الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In the present study, we evaluated the diagnostic, prognostic and follow up values of serum sFas & sFasL in comparison with serum CA15.3 in breast cancer patients. All of these parameters were measured in serum samples collected from normal healthy control group (n=22) and breast cancer females of recently detected breast carcinoma of clinical stages II and III [n=24], before surgery, 2 weeks following surgical removal of the breast and after 6 cycles of FAC chemotherapy. Serum sFas and sFasL levels were measured in all studied groups by ready-to-use Enzyme linked immunosorbent assay (ELISA) kits. Serum CA15-3 was measured using a ready-for-use Immunoradiometric assay (IRMA) kit.
The serum level of sFas was significantly elevated in breast cancer patients group compared with the normal healthy controls group. There was a significant decline of the serum level of sFas after 2 weeks of surgery compared with its level before surgery in the breast cancer group. In addition, there was a significant elevation of the serum level of sFas in response to 6 cycles of chemotherapy compared with its level after 2 weeks of surgery in breast cancer group. These results indicated that, serum sFas level may be considered as a diagnostic biomarker in breast cancer and can be used as a useful marker in the follow up of the breast cancer patients after the surgical removal of the breast and chemotherapeutic treatment. Our results showed a significant correlation of serum sFas with tumor pathological grade in breast cancer patients group. This means that serum sFas can be valuable in predicting breast cancer progression and differentiation.
The serum level of sFasL is significantly decreased in breast cancer patients group compared with the normal healthy control group. This means that the serum level of sFasL could be influenced by both tumor cells production and immune cells consumption of sFasL, that indicating affected level of serum sFasL with the variations in immune responses of patients. These observations revealed that the level of serum sFasL should be combined with other markers as serum sFas in the prognosis and follow up of breast cancer patients.
According to the results of the present study, the serum levels of CA15.3 were significantly higher in breast cancer patients than the controls. We found no follow up role for serum CA15.3 in patients with primary breast cancer neither following the surgical removal of the breast nor after 6 cycles of chemotherapy. The serum CA15.3 showed a significant correlation with clinical stage in breast cancer patients.
In the present study, it was found that serum sFas, CA15.3 and sFasL were diagnostic markers. On comparing their diagnostic values to determine which one is superior to the other, the ROC curve analysis was applied. Inspection of the four curves showed that the ROC curve for serum sFas was above ROC curves for CA15.3 & sFasL, respectively. The area under the curve was 83.8% for sFas, 78.0%for CA15.3 and 75.2% for sFasL. The optimum cut-off value selected for serum sFas was 631.78 pg/ml at which the sensitivity was 66.67% and the specificity was 90.91%, the optimum cut-off value selected for serum CA15.3 was 23.00 U/ml at which the sensitivity was 45.83% and the specificity was 95.45% and the optimum cut-off value selected for serum sFasL was 0.50 ng/ml at which the sensitivity was 70.83% and the specificity was 72.73%. Hence serum sFas is superior to CA15.3 & sFasL, respectively, as a diagnostic tumor marker in breast cancer patients.
Up to the best of our knowledge, this is the first study comparing the diagnostic values of these three parameters using the ROC curve analysis showing sFas as the most superior diagnostic marker. sFas was also found to have a role in monitoring the effect of surgery & chemotherapy on breast cancer patients.