Correlation Between The Serum Levels Of Tumor Markers And Clinicopathological Characteristics In Breast Cancer Patients

Background and Purpose:This study intends to detect the relationship between serum levels of CEA,CA15-3 and CA125 and their molecular subtypes and other clinicopathological characteristics in breast cancer patients before receiving treatment retrospectively,in an attempt to find the possible correlation and internal connection between them,as a result to discuss the predictive value of the change in the treatment of breast cancer.Materials and methods:During January 2014 to December 2017,961 patients diagnosed with breast cancer were admitted to the breast surgery of Qilu hospital of Shandong university.They were fully informed the research purpose and after informed consent they were examined the serum level of TMs before treatment and other clinical pathology data were also collected for statistical analysis.We used variables analysis to detect the correlation between the TMs and molecular subtypes and clinicopathologic factors,and then detected the independent predictive factors by multivariate analysis.Resu ts:CEA,CA15-3 and CA125 levels increase in 48(4.99%),54(5.62%)and 55(5.72%)patients,respectively.Luminal A subtype,Luminal B1(HER-2 negative)subtype,Luminal B2(HER-2 positive)subtype,HER-2 overexpression subtype and TNBC subtype account for 23.31%,39.96%,13.22%,11.34%,12.17%,respectively.The results show that there is a significant difference between the levels of CEA and CA15-3 in patients with different molecular subtypes before treatment(p<0.05,p<0.001),while it is not with the levels of CA125(p =0.2605).Patients with HER-2 overexpression subtype and Luminal B2 subtype are more likely to show elevated CEA,and patients with TNBC and Luminal B2 subtype are more likely to show elevated CA15-3.By analyzing the relationship between the changes of these TMs and clinicopathological characteristics of patients,it can be seen that CEA,CA15-3 and CA125 levels are all enhanced when the tumor was large(p<0.01,p<0.0001,p<0.05} and when patients with lymph node metastasis(p<0.05,p=0.0001,p<0.05).Serum CA15-3 and CA125 levels are also higher in patients with PR negative status than positive ones(p<0.01,p<0.05).Breast cancer patients aged 50 and above and being with HER-2 positive status are more likely to show CEA rising(p<0.05,p<0.01).In addition,patients with ER negative status and higher histological grade are prone to be seen CA15-3 rising(p<0.01,p<0.05).However,there was no correlation between the level of Ki67%and the above three tumor markers.Multivariate analysis showed that age,tumor size,molecular subtype and HER-2 status are all independent predictive factors for the change of CEA level in breast cancer patients before treatment(p=0.0001,p<0.05,p<0.05),that is,patients with aged 50 and above,tumor diameter more than 2cm and HER-2 positive status are more likely to have elevated CEA level before treatment,in which the risk of patients aged 50 and above are about as four times as the risk of aged under 50;HER-2 overexpression subtype and Luminal B1 subtype are more likely to have elevated CEA level before treatment.Lymph node status is no longer an independent factor affecting the change of CEA level.Tumor size,lymph node status and molecular type are independent factors influencing the change of CA15-3 level(p<0.01,p<0.01,p<0.05),more precisely,tumor size more than 2cm,lymph node positive are more likely to show increased CA15-3 level.The risk is about three times higher than the corresponding patients;Luminal B2 subtype is apt to have elevated levels of CA15-3 compared with Luminal B1 subtype.The histological grade of tumor and hormone receptor status are no longer independent factors affecting the change of CA15-3 level(p>0.05,p>0.05).Lymph node positive status and PR negatie status are independent factors for CA125 rising(p<0.05,p<0.05),and tumor size is no longer independent factor for CA125(p=0.1423).Conclusions:The proportion of breast cancer patients with increasing levels of CEA,CA15-3 and CA125 before treatment is close to 5%on average.The univariate analysis results show that different molecular subtypes of breast cancer patients present different levels of CEA and CA15-3 before treatment.Higher level of CEA could be seen in HER-2 overexpression subtype and Luminal B2 subtype,while TNBC subtype and Luminal B2 subtype patients with higher level of CA15-3.The univariate analysis also shows that CEA,CA15-3 and CA125 levels all rise when the tumor was larger and when patients with lymph node metastasis.Serum CA15-3 and CA125 levels are also higher in patients with PR negative status than those with PR positive status.Patients aged 50 and above and patients with HER-2 positive status are more likely to have elevated CEA.In addition,patients with ER negative status and higher histological grade are related to elevated CA15-3 levels.The results of multivariate analysis show that age,tumor size,molecular subtype and HER-2 status are all independent predictive factors for the change of CEA level in breast cancer patients before treatment,that is,patients with aged 50 and above,tumor diameter more than 2cm and HER-2 positive status are more likely to have elevated CEA level before treatment;As regards subtype,HER-2 overexpression subtype have higher CEA level before treatment compared with Luminal B1 subtype.Tumor size,lymph node status and molecular subtype are independent predictive factors in the terms of CA15-3,which means,they are patients with tumor diameter more than 2cm and lymph node positive status;Luminal B2 subtype patients are more likely to have elevated levels of CA15-3 before treatment compared with Luminal B1 subtype patients.Lymph node positive and PR negative are independent factors for elevated CA125 levels.