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Tumor markers CA15-3, CA125, CEA and breast cancer survival by molecular subtype: a cohort study



The burden of breast cancer has grown rapidly in China during recent decades. However, the association between tumor markers (CA15-3, CA125, and CEA) and breast cancer survival among certain molecular subtypes is unclear; we described this association in a large, population-based study.


We conducted a cohort study including 10,836 women according to the Tianjin Breast Cancer Cases Cohort. Demographic and epidemiologic data were collected by a structured face-to-face questionnaire. Clinico-pathological parameters were abstracted from medical records, and follow-up information was obtained once a year by telephone. The primary endpoints were breast cancer-specific survival (BCSS) and disease-free survival (DFS). We utilized the Cox proportional hazard model to calculate hazard ratios (HRs) and 95% confidence intervals (CI).


Among all patients, elevated CA15-3 and CEA exhibited consistently and statistically significant reduced BCSS compared with normal ones (CA15-3: HR 1.54, 95% CI 1.01–2.34; CEA: HR 2.45, 95% CI 1.40–4.30). Similar patterns of association were observed for DFS (CA15-3: HR 2.09, 95% CI 1.44–3.02; CEA: HR 2.71, 95% CI 1.71–4.27). Moreover, in luminal A subtype, high CA15-3 and CEA levels were associated with decreased BCSS (CA15-3: HR 4.47, 95% CI 2.04–9.81; CEA: HR 3.79, 95% CI 1.68–8.55) and DFS (CA15-3: HR 4.06, 95% CI 2.29–7.18, CEA: HR 3.41, 95% CI 1.75–6.64). In basal-like subtype, elevated CEA conferred reduction for BCSS (HR 5.13, 95% CI 1.65–15.9). However, no association was observed between CA125 and breast cancer outcome.


Preoperative CA15-3 and CEA levels differ in breast cancer molecular subtypes and yield strong prognostic information in Chinese women with breast cancer. Measuring CA15-3 and CEA levels before surgery may have the potential in predicting breast cancer survival and offering patients’ personalized treatment strategy among luminal A and basal-like subtypes.

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This work was funded by National Natural Science Foundation of China [Grants 81473039, 81502476, and 81974488], The National Key Research and Development program of China: The Net construction of human genetic resource Bio-bank in North China (2016YFC1201703), the National Key Research and Development Program of China (2016YFC1302703), National Human Genetic Resources Sharing Service Platform (2005DKA21300), and in part by the Program for Changjiang Scholars and Innovative Research Team in University in China (IRT_14R40) and Tianjin Municipal Key Health Research Program Grant 15KG143 and Tianjin Science and Technology Committee Foundation (17JCYBJC25300).

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Correspondence to Fengju Song or Kexin Chen.

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Li, J., Liu, L., Feng, Z. et al. Tumor markers CA15-3, CA125, CEA and breast cancer survival by molecular subtype: a cohort study. Breast Cancer (2020). https://doi.org/10.1007/s12282-020-01058-3

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  • Breast cancer
  • Survival
  • Tumor marker
  • Molecular subtype