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Abstract
ovarian cancer is a malignancy that arises from various different cells within the ovaries. It is the fifth leading cause of death from cancer. It has been called ”Silent killer” because it frequently causes non specific symptoms, which contribute to its diagnostic delay, resulting in a late stage and poor prognosis. The etiology of ovarian cancer is unknown, although, a number of risk factors have been identified that apparently predispose to its development.
Approximately 90% of women diagnosed in early stage ovarian cancer survive more than 5 years. However, 20%-30% of patients who were diagnosed with advanced stage disease translate into a poor 5- year survival. Thus, early detection of ovarian cancer is essential for improved survival.
Many tumor markers have been found to be linked with ovarian tumor. These markers are subdivided into circulating markers as CA-125, CA19-9, carcinomabryonic antigen, and CA15-3, and tissue markers as EGFR and steroid receptors. These markers have a limited ability and require serial measurements in identifying patients with ovarian cancer.
Therefore, there is a desperate need for an early and sensitive marker for detection of ovarian cancer in order to interfere early and thus improve the prognosis. A candidate marker for detection of ovarian cancer is YKL-40. YKL-40 is a protein, which has been termed according to its molecular weight (40 kDa) and the one letter code for its three NH2-terminal amino acids; tyrosine (Y), lysine (K) and leucine (L). It is a glycoprotein which contains a single polypeptide chain composed of 383 amino acids. It is a member of the 18 glycosyl hydrolase family, a protein family which includes chitinases and chitinase-related proteins.
It is speculated that YKL-40 has a function in cancer expansion and invasiveness and the elucidation of YKL-40 function in different cancer conditions is an important objective of future studies. Several studies of some patients with primary or metastatic carcinoma of the ovary, breast, prostate, colon, rectum, glioblastoma, kidney, lung, melanoma, as well as hematological malignancy as acute myeloid leukemia,
In this regard, our study aimed to evaluate the clinical utility of serum YKL-40 in comparison to CA-125 in patients with ovarian cancer. Our study was conducted on 35 female patients who presented to the oncology unit of Ain Shams University Hospitals. The patients’ group included group I (20 patients with early stage ovarian cancer) and group II (15 patients with recurrent ovarian cancer). In addition, 10 healthy subjects were included as controls.
All patients included in this study were subjected to full medical history taking, clinical examination, routine investigations including liver function tests, pelvi- abdominal ultrasound and postoperative histopathological examination of the tumors. In addition, YKL-40 was measured by ELISA and CA-125 was measured by electrochemiluminescence immunoassay in both patients and control subjects.
Serum levels of CA-125 and YKL-40 were significantly higher in group I and group II compared to control group. In addition the level of CA-125 was significantly higher in group II compared to group I. However, there was no statistically significant difference between the two groups regarding YKL-40 levels.
Our correlation study between YKL-40 and different studied parameters in group I and group II, showed a significant positive correlation between YKL-40 and tumor size in both groups. On the other hand, YKL-40 levels show significant positive correlation with CA-125 in early stage ovarian cancer group only. However, a non significant correlation between YKL-40 and age was observed in both groups.
Regarding the sensitivity and specificity of YKL-40 for detection of early stage ovarian cancer, at a cut-off value 200 ng/mL, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency were 100%, respectively and for detection of recurrent stage ovarian cancer, at a cut-off value 500 ng/mL, they were 100%, respectively.
On the other hand, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of CA-125 for detection of early stage ovarian cancer at a cut-off value 38.1 U/mL, were 100%, respectively and for detection of recurrent stage ovarian cancer, at a cut-off value 40 U/mL, they were 100%, respectively.
In conclusion, YKL-40 was found to be a sensitive and early diagnostic marker of ovarian cancer. Addition of YKL-40 to the current standard tests for diagnosis of early and detection of recurrent ovarian cancer would improve the ability to identify patients who might be missed by current diagnostic strategies and thus might provide a better therapeutic outcome.