and CEA. Of the patients with CA15-3, CEA and ESR measured at diagnosis of metastases 84% (56/67) had elevation of 1 or more markers. During therapy the number with elevated marker(s) rose to 96% (64/67). Changes in the markers were in line with and often pre-dated therapeutic outcome as assessed by the International Union Against Cancer (UICC) criteria both for remission and progression. Patients without elevation of markers on diagnosis subsequently showed a rise in the marker(s) at or before documented disease progression by UICC. The 3 women in whom markers were at no time significantly elevated remain in remission. The results using CA15-3 and CEA were similar but 12% less patients were assessable. CA15-3 and CEA (with and without ESR) provide an objective method to guide therapy in patients with metastatic breast cancer.
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Affiliation(s)
- J F Robertson
- Professional Unit of Surgery, City Hospital, Nottingham, UK.
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Wolstenholme JL, Smith SJ, Whynes DK. The costs of treating breast cancer in the United Kingdom: implications for screening. Int J Technol Assess Health Care 1998; 14:277-89. [PMID: 9611903 DOI: 10.1017/s0266462300012253] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Total treatment costs by stage at diagnosis are estimated for a sample of breast cancer patients. At 4 years, stage 4 cancers emerge as being more expensive to treat than those at earlier stages, although this difference fails to achieve significance when expected lifetime costs are considered. The inclusion of treatment cost estimates in a screening model indicates that screening may increase expected treatment costs by a marginal amount, although the model also suggests that the cost-effectiveness ratio of breast cancer screening might be better than had originally been thought.
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Robertson J. Prospective confirmation of a biochemical index for measuring therapeutic efficacy in metastatic breast cancer in a multicentre study. Breast 1996. [DOI: 10.1016/s0960-9776(96)90006-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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