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 Bcl-2, Bax and P53 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=30) and breast cancer females of recently detected breast carcinoma of clinical stages II and III (n=30), before surgery, one month following surgical removal of the breast and after 6 cycles of FAC chemotherapy. Serum Bcl-2, Bax and P53 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 levels of serum Bcl-2 of breast cancer patients either before or after one month of surgery as well as after 6 cycle of chemotherapy were significantly higher than those of control group. It was also noticed that serum Bcl-2 level of breast cancer patients which was significantly similar to those after one month of surgery, significantly decreased after 6 cycles of chemotherapy. On comparing the level of this parameter after 6 cycles of chemotherapy with those after one month of surgery, the difference was significant. These results indicated that, serum Bcl-2 level may be considered as a diagnostic biomarker in breast cancer and can be used as a useful marker in the follow up chemotherapeutic treatment. Our results showed a significant negatively correlation of serum Bcl-2 with estrogen receptors, Her-2 and P53 in breast cancer patients group. This means that, serum Bcl-2 can be valuable in predicting breast cancer progression.
The level of serum Bax in breast cancer patients either before or after one month of surgery as well as after 6 cycles of chemotherapy were nearly within the same range and insignificantly less than those of control group. In addition we found no correlation between serum Bax level in breast cancer patients and the available clinic-pathological parameters of the tumors which could be tested.
The levels of serum P53 of breast cancer patients either before or after one month of surgery as well as after 6 cycle of chemotherapy were significantly less than those of control group. It was also noticed that serum P53 level of breast cancer patients was significantly similar to those after one month of surgery and significantly decreased after 6 cycle of chemotherapy. On comparing the level of this parameter after one month of surgery and those after 6 cycle of chemotherapy the difference was not significant.
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 and tumor size in breast cancer patients.
In the present study, it was found that serum Bcl-2, P53 and CA15.3 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 curves showed that the ROC curve for serum P53 was above ROC curves for Bcl-2 & CA15.3, respectively. The area under the curve was 85.6% for P53, 84.1%for Bcl-2 and 76.1% for CA15.3. The optimum cut-off value selected for serum P53 was 2.82 U/ml at which the sensitivity was 80% and the specificity was 87%, the optimum cut-off value selected for serum Bcl-2 was 1.47 ng/ml at which the sensitivity was 77% and the specificity was 76% and the optimum cut-off value selected for serum CA15.3 was 25 IU/ml at which the sensitivity was 47% and the specificity was 100%. Hence serum P53 is superior to Bcl-2 & CA15.3, 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 P53 as the most superior diagnostic marker. Bcl-2 was also found to have a role in monitoring the effect of surgery & chemotherapy on breast cancer patients.
Due to the small sample size of patients in this study, we need to verify the results obtained from our study by using larger sample size of patients and longer time of Follow up.