title: Tumour necrosis factor-alpha, interleukin-6, and fasting serum insulin correlate with clinical outcome in metastatic breast cancer patients treated with chemotherapy.
abstract: BACKGROUND
  To assess the relationship of various growth factors and cytokines with the clinical outcome in metastatic breast cancer patients receiving chemotherapy.
  
  
  METHODS
  Consecutive, metastatic breast cancer patients with measurable disease and receiving palliative chemotherapy were prospectively evaluated for the predictors of progression free survival (PFS) and overall survival (OAS) in relation to serum insulin, insulin resistance, interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-alpha).
  
  
  RESULTS
  Estrogen receptor (ER) status, serum IL-6 and serum TNF- were the independent determinants of PFS, with RR=0.28 (0.13-0.60), P=0.001, RR=2.48 (1.24-5.61), P=0.012, and RR=0.48 (0.23-1.01), P=0.053, respectively. The factors related with OAS in the multivariate analysis were histological grade (RR=7.88 (2.33-26.62), P=0.001), ER status (RR=0.18 (0.06-0.57), P=0.003), serum insulin (RR=0.87 (0.77-0.97), P=0.016), and serum IL-6 (RR=5.99 (1.89-18.97), P=0.002).
  
  
  CONCLUSIONS
  We show for the first time that fasting serum insulin and TNF-alpha levels are independent predictors for OAS and PFS, respectively, in metastatic breast cancer patients. In addition, we also confirm that IL-6 is a poor prognosticator in this group. These results suggest that insulin and TNF-alpha are important biomolecules that may be directly involved in vivo in the progression of metastatic breast cancer.
authors.affiliation: Akdeniz University Medical Faculty, Department of Medical Oncology, Dumlupinar Bulvari, 07070 Antalya, Turkey. hbozcuk@antnet.net.tr
authors.forename: Hakan
authors.initials: H
authors.lastname: Bozcuk
authors.forename: Gülcan
authors.initials: G
authors.lastname: Uslu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Samur
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yildiz
authors.forename: Tomris
authors.initials: T
authors.lastname: Ozben
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozdoğan
authors.forename: Mehmet
authors.initials: M
authors.lastname: Artaç
authors.forename: Hasan
authors.initials: H
authors.lastname: Altunbaş
authors.forename: Ilhan
authors.initials: I
authors.lastname: Akan
authors.forename: Burhan
authors.initials: B
authors.lastname: Savaş
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005215:Fasting; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D015850:Interleukin-6 / Q000032:analysis*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011237:Predictive Value of Tests; D013534:Survival; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D007328:Insulin; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha