The Role Of Different Combination Of Five Serum Markers In Breast Cancer Diagnosis And The Evaluation Of Neoadjuvant Chemotherapy Effectiveness

Tumor markers were one group of giant molecule substance related to tumor genesis and development, which can be detected from the blood and other body fluid. They were giant molecule protein including tumor associated antigen,ectopic hormone and enzyme , and they included metabolic products about saccharide,grease and protein. Tumor markers can be used in early diagnosis, therapeutic effectiveness evaluation, prognosis judgment and monitoring recurrence and metastasis of malignant tumor. But the sensitivity and specificity were very low when single marker was used in diagnosis with breast cancer, which limited these tumor markers in clinical utilization. Therefore, how to select and combine perfect markers to improve their clinical diagnostic rate is very important. We detect the concentration of CA15-3,CA125,CEA,CYFRA21-1 and TPS in patients with breast diseases by ELISA, and search for the most perfect combination of the five makers for diagnosis and evaluation of neoadjuvant chemotherapy effectiveness in breast cancer by statistical analysis.Objective:1,To explore the clinical application of the different combination of five serum markers in diagnosis of breast cancer.2,Search for the most perfect combination of the five makers for evaluation of neoadjuvant chemotherapy effectiveness in breast cancer.Methods:1.Clinical Material: 204 cases of breast disease confirmed by pathology in our hospital between October 2005 and December 2006 were included. 60 cases were benign, while 144 cases were malignant breast cancer. Among them 93 cases were infiltrating ductal carcinoma, 34 cases were infiltrating lobular carcinoma, 15 cases were cellular cancer and 2 cases was invasive cribriform carcionma. All the breast cancer patients accepted 2-4 cycles of neoadjuvant chemotherapy with TE project ( taxinol 175mg/m2 , Epirubicin 60 mg/m2,d1, once/21d). All the patients accepted medical examination and ultrasomic inspection before and after neoadjuvant chemotherapy.2.The evaluation standards of neoadjuvant chemotherapy: According to WHO solid tumor therapeutic effect evaluation standard, there are four kinds of evaluation: Complete Remission, Partial Remission, Stabilization disease and Progression disease.3.Enzyme linked immunosorbent assay: CA15-3,CA125,CEA,CYFRA21-1 and TPS were detected in all the serum specimens by enzyme linked immunosorbent assay. Once the concentration is over the normal reference limit, it is recorded as positive.4.Statistical analysis: All the statistical analysis was deal by the MATLAB6.5 software. The variability comparison of two samples was analyzed by t test andχ2 test. The different combination of the five markers were analyzed by multiple linear regression.。Results:1.The results of the five tumor markers in diagnosis of breast cancer were as following:①The concentration of CA15-3,CA125,CEA,CYFRA21-1 and TPS between the benign lesions and breast cancer had significant difference( All the p value were less than 0.05 ). It concluded that the five makers were help to the diagnosis of breast cancer.②When the makers were detected respectively, CA15-3 was the better maker with the positive diagnostic rate as 60.4%, false positive rate as 11.7 %, and the diagnostic accurate rate as 68.6%. It inferred that CA15-3 alone was not suitable to diagnosis in breast cancer.③The best combination of two markers was CYFRA21-1+TPS with the positive diagnostic rate as 70.8%, false positive rate as 8.3%, and the diagnostic accurate rate as 76.9%; The best combination of three markers was CEA+CYFRA21-1+TPS with the positive diagnostic rate as 84.0%, false positive rate as 10.0%, and the diagnostic accurate rate as 85.8%; The best combination of four markers was CA125+CEA+CYFRA21-1+TPS with the positive diagnostic rate as 86.8%, false positive rate as 15.0%, and the diagnostic accurate rate as 86.3%; The diagnostic accurate rate of the combination of five markers was less than the four markers combination. It concluded that the different combination of these markers can improve diagnosis rate of breast cancer.④According to theχ2 test, my study consider the CEA+CYFRA21-1+TPS was the best combination in diagnosis of breast cancer. 2 . The results of the five tumor markers in prognostic of the therapeutic effect of neoadjuvant chemotherapy were as follow:①CEA is the better maker when the makers were detected alone. But the consistent rate of prognostic effect in neoadjuvant chemotherapy was only 63.2%, so CEA alone was not suitable to prognose the effect in neoadjuvant chemotherapy.②The best combination of two markers was CA15-3+ TPS with the consistent rate of prognostic effect as 70.4%; The best combination of three markers was CA15-3+CEA+CYFRA21-1 with the consistent rate of prognostic effect as 83.2%; The best combination of four markers was CA15-3+CA125+CEA+CYFRA21-1 with the consistent rate of prognostic effect as 84.8%; The consistent rate of prognostic effect of the combination of the five markers was 83.2%. It inferred that the different combination of these markers can improve the consistent rate of prognostic effect in neoadjuvant chemotherapy.④According to theχ2 test, my study considered that the combination of CA125+CEA+CYFRA21-1 was the best combination in evaluation the therapeutic effect of neoadjuvant chemotherapy .3. The results of the five tumor markers in evaluation of the therapeutic effect of neoadjuvant chemotherapy were as follow:①The concentration of CEA and CYFRA21-1 between the pre and post neoadjuvant chemotherapy had significant difference( All the p value were less than 0.05 ). The concentration of the other 3 makers had no significant difference (All the p value was more than 0.05).It concluded that CEA and CYFRA21-1 were help to evaluate the therapeutic effect of neoadjuvant chemotherapy.②The combination of CEA and CYFRA21-1 was more accurate than the single marker in the evaluation of the therapeutic effect of neoadjuvant chemotherapy.Conclusion:1.The CA15-3,CA125,CEA,CYFRA21-1 and TPS can be used to help breast cancer diagnosis. But the diagnostic rate was low when they were used to diagnosis by single marker alone.2.The CEA+CYFRA21-1+TPS is the best combination for breast cancer diagnosis. It can improve diagnosis rate in breast cancer diagnosis.3.The CA15-3+CEA+CYFRA21-1 is the best combination to prognose the therapeutic effect of neoadjuvant chemotherapy in breast cancer.4.CEA and CYFRA21-1 can help to evaluate the therapeutic effect of neoadjuvant chemotherapy. And the combination of CEA and CYFRA21-1 was more accurate than the single marker in the evaluation of the therapeutic effect of neoadjuvant chemotherapy.