Logistic regression model based on serum CEA, CA 15-3, IGFBP-3, and IL-2R measurement in predicting the presence of axillary lymph node metastases in patients with breast cancer

Background: Approximately 25% of patients with breast cancer (BC) may present with axillary lymph node metastases (NMs) at the time of surgery. Unfortunately, no preoperative imaging studies are available in detecting NMs before sentinel node biopsy, which is considered a routine technique for staging patients. More than 50% of patients had early-stage (stage 0-1) BC, but an early prediction of NMs could be useful in selecting patients scheduled for neoadjuvant chemotherapy and more personalized surgery. A number of serum tumor markers (STMs) have been proposed in the pre- and postoperative management of patients with BC, and the most widely used were carcinoembryonic antigen (CEA), and cancer-specific cancer antigen (CA) 15-3. More recently, relatively new STMs, including insulin-like growth factor binding protein-3 (IGFBP-3) and interleukin-2 receptor (IL-2R), have been suggested. The aim of this study was to evaluate the sensitivity and specificity of serum CEA, CA 15-3, IGFBP-3, and IL-2R in predicting the presence of NMs in patients with pT1-2 BC. Patients and Methods: A group of 34 women with confirmed pN1-2 BC (cases) and 33 age-matched node-negative (pN0) control patients were retrospectively enrolled in the study. All patients underwent serum CEA, CA 15-3, IGFBP-3, and IL-2R measurement using radioimmunoassay (CEA) or chemiluminescent immunoassay, respectively. Results: At univariate analysis, the sensitivity, specificity, and accuracy were the following: 47.1%, 36.4%, 41.8% (CEA); 50%, 48.5%, 49.3% (CA 15-3); 55.9%, 45.4%, 55.2% (IGFBP-3); 52.9%, 48.5%, 50.7% (IL-2R). The IGFBP-3 was the best NMs prediction marker in the univariate analysis, and the area under the curve (AUC) was 0.65. In the multivariate logistic regression analysis, model with IGFBP-3 and IL-2R showed a better predictive value (AUC=0.69), corresponding to a sensitivity and specificity of 70.6% and 66.7%, respectively. Conclusion: In patients with BC, serum IGFBP-3 and IL-2R measurement in combination improves both sensitivity and specificity of STMs in predicting the presence of NMs, and can be useful in selecting patients with elevated risk of having positive sentinel node biopsy.