Background & AimsThe utility of measuring carcinoembryonic antigen(CEA) and cancer antigen 15-3 (CA15-3) levels in patients with breast cancer remains controversial. The present study aims to investigate the prognostic value of preoperative serum CEA and CA15-3 levels in breast cancer patients.MethodsSerum preoperative CEA and CA 15-3 concentration levels were measured in a total of 432 breast cancer patients. The association of tumor markers levels with clinicopathological parameters and outcomes were analyzed.ResultsElevated serum levels of CEA and CA15-3 were identified in 47 (10.9%) and 60(13.9%) patients, respectively. Larger tumor size, advanced axillary lymph nodal and TNM stage exhibited higher proportion of elevated CEA and CA15-3 levels. The elevation of CEA levels was significantly greater in patients with HER2 positive tumors, and the elevation of CA15-3 levels was significantly greater in ER negative breast patients. Univariate and multivariate Cox’s regression analysis revealed that elevated preoperative CEA and CA 15-3 levels were independent prognostic factors for DFS and OS. When considering the combination of both markers levels, patients with both elevated markers presented the worst survival. Independent prognostic significance of elevated preoperative serum CEA and CA15-3 levels were reconfirmed in Luminal B breast cancer.ConclusionsPreoperative serum levels of CEA and CA15-3 are independent prognostic parameters for breast cancer.

A recent review concluded that earthworm presence increases CO 2 emissions by 33% but does not affect soil organic carbon stocks. However, the findings are controversial and raise new questions. Here we hypothesize that neither an increase in CO 2 emission nor in stabilized carbon would entirely reflect the earthworms' contribution to net carbon sequestration. We show how two widespread earthworm invaders affect net carbon sequestration through impacts on the balance of carbon mineralization and carbon stabilization. Earthworms accelerate carbon activation and induce unequal amplification of carbon stabilization compared with carbon mineralization, which generates an earthworm-mediated 'carbon trap'. We introduce the new concept of sequestration quotient to quantify the unequal processes. The patterns of CO 2 emission and net carbon sequestration are predictable by comparing sequestration quotient values between treatments with and without earthworms. This study clarifies an ecological mechanism by which earthworms may regulate the terrestrial carbon sink.

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