الفهرس 
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Abstract
The current thesis was conducted on 30 recently diagnosed breast cancer females of clinical stages II and III and 30 normal healthy control females. The normal healthy control females were matched in age and menstrual status with the breast cancer females. This study aimed to evaluate the clinical roles played by serum nestin, CA15-3 and CEA in breast cancer patients with respect to differentiation of breast cancer patients from controls, monitoring the effect of surgery, chemotherapy and radiotherapy on breast cancer patients and correlating the serum levels of each serum biomarker with the clinicopathological data of the breast cancer patients.
Blood samples were withdrawn once from controls and four times from breast cancer patients: before surgery, before chemotherapy, after chemotherapy and after radiotherapy. Blood samples were used to separate sera on which biochemical analysis were performed. Serum levels of nestin, CA 15-3 and CEA were measured in using ready-to-use ELISA kits according to the manufacture’s protocols.
The serum levels of nestin were significantly higher in the breast cancer patients group compared to the normal control group (p=0.000). Subjects with preoperative nestin levels greater than the cut-off value (9.9 ng/ml) have a significant odds ratio of 27(95% CI= 4.57-159.67), ( P= 0.0003). The serum levels of nestin after surgery were insignificantly lower than its serum levels before surgery (p= 0.057). The serum levels of nestin after chemotherapy were non-significantly decreased compared with its serum levels before chemotherapy (p= 0.307). The serum levels of nestin after radiotherapy were non-significantly lower than its serum levels before radiotherapy (p= 0.567). Preoperative serum nestin levels were insignificantly correlated with breast cancer clinicopathological data (p>0.05).
The serum levels of CA 15-3 were significantly higher in the breast cancer patients group compared to the normal control group (p=0.021). The serum levels of CA 15-3 after surgery were insignificantly decreased relative to its serum levels before surgery (p=0.073). The serum levels of CA 15-3 after chemotherapy were insignificantly lower than its serum levels before chemotherapy (p= 0.055). The serum levels of nestin after radiotherapy were insignificantly different from its serum levels before radiotherapy (p= 0.161). Preoperative serum CA 15-3 levels were insignificantly correlated with breast cancer clinicopathological data (p>0.05).
The serum levels of CEA were significantly higher in the breast cancer patients group compared to the normal control group (p=0.040). The serum levels of CEA after surgery were insignificantly decreased compared to its serum levels before surgery (p= 0.089). The serum levels of CEA before chemotherapy were non-significantly lower than its serum levels after chemotherapy (p= 0.159). The serum levels of CEA after radiotherapy were insignificantly lower than its serum levels before radiotherapy (p= 0.153). Preoperative serum CEA levels were insignificantly correlated with breast cancer clinicopathological data (p>0.05).
For comparing the diagnostic roles of serum nestin, CA15-3 and CEA in breast cancer patients, the Receiver Operating characteristic ( ROC) curve analysis was applied. This comparison depends on the area under the ROC curve (AUC). The higher AUC corresponds to a better diagnostic test. Serum nestin showed a significant AUC (85.2%, p=0.000*) with sensitivity (80%) and specificity (75%) at a cut-off (9.90 ng/ml). Serum CA 15.3 showed a significant AUC (70%, p=0.021*) with sensitivity (45%) and specificity (85%) at a cut-off (22.05 U/ml). Serum CEA showed a significant AUC (69%, p=0.040*) with sensitivity (40%) and specificity (75%) at a cut-off (4.07 ng/ml).