Abstract
Our objective was to estimate the efficacy of the measurement of serum YKL-40 alone or with CA125 as biomarkers for the diagnosis of epithelial ovarian cancer (EOC) using the YKL-40 ELISA kit. An experimental group of 49 ovarian cancer patients included 42 patients with EOC (53 ± 15 years, range: 19-81 years) and 7 patients (48 ± 13 years, range: 29-36 years) with borderline epithelial ovarian tumor. A control group of 88 non-malignant cases included 42 patients (43 ± 10 years, range: 26-77 years) with benign gynecological disease and 46 healthy women (45 ± 14 years, range: 30-68 years) at a teaching hospital. Both YKL-40 (220.1 ± 94.1 vs 61.6 ± 48.4 and 50.1 ± 41.2 ng/mL) and CA125 (524.9 ± 972.5 vs 13.4 ± 7.6 and 28.5 ± 29.6 U/mL) levels were significantly higher (P < 0.05) in patients with ovarian cancer compared to the healthy and non-malignant groups. YKL-40 had 92.9% sensitivity and 94.4% specificity for the diagnosis of EOC. When YKL-40 and CA125 were tested in parallel, the sensitivity was increased to 98.2%, but the specificity was decreased to 81.3%. The correlations between serum YKL-40 and tumor stage, grade histology, performance status, patient age, and extension of debulking surgery were tested. With increasing stage and grade of EOC, preoperative serum YKL-40 levels were significantly increased (P = 0.029, P = 0.05, respectively). Serum YKL-40 alone or with serum CA125 levels are useful, although with some limitations, to diagnose ovarian cancer. Our study showed that YKL-40 may not be an independent prognostic factor for ovarian cancer. This prospective study may be a new trend in looking for biomarkers that optimize diagnosis of ovarian cancer.
Highlights
YKL-40, a secreted glycoprotein belonging to the chitinase protein family [1], was identified in a search for new bone proteins in 1992
A number of studies have suggested that YKL-40 was highly expressed in many solid tumors, such as primary colorectal cancer [6], metastatic breast cancer [7], cervical cancer [8], endometrial carcinoma [9], recurrent ovarian cancer [10], and epithelial ovarian cancer (EOC) [11]
Fourteen (33.3%) patients were in the early stage (FIGO stage I-II) while the rest were in the advanced stage (FIGO stage III-IV)
Summary
YKL-40, a secreted glycoprotein belonging to the chitinase protein family [1], was identified in a search for new bone proteins in 1992. YKL-40 is secreted by a variety of human nonmalignant cells, including monocytes, macrophages, articular cartilage cells, and synovial cells. Studies have indicated that YKL-40 levels were elevated in patients with inflammation [3,4]. YKL-40 was mainly secreted by tumor-associated macrophages, monocytes, neutrophils, and tumor cells [5]. A number of studies have suggested that YKL-40 was highly expressed in many solid tumors, such as primary colorectal cancer [6], metastatic breast cancer [7], cervical cancer [8], endometrial carcinoma [9], recurrent ovarian cancer [10], and epithelial ovarian cancer (EOC) [11]
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