Tumor markers in patients with advanced breast cancer as prognosticators: a preliminary study.

A retrospective study was performed on 69 breast cancer patients (stage II, N = 18; advanced disease, N = 51) in order to assess the prognostic value of circulating prolactin (PRL), CEA, CA 15-3, insulin-like growth factor-1 (IGF-1), and epidermal growth factor (EGF) by RIA/IRMA. These markers were compared with short-term prognosis (two years). Significant difference was observed only for PRL ( < 20.0 ng/ml vs. > 20.0 ng/ml), which provide an independent predictor of short-term prognosis in advanced breast cancer.

Usefulness of terminal deoxynucleotidyl transferase as prognosticator in leukemia patients.

Peripheral blood samples from 55 previously untreated leukemia patients (33 males, 22 females) were analysed for terminal deoxynucleotidyl transferase (TdT) activity. TdT was significantly higher in patients with acute myelogenous leukemia (AML; P < 0.001), chronic myelogenous leukemia (CML; P < 0.05) and acute lymphoblastic leukemia (ALL; P < 0.001) when compared with controls. One patient with chronic lymphocytic leukemia (CLL) had undetectable TdT. Among leukemic patients, ALL patients had higher concentration of TdT than CML and AML patients. Females had higher TdT activity than males, although the difference between the two groups was not statistically significant. 68% TdT+ and 32% TdT- patients were in blastic crisis. Patients with more than 10% of blasts in the circulation had significantly higher TdT than blast-negative patients (P < 0.001). No difference in survival was observed between TdT+ and TdT- group. From these results, we conclude that the absolute TdT concentration is of little prognostic value in leukemia patients.

Comparison of plasma prolactin and CEA in monitoring patients with adenocarcinoma of colon and rectum.

Plasma prolactin (PRL) and carcinoembryonic antigen (CEA) were measured by radioimmunoassay in 74 patients with adenocarcinoma of colon and rectum. The markers were correlated with disease stage, histological grade and progression/remission of disease. The circulating preoperative median PRL and CEA levels were significantly higher in colorectal cancer patients than in their respective controls. PRL was elevated in all Dukes stages and in all histological grades of the tumour whereas the rise in CEA was more pronounced in Dukes D. Out of 74 patients, 29% (21/74) developed recurrent disease and 31% (23/74) responded to the treatment. With regard to monitoring recurrence(s), the predictive value of PRL was 94% which was significantly greater than that of CEA which was only 62%. In patients who developed liver metastases PRL remained elevated whereas CEA showed more than 100-fold increase. Therefore, we feel that CEA is a better marker for monitoring patients who developed liver metastases. From our results, we suggest that PRL can be used as a better overall marker for detecting recurrence(s) in patients with colorectal adenocarcinoma.

Endocrine function in premenopausal and postmenopausal advanced breast cancer patients treated with CMF or tamoxifen.

The effect of CMF (cyclophosphamide, methotrexate and 5-fluorouracil) or tamoxifen treatment on endocrine function was investigated in premenopausal and postmenopausal breast cancer patients. CMF therapy resulted in ovarian failure but pituitary and adrenal functions were unaffected in premenopausal patients. Although amenorrhea was achieved within two to five months in older patients, younger patients required large cumulative doses of cytotoxic drugs to exhibit ovarian dysfunction. CMF therapy had no effect on hormonal levels in postmenopausal patients indicating that in this group therapeutic response is not mediated via the endocrine system. On the other hand, tamoxifen therapy in postmenopausal patients resulted in hyperestrogenemia.

Estrogen and progesterone receptor status of primary breast cancer: relationship with the pattern of first metastasis and survival.

Estrogen (ER) and progesterone receptor (PR) contents in primary tumors from 127 advanced breast cancer patients were measured by DCC method. The patients were followed for 2 years and the prognostic value of the receptor levels was evaluated and compared with other tumor and patient characteristics. No relation was found between receptor levels and tumor, first relapse site as well as short-term survival (2 years) which might be due to the advanced stage of disease at diagnosis.

