－S 535 －
― S-369 ―
Clinical implications of tumor marker surge in advanced breast cancer
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
*Hyo Song Kim, Myung Hee Chang, Hyun Jung Jun, Kyoung Ha Kim, Yeon Hee Park
Background: For monitoring patients with advanced breast cancer, serum tumor markers, such as CA 15-3 or CEA, can be used in conjunction with diagnostic imaging. However, caution should be used when interpreting a rising serum tumor marker during the treatment. We investigate the clinical significance and implications of tumor marker surge during chemotherapy. Methods: Tumor marker surge was defined as an initial increase of >10% from baseline followed by subsequent drop. The tumor markers (CEA, CA15-3) were serially monitored during chemotherapy with response to chemotherapy and clinical outcomes. Results: 146 patients with advanced breast cancer received palliative chemotherapy at Samsung Medical Center from 1999 to 2006 were included. CEA and CA15-3 were monitored serially during chemotherapies. The patients were categorized into three groups according to the change of CA15-3; Group 1, the patients who showed continuous elevation of CA15-3
; Group 2, the patients who showed serial drop after chemotherapy without surge; Group 3, the patients who showed initial surge followed by subsequent drop. There was no difference among three groups in terms of median age, bone and visceral organs involvement. However, brain metastasis was more common in group 3.Among the 122 patients in group 2 (n=92) and 3 (n=30), there was a significantly different disease control rate between two groups (P=0.004). Patients with surge had significantly higher risk of disease progression (odd ratio 2.62, 95% CI = 1.45 - 4.72). The median PFS from the date of first administration of palliative chemotherapy in the group 2 was 7.7 (95% CI, 5.7-9.7 months) months and that in the group 3 was 6.1 (95% CI, 4.3-7.9) months (P = 0.02). Among 61 patients showed concomitantly raised CEA levels, there was a statistically significant agreement between CA 15-3 and CEA levels (kappa = 0.451, 95% CI=0.245-0.657, P< 0.001).
Conclusion: Surge phenomenon for the patients with advanced breast cancer seems to be an adverse prognostic factor in terms of treatment response. An early tumor marker surge after the treatment should be cautiously followed sequentially and concerned as an early signal for poor response to chemotherapy.
― S-370 ―
폐전이을 동반한 Bellini ductal carcinoma 1례
가톨릭대학교 의과대학 강남성모병원 종양내과
*이지은, 고윤호, 원혜성, 김태희, 강진형, 홍영선
신세포암은 전체 종양 중 약 2.6%의 발생률을 보이는 종양으로, 조직학적으로 clear cell carcinoma가 90% 이상의 분포를 보이고 있다.
Bellini ductal carcinoma는 collecting duct의 Bellini cell에서 기원하는 종양으로, 분류학적으로 신세포암의 범주에 포함되지만 조직학적 소견 으로는 요로상피세포암종과 비슷한 특성을 보인다. 예후는 불량하여 진단 후 2년 이내에 60% 이상의 환자가 사망하는 것으로 알려져 있으 며, 현재까지 확립된 표준 치료는 없는 상태이다. 증례) 53세 남성이 1주일간 지속된 육안적 혈뇨 및 우연히 발견된 다발성 폐 결절을 주소로 내원하였다. 복부 전산화 단층 촬영에서 왼쪽 신장에 경계가 불분명한 저음영의 종괴가 발견되었고, 흉부 전산화 단층 촬영에서는 여러 개의 경계가 비교적 분명하고 불규칙한 양상의 공동을 동반한 결절이 양폐하엽에 분포하였다. 원인질환 감별을 위해 시행한 신장 조직검사상 집 합관에서 발병한 Bellini ductal carcinoma가 진단되었다. 환자는 M-VAC (Methotrexate, Vincristine, Adriamycin, Cisplatin) 전신 항암 화학요 법을 시행하였다. 추적 흉부 전산화 단층 촬영에서 전이성 종괴의 수 및 크기가 모두 감소하는 부분 반응을 보였으며 4개월의 무병진행기간 을 보이고 있다. 결론) 저자들은 폐전이를 동반한 Bellini ductal carcinoma 에서 요로상피세포암종에서 사용되는 M-VAC 항암요법 후 호전된 증례를 경험하였기에 보고하는 바이다.
