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
A partir d'une revue systématique de la littérature scientifique publiée jusqu'en janvier 2026 (31 études incluant au total 178 047 patientes atteintes d'un cancer du sein), cette méta-analyse évalue l'association entre le niveau sérique préopératoire de l'antigène CA15-3 et la survie globale, la survie sans maladie et la présence de métastases au niveau des ganglions axillaires
Background : Breast cancer (BC) is the leading cause of cancer-related death among women. Axillary lymph node metastasis (ALNM) is a key prognostic factor, yet its assessment relies on invasive procedures. The prognostic value of preoperative CA15-3 remains controversial. We aimed to evaluate the association between preoperative CA15-3 levels and overall survival (OS), disease-free survival (DFS), and ALNM in breast cancer patients.
Methods : We systematically searched PubMed, Scopus, Web of Science, Embase, and Cochrane Library up to January 2026. Cohort studies assessing preoperative CA15-3 and OS, DFS, or ALNM were included. Pooled hazard ratios (HRs) for OS and DFS, as well as pooled odds ratios (ORs) with 95% confidence intervals (CIs) for metastasis outcomes (Any metastasis or ALNM), were calculated using random-effects models.
Results : Thirty-one cohort studies comprising 178,047 patients were included. Elevated CA15-3 was significantly associated with worse OS (HR: 1.91; 95% CI: 1.67–2.15), poorer DFS (HR: 2.04; 95% CI: 1.78–2.31), and increased metastasis risk (OR: 2.73; 95% CI: 2.04–3.42). The strongest association was observed for ALNM (OR: 3.08; 95% CI: 2.09–4.08). Subgroup and meta-regression analyses confirmed consistent findings across regions and identified age, tumor stage, and CA15-3 cutoff as heterogeneity sources.
Conclusions : Elevated preoperative CA15-3 is significantly associated with reduced survival and increased ALNM risk. This association remained significant after adjustment for tumor characteristics in most primary studies, suggesting CA15-3 may reflect more aggressive tumor biology. These findings support CA15-3’s potential as an adjunctive biomarker; however, prospective validation is warranted.
Breast Cancer , résumé, 2026