Klinische Bedeutung erhöhter CEA-Werte in der Nachsorge von Patientinnen mit Mammakarzinom

Abstract

To evaluate the clinical significance of elevated CEA titers in primary breast cancer post-mastectomy 942 patients were followed up by means of clinical methods and CEA analysis according to a routine schedule. In 282 patients CEA in serum was found to be elevated (greater than or equal to 5 ng/ml) on at least one occasion. Recurrent disease became clinically evident in 255 patients (27%). CEA-positive patients had a significantly higher recurrence rate than CEA-negative patients (52% versus 16%, p less than 0.001). The mean lead time from first elevation of CEA to clinical diagnosis of recurrence was 5 months. The frequency of recurrent disease depended on the height of the CEA titer and the further course of CEA. With titers above 30 ng/ml 91% of patients developed recurrent disease, with constantly elevated or further increasing titers 74% and 100%, respectively. Regarding CEA and the type of metastases, no clear correlation was demonstrable. However, patients with soft tissue metastases exhibited a higher frequency of normal or low (less than 30 ng/ml) CEA titers as compared to patients with visceral or bone metastases. With respect to the criteria mentioned above, CEA is a valuable laboratory tool for early diagnosis of recurrence in breast cancer patients. However, the simple criterion much greater than CEA elevation much less than (5 ng/ml threshold) is of low prognostic significance. Despite intensive clinical searches for metastases and a mean observation time of 20 months, no recurrence became clinically evident in 48% of CEA-positive patients.(ABSTRACT TRUNCATED AT 250 WORDS)