Niemi Riikka Johanna, Roine Antti N, Häkkinen Merja R, Kumpulainen Pekka S, Keinänen Tuomo A, Vepsäläinen Jouko J, Lehtimäki Terho, Oksala Niku K, Mäenpää Johanna U
*Department of Obstetrics and Gynecology, Tampere University Hospital; †Faculty of Medicine and Life Sciences, University of Tampere, Tampere; ‡School of Pharmacy, Biocenter Kuopio, University of Eastern Finland, Kuopio; §Digital Health Solutions; ∥Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Life Sciences; ¶Department of Surgery, Faculty of Medicine and Life Sciences, University of Tampere; #Department of Vascular Surgery, Tampere University Hospital; and **Department of Obstetrics and Gynecology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
Int J Gynecol Cancer. 2017 Sep;27(7):1360-1366. doi: 10.1097/IGC.0000000000001031.
Elevated concentrations of polyamines have been found in urine of patients with malignant tumors, including ovarian cancer. Previous research has suffered from poorly standardized detection methods. Our liquid chromatography-tandem mass spectrometry (LC-MS/MS) method is capable of simultaneous standardized analysis of most known polyamines. Liquid chromatography-tandem mass spectrometry has not previously been used in the differential diagnostics of ovarian tumors in postmenopausal women.
In this prospective study, postmenopausal women (n = 71) presenting with an adnexal mass and, as controls, women with genital prolapse or urinary incontinence scheduled for surgery (n = 22) were recruited in the study. For analysis of the polyamines, a morning urine sample was obtained before surgery. Preoperative serum CA125 concentrations were determined in the study group.
Twenty-three women with benign and 37 with malignant ovarian tumors were eligible. Of all analyzed polyamines, only urinary N,N-diacetylspermine showed statistically significant differences between all groups except controls versus benign tumors. N,N-diacetylspermine was elevated in malignant versus benign tumors (P < 0.001), in high-grade versus low malignant potential tumors (P < 0.001), in stage III to IV versus stage I to II cancers (P < 0.001), and even in early-stage cancer (stage I-II) versus benign tumors (P = 0.017). N,N-diacetylspermine had better sensitivity (86.5%) but lower specificity (65.2%) for distinguishing benign and malignant ovarian tumors than CA125 with a cut-off value of 35 kU/L (sensitivity, 75.7%; specificity, 69.6%).
Urinary N,N-diacetylspermine seems to be able to distinguish benign and malignant ovarian tumors as well as early and advanced stage, and low malignant potential and high-grade ovarian cancers from each other, respectively.
在包括卵巢癌在内的恶性肿瘤患者的尿液中发现多胺浓度升高。以往的研究存在检测方法标准化程度低的问题。我们的液相色谱 - 串联质谱法（LC-MS/MS）能够同时对大多数已知多胺进行标准化分析。液相色谱 - 串联质谱法此前尚未用于绝经后女性卵巢肿瘤的鉴别诊断。
在这项前瞻性研究中，招募了出现附件包块的绝经后女性（n = 71），并将计划接受手术的生殖器脱垂或尿失禁女性（n = 22）作为对照纳入研究。为分析多胺，在手术前采集晨尿样本。在研究组中测定术前血清CA125浓度。
23例患有良性卵巢肿瘤和37例患有恶性卵巢肿瘤的女性符合条件。在所有分析的多胺中，除了对照组与良性肿瘤组外，只有尿中N，N - 二乙酰精胺在所有组之间显示出统计学上的显著差异。与良性肿瘤相比，恶性肿瘤中的N，N - 二乙酰精胺升高（P < 0.001）；与低恶性潜能肿瘤相比，高等级肿瘤中的N，N - 二乙酰精胺升高（P < 0.001）；与I至II期癌症相比，III至IV期癌症中的N，N - 二乙酰精胺升高（P < 0.001）；甚至在早期癌症（I - II期）与良性肿瘤相比时N，N - 二乙酰精胺也升高（P = 0.017）。与CA125（临界值为35 kU/L，敏感性为75.7%；特异性为69.6%）相比，N，N - 二乙酰精胺在区分良性和恶性卵巢肿瘤方面具有更高的敏感性（86.5%）但更低的特异性（65.2%）。
尿中N，N - 二乙酰精胺似乎能够分别区分良性和恶性卵巢肿瘤以及早期和晚期、低恶性潜能和高等级卵巢癌。
