title: Primary tumor levels of human tissue kallikreins affect surgical success and survival in ovarian cancer patients.
abstract: OBJECTIVE
  Proteolytic factors of the human tissue kallikrein (hK) family and the plasminogen activation system play a key role in tumor progression in various malignancies. We determined antigen levels of urokinase-type plasminogen activator (uPA), its inhibitor PAI-1, and hK5-8, hK10, hK11, and hK13 by ELISA in primary tumor tissue extracts of 142 International Federation of Gynecology and Obstetrics (FIGO) I to IV ovarian cancer patients (median follow-up 41 months).
  
  
  RESULTS
  After radical surgery, absence of macroscopically visible residual tumor (RT) was achieved in 72 patients; all patients received postoperative platinum-containing chemotherapy. Significant univariate predictors of poor progression-free survival (PFS) were RT (>0), FIGO stages (III/IV versus I/II/III), ascites volume >500 mL, nodal status, and the difference between PAI-1 and uPA (fractionally ranked). In multivariate analysis, significant independent factors for poor PFS were RT [hazard ratio (HR), 4.53] and low hK11 fractional rank (HR, 0.30). Univariate predictors of poor overall survival were RT, FIGO stages, nodal status, ascites volume, nuclear grade, and low hK10 and hK13. In multivariate analysis, significant independent factors for poor overall survival were RT (HR, 7.49), ascites (HR, 1.97), and low hK10 (HR, 0.196). We constructed a multivariate scoring model estimating RT probability, based on ascites [odds ratio (OR), 13.1], nuclear grade (OR, 2.92), hK6 (OR, 8.54), and hK13 (OR, 0.14), with good in-sample predictive performance (area under receiver operating characteristic, 0.833).
  
  
  CONCLUSIONS
  In view of risks and benefits of radical surgery, such a score could support preoperative risk stratification and identify candidates for alternative therapeutic strategies. These results highlight the distinct roles of the hKs for different disease end points in ovarian cancer and their potential to support individualized therapy decisions.
authors.affiliation: Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Dorn
authors.forename: Manfred
authors.initials: M
authors.lastname: Schmitt
authors.forename: Ronald
authors.initials: R
authors.lastname: Kates
authors.forename: Barbara
authors.initials: B
authors.lastname: Schmalfeldt
authors.forename: Marion
authors.initials: M
authors.lastname: Kiechle
authors.forename: Andreas
authors.initials: A
authors.lastname: Scorilas
authors.forename: Eleftherios P
authors.initials: EP
authors.lastname: Diamandis
authors.forename: Nadia
authors.initials: N
authors.lastname: Harbeck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D016019:Survival Analysis; D020840:Tissue Kallikreins / Q000378:metabolism*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000378:metabolism
chemical_list: D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D020840:Tissue Kallikreins; D014568:Urokinase-Type Plasminogen Activator