الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Summary and conclusions
The potential uses of serum markers in breast cancer include aiding early diagnosis, determining prognosis, prospectively predicting response or resistance to specific therapies, surveillance after primary surgery, and monitoring therapy in patients with advanced disease.
Although multiple serum-based tumor markers have been described for breast cancer, the most widely used are CA 15-3 and CEA.
This retrospective study was conducted at clinical pathology department, Sohag University Hospitals in the period between October 2015 &October 2016 (one year).
Fifty diagnosed breast cancer patients with distant metastasis were included in this study, for each patient the following was done:
History taking and clinical examination, routine investigations as (complete blood picture, liver function tests, kidney function tests), Special investigations (tumour markers, cancer antigen15-3, carcinoembryonic antigen), Immunohistochemistry (Estrogen receptor (ER), Progesterone receptor (PR), Human epidermal growth factor receptor 2(HER2), Ki -67 proliferation index) and written Consent was taken from all patients.
All the patients were staged according to the American Joint Committee on Cancer (AJCC, 7th edition) TNM staging system for breast cancer, distant metastasis refers to the presence of breast cancer lesions at sites distant to the primary site, the sites of distant relapse were categorized as follows: bone, brain, liver, lungs and distant lymph nodes, breast cancer patients without distant spread will be excluded.
The concentration of serum CA15-3 and CEA levels were measured using chemiluminescent microparticle immunoassay (CMIA) (on ABBOTT ARCHITECT). The upper limits of normal for CA15-3 and CEA were 31.3 U̸ ml and 5 ng̸ ml, respectively
All the pathological specimens were reviewed by experienced pathologists. Immunohistochemical staining was performed for ER, PR, HER2 and Ki-67.
In our results CA15-3 and CEA have no significant relationship with patient age, tumour size, lymph node status, and grade of tumour.
In this study we found no correlation between hormonal receptors estrogen and progesterone, HER2 status and Ki-67 proliferation index with both levels of CA15-3 and CEA.
Also, there is no association in our study between number of metastatic site (single and multiple) with CA15-3 and CEA levels.
In addition, an elevated CA 15-3 level was sensitive for demonstrating metastatic bone disease than CEA, whereas elevated CEA was observed regardless of metastatic site.
In conclusion, CA 15-3 and CEA level elevation at initial diagnosis of recurrence were found to be associated with breast cancer molecular subtype; these serum tumor markers are frequently increased in the HER2-enriched and TN molecular subtypes of breast cancer.
Recommendations
The study recommendations are:
I- CEA and CA15-3 are sensitive tumour markers for demonstrating metastatic bone disease in breast cancer patients, CA15-3 being more sensitive than CEA.
II- CA15-3 and CEA level elevation at initial diagnosis of recurrence were found to be associated with breast cancer molecular subtype.
III- The incidence of the increase in CA15-3 and CEA levels according to breast cancer molecular subtype may be useful in clinical practice.
IV- Further prospective studies are required to evaluate the significance of these findings to provide more information regarding therapeutic decision-making in the clinical setting.
V- Other markers for breast cancer such as HE4, P53, cathepsin D, cyclin E, and nestin look promising, but further studies are needed before their clinical utility is well established.