Endocrine status in stage II vs. advanced premenopausal and postmenopausal breast cancer patients.

Circulating preoperative levels of DHEA-S, androstenedione and SHBG were measured in 40 premenopausal and 49 postmenopausal breast cancer patients, and in 30 and 15 age-matched healthy controls, respectively. Moreover, the levels of LH, FSH, prolactin, estradiol, progesterone, testosterone, DHEA-S, androstenedione and SHBG of Stage II breast cancer patients were compared with advanced patients and also with controls. In premenopausal patients the levels of steroid hormones were significantly low whereas those of peptide hormones were significantly high. On the contrary, in postmenopausal patients, except DHEA-S, all other hormones were significantly elevated in comparison with controls. In premenopausal patients, DHEA-S, androstenedione, estradiol, progesterone, and testosterone decreased as stage advanced with concomitant increase of SHBG, LH, FSH and prolactin when compared with hormone levels of Stage II patients. In postmenopausal advanced breast cancer patients, when compared with Stage II patients, the levels of SHBG, LH, FSH, and prolactin increased significantly, while DHEA-S, androstenedione, estradiol, and progesterone decreased as stage advanced.

Plasma prolactin as an indicator of disease progression in advanced breast cancer.

Serial plasma prolactin levels were measured in 144 breast cancer patients (premenopausal [PR-M], N = 64; postmenopausal [PO-M], N = 80) and compared with respective controls. Patients with breast cancer were grouped into those who (1) developed distant metastasis, (2) developed local recurrence, (3) stable disease, and (4) responded to the various therapeutic modalities at the end of 2 years. The authors' analysis showed excellent correlation between serial plasma prolactin changes and the response to therapy or progression of disease in patients with advanced breast carcinoma.

Comparison of prolactin, CA 15-3 and TPA in breast carcinomas.

Circulating prolactin, CA 15-3 and TPA were assayed pre-therapeutically and sequentially thereafter from 68 breast cancer patients attending the Gujarat Cancer and Research Institute, Ahmedabad--a regional cancer institute in Western India. The three marker values were correlated with the stage, histologic grade and disease status. At least one of the markers was elevated in 82% of patients. CA 15-3 and TPA levels were elevated with the advancement of stage. Prolactin levels were high in poorly differentiated tumors of pre-menopausal patients. The disease status was effectively reflected by the levels of prolactin and CA 15-3. TPA showed high false positivity so was of no use as an indicator of disease status. Recurrence could be predicted early, with a lead time of 3-6 months using prolactin and CA 15-3.

Prognostic value of squamous cell carcinoma antigen in patients with uterine cervical carcinoma.

Squamous cell carcinoma antigen (SCC Ag) was estimated in 30 controls, in 16 patients with benign lesions of the uterine cervix, and in 51 patients with uterine cervical carcinoma. The rate of positivity of the antigen among the cancer patients was 87% (N = 49). SCC Ag estimations were of no diagnostic value, since 37% of patients with benign lesions had elevated levels compared to controls. SCC Ag was highly correlated to histologic subtype. The highest values were obtained in keratinizing tumors, followed by large cell nonkeratinizing and small cell nonkeratinizing types. Moreover, elevation of SCC Ag was statistically significant (p less than 0.001) among all the three histologic subtypes compared to controls. However, SCC Ag levels were not consistently correlated to the stage of the disease. Patients with pretherapeutic SCC Ag levels above 30 ng/ml had a faster recurrence rate and shorter survival than those who exhibited antigen values below 2.0 ng/ml. From our results, it is suggested that SCC Ag has limited use as a parameter for early diagnosis of cervical carcinoma, but it seems to reflect advancement of the disease. These findings indicate that SCC Ag elevation may prove to be a valuable marker in predicting subclinical disease.

Correlation of steroid receptors with histopathologic characteristics in breast carcinoma.

