The Clinical Value of Tissue Carcinoembryonic Antigen in Breast Cancer Shunsuke HAGA, O s a m u WATANABE,T a d a o SHIMIZU,Hiroshi IMAMURA, Tomio hDA, Masujiro MARITAa n d Tetsuro KAJIWARA

ABSTRACT: T h e relationship o f tissue carcinoembryonic antigen (CEA) to clinicopathological factors a n d prognosis was investigated in 168 patients with invasive ductal carcinoma o f the breast. Tissue CEA was determined by radioimmunoassay and a level o f 5.1 n g / m l or m o r e considered to be positive. Tissue CEA was positive in 31.5 per cent of the patients overall and, o f the clinicopathological factors, tumor size and the presence or absence o f lymph n o d e involvement were not f o u n d to be correlated with tissue CEA. However, the tissue CEA positivity rate was significantly higher in patients who h a d four or m o r e metastatic lymph nodes (p(0.01). Tissue CEA-positive patients showed earlier recurrence than CEA-negative patients (p~0.01) a n d h a d a p o o r e r outcome (p~0.05). Thus, tissue CEA is considered useful as a prognostic index for primary breast cancer patients. KEY WORDS:

breast cancer, tissue CEA, CEA

INTRODUCTION

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it was first detected in the tissues o f colorectal carcinoma, 1 carcinoembryonic antigen (CEA) has b e e n f o u n d in the tissues o f various other carcinomas a n d in the serum of tumor-bearing patients. It is therefore now utilized widely as a clinical marker. I n cases Of breast cancer, although the preoperative positivity rate o f serum CEA is too low to be useful for screening, its clinical use as an index for forecasting recurrence has b e e n widely p r o m o t e d 3 Moreover, a relationship between serum CEA a n d prognosis has b e e n suggested, and special attention focused on serum CEA as a prognostic

The Department of Surgery, Tokyo Women'sMedical College, Daini Hospital, Tokyo,Japan Reprint requests to: Shunsuke Haga, MD, The Department of Surgery, Tokyo Women's Medical College, Daini Hospital, 2-1-10, Nishiogu, Arakawaku, Tokyo 116, Japan

factor, s-7 It is therefore possible that a certain relationship exists between prognosis and tissue CEA in breast cancer, since tissue CEA is detected at a higher frequency t h a n serum CEA. I n the present study, the usefulness o f CEA as a prognostic index in breast cancer tissue was investigated by examining its relationship with clinicopathological factors a n d survival rate. MATERIALSAND METHODS

Patients T h e subjects comprised 168 patients with invasive ductal c a r c i n o m a o f the b r e a s t who were treated surgically at the Tokyo W o m e n ' s Medical College , Daini Hospital during the 7 years between January, 1982 and December, 1988. T h e patients ranged in age f r o m 35 to 72 years, with a m e a n age o f 52.5 years a n d the follow-up period was 3 to 86 months, with a m e a n period of 41.5 months.

JAPANESEJOURNALOFSURGERY,VOL. 21, No. 3 pp. 278-283, 1991

Volume 21 Number 3

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Tissue CEA in breast cancer

Lymph node metastasis was positive in 78 patients and negative in 90 and, of the 168 patients, the tumor size was 2 cm or less in 25, 2.1-5.0 cm in 111, and 5.1 cm or more in 17, excluding 15 who showed accompanying skin invasion. CEA radioimmunoassay

Part (0.5 g) of the cancer tissue was sampied, and frozen immediately after the removal o f fat and blood components. T h e frozen sample was then ground and pulv e r i z e d and, if it still c o n t a i n e d blood, washed 3 times with a buffer solution (TrisEDTA). T h e sample was. homogenized 3 times, for 10 Sec or less, with 2-fold its weight o f ice-cooled buffer solution. T h e homogenized sample was then centrifuged at 4000 rpm for 65 min at 4~ to obtain the supernatant cytosol. T h e level o f CEA in the supernatant was determined by the m e t h o d o f H a n s e n et al. 8 using a Roche CEA radioimmunoassay kit with the level obtained being regarded as the level o f tissue CEA. T h e criterion level was 5.0 n g / m g as determined by Shimizu's method 9 and cases with a level o f 5.1 n g / m l or more were considered positive. Statistical analysis

T h e significance o f differences in the tissue CEA posjtivity rate and clinicopathological factors was analyzed by the chi-square test, while the survival rate and disease-free rate were calculated by the Kaplan-Meier method, and their significance analyzed by the log-rank test.

tissue CEA was positive in 35.9 per cent o f cases with lymph node metastasis a n d 27.8 per cent o f those without, however, there was no correlation between the two groups. When patients with lymph n o d e metastasis were divided into two groups according to the n u m b e r o f lymph nodes involved, namely; 1-3 nodes and 4 or more nodes, the tissue CEA positivity rate was 17.6 per cent for the former group and 50.0 per cent for the latter. T h e r e was a significant difference between these two groups (p

The clinical value of tissue carcinoembryonic antigen in breast cancer.

The relationship of tissue carcinoembryonic antigen (CEA) to clinicopathological factors and prognosis was investigated in 168 patients with invasive ...
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