Multiple biological markers and breast carcinoma: A preliminary study in the detection of recurrent disease after primary therapy

Tp, Waalkes; Abeloff,; Ds, Ettinger; Kb, Woo; Cw, Gehrke; Je, Mrochek

doi:10.1002/jso.2930180103

Cited by 9 publications

(1 citation statement)

References 36 publications

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“…The majority of groups agree that clinical assessment for local recurrence or recurrence in the other breast is mandatory [9]. However, serial investigations tend to be performed at regular intervals in the absence of clinical abnormalities in an attempt to detect early relapse [2,3,[10][11][12][13][14]. The most useful markers have been shown to be AP, GGT, CEA, and chest x-ray [3], but in many cases the markers are transiently or persistently abnormal and these patients are then subjected to further specialized tests to either con- Metastases > 2yrs AP 6 (55) 1 (9) 0 (n = 11) GGT 3 (27) 1 (9) 0 CEA 2 (18) 0 1 (9) AP = Alkaline phosphatase; GGT = Gamma glutamyl-transpeptidase, CEA = Carcinoembryonic antigen.…”

Section: Discussionmentioning

confidence: 99%

Tests for detecting recurrent disease in the follow-up of patients with breast cancer

Mansi

Earl

Powles

et al. 1988

Breast Cancer Res Tr

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In 141 postmenopausal node-positive patients with primary breast cancer, routine biochemical markers (alkaline phosphatase, gamma-glutamyl transpeptidase, carcinoembryonic antigen), and chest x-ray, in combination with history and clinical examination, have been performed at 3 monthly intervals for at least 2 years. Sixty one patients relapsed at a median time of 14 months. The recurrence was detected at routine follow-up in 40 (66%) patients. Of these 40 patients, 26 (65%) presented with symptoms, 11 (28%) were asymptomatic but were found to have relapsed on clinical examination, and only 3 (8%) had their relapse diagnosed on the basis of an abnormal chest x-ray. The remaining 21 patients presented early with symptoms. Therefore symptoms and clinical examination accounted for the detection of relapse in 58 of the 61 (95%) patients. Of the patients who had relapsed, 49% (30 of 61) had one or more abnormal markers/chest x-rays prior to relapse, rising to 79% (48 of 61) at the time of relapse. Of 80 patients with no evidence of recurrence, 36% (29) had no marker abnormality recorded, whereas in 64% (51) one or more abnormalities were found. These results suggest that history and examination are the important procedures in follow-up, and that abnormal markers are not always due to metastatic disease and may be misleading.

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Section: Discussionmentioning

confidence: 99%

Tests for detecting recurrent disease in the follow-up of patients with breast cancer

Mansi

Earl

Powles

et al. 1988

Breast Cancer Res Tr

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Biological markers as an aid in the clinical management of patients with liver metastases

Waalkes¹,

Abeloff

Ettinger

et al. 1982

Journal of Surgical Oncology

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Liver metastases due to the more common neoplastic diseases such as colorectal, breast, or bronchogenic carcinoma are a frequent occurrence and are associated with an ominous prognosis. Earlier detection followed by appropriate therapeutic interventions might have a decided effect on the subsequent course of disease. Controversy exists over the selection of tests with the greatest sensitivity, specificity, and potential utility. Preliminary evidence suggest that gamma-glutamyl transpeptidase and 5'-nucleotidase may be of particular significance. Four enzymes--gamma-glutamyl transpeptidase, 5'-nucleotidase, leucine aminopeptidase, and alkaline phosphatase plus carcinoembryonic antigen--were compared in the same blood samples from selected patients with breast and small cell carcinoma of the lung. Gamma-Glutamyl transpeptidase was the most sensitive test with 28/29 (97%) patients with hepatic metastases having elevated enzymatic activity in their sera. For patients with small cell carcinoma of the lung followed serially, gamma-glutamyl transpeptidase activity was increased an average of 5 months before liver metastases were detected by clinical means. Two factors are important in the interpretation of the results of gamma-glutamyl transpeptidase analysis: (1) Hepatic dysfunction due to diseases other than metastatic tumor involvement can cause a rise in enzyme levels as can (2) medications or ethanol which activate the hepatic microsomal drug metabolizing system. Of particular importance, however, is the fact that antitumor chemotherapy, even intensive and multiple agent, did not appear to effect the enzyme activity in the sera of patients with breast or small cell carcinoma of the lung. Gamma-glutamyl transpeptidase in combination with carcinoembryonic antigen may be of particular value in detecting liver metastases and in assessing subsequent response to therapy.

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Biochemical and hematological tests in patients with breast carcinoma: Correlations with extent of disease, sites of relapse, and prognosis

Lee

1985

Journal of Surgical Oncology

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The value of serial biochemical and hematological tests of blood in differentiating stages and in detecting recurrence of breast carcinoma was studied in 500 patients. Patients who had mastectomy and were with no evidence of disease (NED group) had higher hemoglobin, albumin, total protein, and lower LDH than patients with any amount of breast carcinoma. These four tests became more abnormal in patients with metastatic disease (group IV). In addition, peripheral lymphocyte count was significantly decreased, and SGOT, AP, alpha-1 globulin, and CEA significantly increased, when patients developed recurrent or metastatic disease. Patients with disseminated soft tissue or lung metastasis had less abnormality of such blood tests than those with metastasis in bone or other visceras. Immunoglobulins (IgG, IgA, IgM) were not different between early or late stages, nor specific sites of metastatic involvement. Among patients with a greater amount of loco-regional disease (group III) and patients with metastatic disease (group IV), those who had hemoglobin greater than or equal to 12.5 gm%, lymphocyte count of 15-2,500/cmm, albumin greater than or equal to 4 gm%, AP less than or equal to 25 units, or LDH less than or equal to 400 units had significantly better 5-year survival rates.

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Multiple biological markers and breast carcinoma: A preliminary study in the detection of recurrent disease after primary therapy

Cited by 9 publications

References 36 publications

Tests for detecting recurrent disease in the follow-up of patients with breast cancer

Tests for detecting recurrent disease in the follow-up of patients with breast cancer

Biological markers as an aid in the clinical management of patients with liver metastases

Biochemical and hematological tests in patients with breast carcinoma: Correlations with extent of disease, sites of relapse, and prognosis

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