Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jun 24, 2022; 13(6): 529-539
Published online Jun 24, 2022. doi: 10.5306/wjco.v13.i6.529
Significance of serum carcinoembryonic antigen in metastatic breast cancer patients: A prospective study
Thattungal Manoharan Anoop, Rona Joseph P, Saikumar Soman, Steffi Chacko, Mintu Mathew
Thattungal Manoharan Anoop, Rona Joseph P, Saikumar Soman, Steffi Chacko, Mintu Mathew, Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, Kerala, India
Author contributions: Anoop TM designed the study, drafted the manuscript, and supervised the study and treatment; Joseph P R participated in the design and supervision of the study and treatment; Chacko S participated in the design of the study; Soman S was involved in data collection, analysis, and statistics; Mathew M participated in data collection; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board/EC according to the ethical norms and regulations.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data are available from the corresponding author upon reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thattungal Manoharan Anoop, MD, DM, DNB, Associate Professor, Department of Medical Oncology, Regional Cancer Center, Medical College Campus, Trivandrum 695011, Kerala, India. dranooptm@yahoo.co.in
Received: January 7, 2022
Peer-review started: January 7, 2022
First decision: April 13, 2022
Revised: April 16, 2022
Accepted: May 28, 2022
Article in press: May 28, 2022
Published online: June 24, 2022
Abstract
BACKGROUND

Carcinoembryonic antigen (CEA) is an important serum tumour marker with a substantial role in diagnosis and monitoring of various solid tumours. About 36%-70% of breast cancers have elevated serum CEA. And the available studies show discrepancy in addressing the prognostic significance of CEA in advanced breast cancer.

AIM

To estimate the serum CEA level in our metastatic breast cancer patients and correlate it with response to treatment and clinical outcome.

METHODS

This was a prospective clinical study conducted on 50 metastatic breast cancer patients treated at breast clinic, with newly diagnosed metastatic breast cancer planned for palliative chemotherapy, targeted therapy, and hormonal treatment. We estimated the proportion of patients with elevated serum CEA level at baseline and after palliative treatment and also studied the association of serum CEA levels with known prognostic factors. The response to treatment was correlated with the serum CEA levels in the context of responders and non-responders.

RESULTS

The median pre-treatment and post-treatment CEA levels were 7.9 (1.8-40.7) ng/mL and 4.39 (1.4-12.15) ng/mL, respectively, in the whole study population (P = 0.032). No statistically significant difference was seen in baseline serum CEA between responders and non-responders. Even in the luminal group, pre-treatment serum CEA was not a predictor of response, but post-treatment CEA was a significant predictor of tumour progression. In patients with liver and lung metastases, post-treatment CEA level difference was not statistically significant in both responders and non-responders though the values were higher in non-responders. Among those with bone metastases, 69.5% had elevated post-treatment serum CEA, and only 37.5% had elevated serum CEA in those with no bone metastases.

CONCLUSION

Elevated post-treatment serum CEA levels are associated with disease progression and poor response to therapy. Persistently elevated post-treatment serum CEA levels are significantly associated with bone metastases. Elevated serum CEA and hormonal status are significant predictors of treatment response.

Keywords: Carcinoembryonic antigen, Metastatic breast cancer, Serum tumour marker, Luminal and non-luminal metastatic breast cancer, Palliative chemotherapy

Core Tip: In breast cancer patients, elevated serum carcinoembryonic antigen (CEA) levels are particularly noted in advanced disease. Our study suggested that serum CEA has potential clinical value in monitoring the treatment response of metastatic breast cancer patients, especially in those with bone metastasis.