Estrogen and progesterone receptors were correlated to histologic variables in 288 breast cancer patients from western India. The progesterone receptors (PR) were significantly elevated as compared to estrogen receptors (ER) amongst primary pre- and peri-menopausal breast carcinomas. ER positivity was correlated significantly to nuclear grade. Lymphatic invasion and vascular permeation were not found to be linked to ER, while PR positivity could be linked to lymphatic invasion and inversely to vascular permeation. Higher frequency of ER positivity was observed in lobular carcinomas. PR concentrations of the tumor had better correlations with histologic variables as compared to ER.

Significance of ferritin as a marker in head and neck malignancies.

The efficiency of the combination of two tumor-associated antigens in recognising head and neck cancer was evaluated. The markers studied were CEA and ferritin by radioimmunoassay. CEA was estimated in 22 controls and 41 head and neck cancer patients. There was no difference in CEA values of controls and head and neck cancer patients, suggesting that CEA was not specific for head and neck malignancies. We measured serum ferritin in 27 controls and 58 patients with head and neck cancer. The mean ferritin level was significantly higher in patients (P less than 0.001) than in normal subjects. The ferritin level in patients with no evidence of clinical disease 8 months after treatment showed approximately normal levels, whereas the levels showed a tendency to increase or remain at high levels in patients with a poor prognosis, giving support to the contention that ferritin may prove to be a valuable adjunct in head and neck cancer.

Prognosis in breast carcinoma utilizing plasma carcinoembryonic antigen and histologic characteristics of the primary tumor.

Plasma carcinoembryonic antigen (CEA) concentrations in 128 patients with breast cancer were measured preoperatively. The data were related to the histologic features of the primary breast carcinoma and to the clinical follow-up data. Analysis of the plasma CEA values did not show a significant correlation with the histologic type and the histologic and nuclear grade of the primary tumor (n = 73) as well as to the presence or absence of keratin, necrosis, desmoplasia, tubule formation and mucin production. Furthermore, the results indicated that high CEA values (more than 10 ng/ml) may be associated with distant metastasis and not with the metastatic spread to lymph nodes. High CEA levels were also associated with reduced survival of the patients. This study confirms our previous report suggesting that high CEA levels are correlated with tumors of endodermal origin, whereas the CEA levels were within the normal range in the tumors of ectodermal origin. In agreement with other studies, however, it was found that the predictive value of plasma CEA concentrations in general is weak, so that the use of CEA measurement for prognosis is of limited value.

Peptide and steroid hormone levels in pre- and postmenopausal breast carcinoma.

Circulating levels of LH, FSH, prolactin, estradiol, progesterone and testosterone were measured by radioimmunoassay in 15 premenopausal (PR-M) age matched healthy controls, 35 premenopausal breast cancer patients prior to therapy, 20 postmenopausal (PO-M) age matched healthy controls and 68-71 postmenopausal breast cancer patients prior to therapy. The patients had histologically proven breast cancer. In PR-M breast cancer group, the LH and progesterone did not differ significantly whereas prolactin showed marked elevation (p less than 0.001) and estradiol and testosterone showed significant decrease (p less than 0.001). The PO-M breast cancer patients exhibited remarkable increase in the levels of LH, FSH, prolactin and testosterone (p less than 0.001) whereas estradiol and progesterone showed little increase in the levels (p less than 0.2 and less than 0.1, respectively). From the results, it is concluded that prolactin and altered ratio of estrogen and androgen plays a major role in the genesis of breast cancer.

Sacrococcygeal teratoma: a 33-year experience.

During the years 1941 through 1973, 48 patients, 16 males and 32 females, with sacrococcygeal teratoma were seen at the Childrens Hospital of Los Angeles. Forty-four patients have been followed, three are lost to follow-up, and one patient died 2 wk after excision of teratoma. Of the 44 patients with follow-up, 26 had teratoma with mature tissues only, all these patients are living. Six patients had tumor containing mature and embryonic tissues. Of these, five are living and one died with metastases of malignant teratoma 1 yr after excision of the primary tumor. Of the remaining 12 patients, 11 have died during the first 4 yr of life due to malignant teratoma and only one is living without recurrence 15 yr after excision of teratoma containing frankly neoplastic tissues. Recurrence and/or metastasis of malignant sacrococcygeal teratoma was lethal in all instances.