RESUMO
Breast cancer (BRC) is an important malignant disease. Its incidence is highest among the female cancers in Thailand, with a trend to increase annually. The discovery of new tumor markers is urgently needed, to enable BRC to be detected in its early stages, to improve prognosis, to monitor treatment, and to detect recurrence, and thereby control this serious neoplasm. It has been reported that CSLEX (sialyl LewisX), a cancer-associated carbohydrate antigen on cancer-cell membrane, can be detected in the serum of cancer patients at higher levels than healthy controls; it can be used for monitoring the treatment of patients with cancers of the lung, stomach, colon, and breast. The aims of this study were to investigate differences in the serum CSLEX levels of BRC patients and healthy controls, and the correlation of serum CSLEX levels with stages and histological types. The level of serum CSLEX was measured in 200 breast-cancer patients and 200 healthy controls by enzyme immunoassay technique. The average level of serum CSLEX in the breast-cancer group was 12.14 + 15.70 U/ml (mean + SD) which was significantly higher than the healthy control group (3.56 + 2.41 U/ml) (p\<0.001). In the healthy control group, the cutoff value was 8.38 U/ml (mean + 2SD). The sensitivity and specificity of serum CSLEX for the detection of BRC were 69.0% and 98.0%, respectively. The serum CSLEX levels increased among the advanced-stage BRC patients. However, no correlation was found between serum CSLEX level and histological type. The findings of this study suggest that the detection of serum CSLEX level may be a useful tool for the diagnosis and prognosis of breast cancers among Thai women. (Thai Cancer J 2010;30:145-152)
RESUMO
A retrospective cohort of registered breast cancer patients at the National Cancer Institute of Thailand in 2004 was investigated to explore the association of prognostic factors with the probability of distant metastasis. The analysis was done using binary and ordinal logistic regression models. There were 893 breast cancer patients included in a 3 year follow up study. During the study period 129 (14.45%) were reported as metastasis cases, which the highest number of metastasis patients was found in bone (47.3%). The prognostic variables related to the distant metastasis breast cancer using binary logistic regression model were found among vascular invasion (OR=8.8), histologic grade III (OR=2.9), lymphatic invasion (OR=2.4), estrogen receptor (OR=2.2), progesterone receptor (OR=2.0), p53 (OR=1.8), tumor size (OR=1.2), radiation therapy (OR=0.5) and hormonal therapy (OR=0.4). Patients in which metastasis occurred within the 1st, 2nd and 3rd years after initial diagnosis were 75, 28 and 26 cases respectively. Using an ordinal logistic regression model, the prognostic factors included vascular invasion (OR=5.6), estrogen receptor (OR=2.3), lymphatic invasion (OR=2.3), histologic grade III (OR=1.9), p53 (OR=2.0), tumor size (OR=1.2), radiation therapy (OR=0.6) and hormonal therapy (OR=0.5). The prognostic factor of vascular invasion showed the highest OR in this study. Another group of variables with moderate OR were estrogen receptor, lymphatic invasion, histologic grade III, p53 and tumor size. The adjuvant therapies were protective factors (OR \< 1). A follow up system for those at risk for metastasis is suggested.