Clinical Value of Serum Neopterin in Breast Cancer

Abstract

Background: Neopterin is an aromatic pteridine produced by monocytes and macrophages after the stimulation of interferon-gamma (IFN-c), which is secreted by activated T-cells. Its production reflects the activity of monocytes and macrophages and may provide information about current status of cellular immunity. There was a positive between high neopterin levels and advanced tumor stage. Also high neopterin levels were significantly associated with a poor prognosis. The aim of the current study was to assess the relation between pre-chemotherapy serum neopterin level and clinical and pathological features of breast cancer. Patients and method: The current prospective study was conducted in clinical oncology department in Menoufia University. This study was approved by the ethical committee of the faculty of medicine, Menoufia University. After consent, Sixty eight patients with histologically verified breast cancer were enrolled. All patients were subjected to full history taking, through medical examination and full investigation in the form of: complete blood count, baseline kidney and liver function, x-ray and abdomen and pelvic ultrasound for patients with early stage disease and computed tomography of chest abdomen and pelvis, bone scan and baseline tumor markers (carbohydrate antigen 15-3 and carcino-embryonic antigen) in patients with advanced stage disease. Venous blood sample were administrated for measurements of serum neopterin level. And the samples were delivered before chemotherapy. Results were collected, tabulated and statistically analyzed by an IBM compatible personal computer with SPSS statistical package version 20. Result(s): Serum neopterin was higher in patients with older age >50 years, postmenopausal, with poorer performance status and with extreme BMI either underweight or have morbid obesity. There was negative correlation between the serum neopterin level and the hemoglobin level. Also there was positive significant relation between neopterin level and TLC, absolute neutrophil counts and absolute lymphocytic counts. In relation to disease features serum neopterin was higher in patients with T4, N3, stage IV disease, and higher tumor grade and hormone negative her2neu positive tumors. There was significant relation between number of metastatic sites and neopterin level where 2 sites of metastasis has significantly higher neoptrin level than 0 and 1 sites. Conclusion(s): Serum neopterin was elevated in patients with stage IV disease, high grade tumors and was significantly elevated in patients with 2 or more involved metastatic site. So neopterin can be considered as a potential prognostic marker in patients with breast cancer.