الفهرس 
BREAST CANCEROnly 14 pages are availabe for public view
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Abstract
Breast cancer is the most common cancer and the second most common cause of death from cancer in women. Because of the high frequency of the disease, breast cancer research has increased dramatically during the last 2 decades, resulting in extraordinary progress in our understanding of the disease and in new, more efficient and less toxic treatments. Furthermore, the diffusion of knowledge, the medical advancements, and the increased public awareness have led to earlier diagnosis at stages usually amiable to complete resection and potential cure of the disease.
Over the past few decades, breast cancer management has undergone significant changes characterized by the less aggressive approaches to diagnosis and treatment.
Many tumor markers have been found to be linked with breast cancer. These markers are subdivided into circulating markers as CA-15.3, CA27-29, carcinomebryonic antigen, while there are further more useful serum markers which involve invasion markers such as Urokinase plasminogen activater (Upa), and tissue receptors such as HER-2 and steroid receptors. These markers have a limited ability and require serial measurements in identifying patients with breast cancer.
Therefore, there is a desperate need for an early and sensitive marker for detection of breast cancer in order to interfere early and thus improve the prognosis. A candidate marker for detection of breast cancer is YKL-40. YKL-40 is a protein, which has been termed according to its molecular weight (40 kDa) and the one letter code for its three NH2-terminal amino acids; tyrosine (Y), lysine (K) and leucine (L). It is a glycoprotein which contains a single polypeptide chain composed of 383 amino acids. It is a member of the 18 glycosyl hydrolase family, a protein family which includes chitinases and chitinase-related proteins.
It is speculated that YKL-40 has a function in cancer expansion and invasiveness and the elucidation of YKL-40 function in different cancer conditions as in breast, ovary, prostate, colon, rectum, glioblastoma, kidney, lung, melanoma, as well as hematological malignancy as acute myeloid leukemia is an important objective of future studies.
In this regard, our study aimed to evaluate the clinical utility of serum YKL-40 in comparison to CA-15.3 in patients with breast cancer. Our study was conducted on 35 female patients who presented to the surgery and oncology units of Ain Shams University Hospitals. The patients’ group included group I (35 patients with breast cancer) who were subdivided into 2 subgroups, GPIA (n=15) with primary breast cancer with no metastasis, and GPIB (n=20) with breast cancer with distant metastasis. In addition, 10 healthy subjects were included as controls.
All patients included in this study were subjected to full medical history taking, clinical examination, routine investigations and postoperative histopathological examination of the tumors. In addition, YKL-40 was measured by ELISA and CA-15.3 was measured by electrochemiluminescence immunoassay in both patients and control subjects.
Serum levels of CA-15.3 and YKL-40 were significantly higher in GPIA and GPIB compared to control group. In addition the level of CA-15.3 was significantly higher in GPIB group compared to GPIA group. However, there was no statistically significant difference between the two groups regarding YKL-40 levels.
Our correlation study between YKL-40 and different studied parameters in GPIA and GPIB, showed a significant positive correlation between YKL-40 and tumor size in GPIAb group . On the other hand, YKL-40 levels show no significant correlation with CA-15.3 in all patient groups.. However, a higher medium YKL-40 levels was observed in PR,ER negative patients compared to PR, ER positive patients in all breast cancer patient group , while no statistical significant difference was observed.
Regarding the sensitivity and specificity of YKL-40 for detection of breast cancer against the control , at a cut-off value 1000 ng/mL, the diagnostic sensitivity was 95%, specificity was 40%, positive predictive value was 67%, negative predictive value was 85% and efficiency was 71%, whereas it could not discriminate (GP1A) primary breast cancer versus (GPIB) breast cancer with distant metastasis. Also regarding YKL-40 levels and metastatic sites in GPIB group, it was found that breast cancer patients with visceral metastasis, had the highest level of YKL-40 than other sites as soft tissue and bone metastasis.