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CA15-3 and alkaline phosphatase as predictors for breast cancer recurrence: a combined analysis of seven International Breast Cancer Study Group trials

Keshaviah, A. ; Dellapasqua, S. ; Rotmensz, N. ; Lindtner, J. ; Crivellari, D. ; Collins, J. ; Colleoni, M. ; Thürlimann, B. ; Mendiola, C. ; Aebi, S. ; Price, KN ; Pagani, O. ; Simoncini, E. ; Castiglione Gertsch, M. ; Gelber, RD ; Coates, AS ; Goldhirsch, A.

In: Annals of Oncology, 2007, vol. 18, no. 4, p. 701-708

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    Title
    • CA15-3 and alkaline phosphatase as predictors for breast cancer recurrence: a combined analysis of seven International Breast Cancer Study Group trials
    Author
    • Keshaviah, A.. International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, MA, USA
    • Dellapasqua, S.. European Institute of Oncology, Milan, Italy
    • Rotmensz, N.. European Institute of Oncology, Milan, Italy
    • Lindtner, J.. The Institute of Oncology, Ljubljana, Slovenia
    • Crivellari, D.. Centro di Riferimento Oncologico, Aviano, Italy
    • Collins, J.. Department of Surgery, The Royal Melbourne Hospital, Melbourne, Australia
    • Colleoni, M.. European Institute of Oncology, Milan, Italy
    • Thürlimann, B.. Kantonsspital, St Gallen, Switzerland
    • Mendiola, C.. Hospital 12 de Octubre, Madrid, Spain
    • Aebi, S.. Swiss Group for Clinical Cancer Research, Bern, Switzerland
    • Price, KN. International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, MA, USA
    • Pagani, O.. Swiss Group for Clinical Cancer Research, Bern, Switzerland
    • Simoncini, E.. Oncologia Medica-Spedali Civili, Brescia, Italy
    • Castiglione Gertsch, M.. International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
    • Gelber, RD. International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, MA, USA
    • Coates, AS. International Breast Cancer Study Group, Australian New Zealand Breast Cancer Trials Group and University of Sydney, Australia
    • Goldhirsch, A.. European Institute of Oncology, Milan, Italy
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Annals of Oncology, 2007, vol. 18, no. 4, p. 701-708. Oxford University Press
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:297470
    Summary
    Background: We evaluated the ability of CA15-3 and alkaline phosphatase (ALP) to predict breast cancer recurrence. Patients and methods: Data from seven International Breast Cancer Study Group trials were combined. The primary end point was relapse-free survival (RFS) (time from randomization to first breast cancer recurrence), and analyses included 3953 patients with one or more CA15-3 and ALP measurement during their RFS period. CA15-3 was considered abnormal if >30 U/ml or >50% higher than the first value recorded; ALP was recorded as normal, abnormal, or equivocal. Cox proportional hazards models with a time-varying indicator for abnormal CA15-3 and/or ALP were utilized. Results: Overall, 784 patients (20%) had a recurrence, before which 274 (35%) had one or more abnormal CA15-3 and 35 (4%) had one or more abnormal ALP. Risk of recurrence increased by 30% for patients with abnormal CA15-3 [hazard ratio (HR) = 1.30; P = 0.0005], and by 4% for those with abnormal ALP (HR = 1.04; P = 0.82). Recurrence risk was greatest for patients with either (HR = 2.40; P < 0.0001) and with both (HR = 4.69; P < 0.0001) biomarkers abnormal. ALP better predicted liver recurrence. Conclusions: CA15-3 was better able to predict breast cancer recurrence than ALP, but use of both biomarkers together provided a better early indicator of recurrence. Whether routine use of these biomarkers improves overall survival remains an open question