Preoperative CA15-3 as a predictor of axillary lymph node metastasis and prognosis in women with breast cancer: a GRADE-assessed systematic review and meta-analysis.
Mansour Bahardoust, Anita Rezaei, Anahita Hosseinali et al.
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In 30 seconds
This GRADE-assessed systematic review and random-effects meta-analysis examined cohort studies of preoperative CA15-3 in women with breast cancer, assessing survival and metastatic outcomes. Across 31 studies comprising 178,047 patients, elevated CA15-3 was associated with worse overall survival (HR: 1.91; 95% CI: 1.67-2.15), poorer disease-free survival, and greater metastasis risk. The strongest reported association was with axillary lymph node metastasis (OR: 3.08; 95% CI: 2.09-4.08). Findings were consistent across regions, although age, tumor stage, and CA15-3 cutoff contributed to heterogeneity.
Key findings
- Elevated CA15-3 was associated with worse overall survival (HR: 1.91; 95% CI: 1.67-2.15).
- Elevated CA15-3 was associated with poorer disease-free survival (HR: 2.04; 95% CI: 1.78-2.31).
- The pooled association with axillary lymph node metastasis was OR: 3.08; 95% CI: 2.09-4.08.
- Elevated CA15-3 was associated with increased metastasis risk overall (OR: 2.73; 95% CI: 2.04-3.42).
Why it matters
Axillary nodal involvement and survival are clinically important outcomes in breast cancer. The pooled associations suggest preoperative CA15-3 may provide prognostic information alongside tumor characteristics, while variation related to age, stage, and assay cutoff underscores the need for careful interpretation. The evidence concerns associations and does not establish that CA15-3 can replace invasive nodal assessment.
What to keep in mind
The evidence came from cohort studies, and heterogeneity was linked to age, tumor stage, and CA15-3 cutoff. Prospective validation is warranted.