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Titolo:
Tumor markers in breast cancer monitoring should be scheduled according toinitial stage and follow-up time: A prospective study on 859 patients
Autore:
Gion, M; Peloso, L; Mione, R; Vignati, G; Fortunato, A; Saracchini, S; Biasioli, R; Gulisano, M; Cappelli, G;
Indirizzi:
Gen Reg Hosp, Ctr Study Biol Markers Malignancy, Venice, Italy Gen Reg Hosp Venice Italy Study Biol Markers Malignancy, Venice, Italy Gen Reg Hosp, Div Oncol, Venice, Italy Gen Reg Hosp Venice ItalyGen Reg Hosp, Div Oncol, Venice, Italy Fornaroli Hosp, Div Internal Med, Magenta, Italy Fornaroli Hosp Magenta Italy oli Hosp, Div Internal Med, Magenta, Italy S Bortolo Hosp, Serv Lab Med, Vicenza, Italy S Bortolo Hosp Vicenza Italy Bortolo Hosp, Serv Lab Med, Vicenza, Italy S Bortolo Hosp, Div Med Oncol, Vicenza, Italy S Bortolo Hosp Vicenza Italy ortolo Hosp, Div Med Oncol, Vicenza, Italy Careggi Hosp, Nucl Med Serv, Florence, Italy Careggi Hosp Florence Italy areggi Hosp, Nucl Med Serv, Florence, Italy
Titolo Testata:
CANCER JOURNAL
fascicolo: 3, volume: 7, anno: 2001,
pagine: 181 - 190
SICI:
1528-9117(200105/06)7:3<181:TMIBCM>2.0.ZU;2-Z
Fonte:
ISI
Lingua:
ENG
Soggetto:
CARCINOEMBRYONIC ANTIGEN; EARLY DIAGNOSIS; CA 15-3; CLINICAL UTILITY; CA-15.3; CEA; TPA; SURVEILLANCE; RECURRENCE; THERAPY;
Keywords:
tumor markers; breast cancer; follow-up; decision criteria; CA15.3; CEA;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
35
Recensione:
Indirizzi per estratti:
Indirizzo: Gion, M Osped Civile, Ctr Reg Indicatori Biochim Tumore, ULSS 12 Veneziana, I-30122 Venice, Italy Osped Civile ULSS 12 Veneziana Venice Italy I-30122 Venice, Italy
Citazione:
M. Gion et al., "Tumor markers in breast cancer monitoring should be scheduled according toinitial stage and follow-up time: A prospective study on 859 patients", CANCER J, 7(3), 2001, pp. 181-190

Abstract

PURPOSEThe purpose of this study was to identify and standardize optimal decisioncriteria for maximizing the effectiveness of tumor markers in clinical useduring the follow-up of patients operated on for breast cancer. MATERIALS AND METHODSThe study was prospectively performed on 859 patients enrolled in 10 institutions. A total of 13,337 determinations of CEA and 14,330 determinations of CA15.3 were available. The median number of samples per patient was 16 for CEA and 17 for CA15.3. The median follow-up was 7 years. Receiver-operating characteristic analysis was used to evaluate the ability of CEA and CA15.3 to discriminate relapses from patients who had no evidence of disease. The diagnostic performances of the two markers were evaluated using decision criteria based on both dichotomic cutoff points and dynamic variations among serial samples. RESULTSWe selected decision levels corresponding to preset levels of 90% and 99% specificity. Patients with CEA and/or CA15.3 levels above the cut-off values were considered positive only if a 1.5-fold increase occurred among the last sample and the mean of the first three samples. According to the different cut-offs used, specificity ranged from 94% to 99% and sensitivity from 48% to 63%. We calculated predictive values using the prevalence expected with reference to the stage of primary tumor and the length of follow-up. Positive predictive values ranged from 1.6% to 93.7%, and negative predictivevalues from 88.9% to 100%, according to the clinical scenarios and the decision criteria used. The choice of the decision criteria significantly affected positive predictive values within each patient subset. Differences related to lime from surgery were still remarkable for every decision criteria(i.e., positive predictive values ranged from 36.6% to 2.8% in node-negative patients according to the year of observation, although the same cut-offpoint was used). DISCUSSIONThe results of the present prospective study show that different decision criteria may provide different diagnostic performances for the same tumor marker and in the same patient. Therefore, we suggest that different decision criteria be settled and used according to the clinical goals.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/04/20 alle ore 12:32:54