Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
Department of Medical Life Science, Graduate School of Medical Life Science, Yokohama City University, Yokohama, Japan.
Int J Clin Oncol. 2021 Jul;26(7):1336-1344. doi: 10.1007/s10147-021-01914-y. Epub 2021 May 19.
Tissue factor pathway inhibitor 2 (TFPI2) is a novel serum biomarker that discriminates ovarian clear cell carcinoma (CCC) from borderline ovarian tumors (BOTs) and non-clear cell epithelial ovarian cancers (EOCs). Here, we examined the performance of TFPI2 for preoperative diagnosis of CCC.
Serum samples were obtained preoperatively from patients with ovarian masses, who needed surgical treatment at five hospitals in Japan. The diagnostic powers of TFPI2 and cancer antigen 125 (CA125) serum levels to discriminate CCC from BOTs, other EOCs, and benign lesions were compared.
A total of 351 patients including 69 CCCs were analyzed. Serum TFPI2 levels were significantly higher in CCC patients (mean ± SD, 508.2 ± 812.0 pg/mL) than in patients with benign lesions (154.7 ± 46.5), BOTs (181 ± 95.5) and other EOCs (265.4 ± 289.1). TFPI2 had a high diagnostic specificity for CCC (79.5%). In patients with benign ovarian endometriosis, no patient was positive for TFPI2, but 71.4% (15/21) were CA125 positive. TFPI2 showed good performance in discriminating stage II-IV CCC from BOTs and other EOCs (AUC 0.815 for TFPI2 versus 0.505 for CA125) or endometriosis (AUC 0.957 for TFPI2 versus 0.748 for CA125). The diagnostic sensitivity of TFPI2 to discriminate CCC from BOTs and other EOCs was improved from 43.5 to 71.0% when combined with CA125.
High specificity of TFPI2 for preoperative detection of CCC was verified with the defined cutoff level of TFPI2 in clinical practice. TFPI2 and CA125 may contribute substantially to precise prediction of intractable CCC.
组织因子途径抑制剂 2（TFPI2）是一种新型血清生物标志物，可区分卵巢透明细胞癌（CCC）与交界性卵巢肿瘤（BOT）和非透明细胞上皮性卵巢癌（EOC）。在此，我们研究了 TFPI2 用于术前诊断 CCC 的性能。
在日本五家医院，对需要手术治疗的卵巢肿块患者术前采集血清样本。比较了 TFPI2 和癌抗原 125（CA125）血清水平对 CCC 与 BOT、其他 EOC 和良性病变的诊断能力。
共分析了 351 例患者，其中 69 例为 CCC。CCC 患者的血清 TFPI2 水平明显高于良性病变患者（154.7 ± 46.5）、BOT 患者（181 ± 95.5）和其他 EOC 患者（265.4 ± 289.1）（均值 ± 标准差，508.2 ± 812.0 pg/mL）。TFPI2 对 CCC 具有很高的诊断特异性（79.5%）。在患有良性卵巢子宫内膜异位症的患者中，无患者 TFPI2 阳性，但 CA125 阳性率为 71.4%（15/21）。TFPI2 可很好地区分 II-IV 期 CCC 与 BOT 和其他 EOC（TFPI2 的 AUC 为 0.815，CA125 的 AUC 为 0.505）或子宫内膜异位症（TFPI2 的 AUC 为 0.957，CA125 的 AUC 为 0.748）。当与 CA125 联合使用时，TFPI2 对区分 CCC 与 BOT 和其他 EOC 的诊断敏感性从 43.5%提高到 71.0%。
在临床实践中，通过定义 TFPI2 的临界值，验证了 TFPI2 对 CCC 术前检测的高特异性。TFPI2 和 CA125 可能对精确预测难治性 CCC 有重要贡献。
