Tissue carcinoembryonic antigen and oestrogen receptor status in breast carcinoma: an immunohistochemical study of clinical outcome in a series of 252 patients with long-term follow-up

Abstract

Summary Carcinoembryonic antigen (CEA) is a well-known tumour marker whose immunohistochemical expression could be prognostically relevant in breast carcinomas. We evaluated CEA immunohistochemical expression, using the specific T84.66 monoclonal antibody, in a series of 252 consecutive cases of infiltrating breast carcinomas (104 NO, 148 N1/2) with median follow-up of 84 months. Oestrogen receptor (ER) status has been evaluated with the immunohistochemical method (ER1 D5 antibody, 10% cut-off value): 121 cases were ER negative, 128 cases were ER positive and in three cases ER status was unknown. CEA staining was cytoplasmic; staining intensity and percentage of reacting cells were combined to obtain a final score (CEA score). The difference between the distribution of CEA score within the modalities of the other variables was not statistically significant. Univariate survival analysis has been performed on the series of node-negative and node-positive patients. In the latter subgroup, this has been performed separately for patients treated with systemic adjuvant hormonal therapy or chemotherapy. A multivariate analysis was only performed for node-positive patients treated with adjuvant therapy. CEA immunoreactivity was not prognostically relevant in any subset of analysed patients. The most important prognostic markers were nodal status and tumour size.

Expression of cell adhesion molecules and prognosis in breast cancer

“…The findings in the present study are consistent with previous investigations in which E‐cadherin was shown to be a tumour dissemination suppressor13, 16, 17. Studies assessing CEA expression on breast cancer tissue have not been conclusive7–12. Results of these studies are difficult to compare for various reasons.…”

“…Tumour expression of CEA has been assessed in different patient populations using different antibodies and different immunohistochemical cut‐offs for defining high CEA tumour expression7–12. The number of patients studied, and the follow‐up times also differed7–12. The present results have confirmed that there is a difference in RFP for patients with high versus low CEA tumour expression9, 11.…”

“…Results of these studies are difficult to compare for various reasons. Tumour expression of CEA has been assessed in different patient populations using different antibodies and different immunohistochemical cut‐offs for defining high CEA tumour expression7–12. The number of patients studied, and the follow‐up times also differed7–12.…”

“…CEA, described by Gold and Freedman5 in 1965, mediates, among others, cell–cell adhesion5. Although the association between CEA expression and prognosis for breast cancer has been evaluated in the past, the results have not been conclusive6–12.…”

How shall we apply the new biology to diagnostics in surgical pathology?

“…Serving as a model for the studies of other molecular markers, the prognostic significance of these factors has been investigated in a number of well-designed clinical trials. [42][43][44][45] More importantly, oncologists have devised treatment protocols, with stratification of patients using these markers, which are currently being tested in prospective trials. Such a concerted effort to develop clinically relevant and wellaccepted molecular markers is essential for progress but requires a level of organization and coordination that is not typically seen in most clinicopathological investigations.…”