Serum YKL-40 as a marker for cervical adenocarcinoma.
BACKGROUND
The current study examined the clinical usefulness of YKL-40 in detection and prognosis of uterine cervical cancer.


METHODS
Serum levels of YKL-40, cancer antigen 125 (CA 125), carbohydrate antigen 19-9 (CA19-9), and squamous cell carcinoma (SCC) antigen were determined by enzyme-linked immunosorbent assay in women with benign gynecologic disease (n=24), cervical malignancy (SCC, n=104; adenocarcinoma, n=37), and age-matched healthy controls (n=45). Immunohistochemical analysis for local YKL-40 expression was carried out on 28 adenocarcinomas.


RESULTS
Receiver operating characteristic curve analysis showed that YKL-40 [area under the curve (AUC)=0.882] was significantly better at discriminating adenocarcinoma from healthy control than SCC antigen, CA 125, and CA19-9. For SCC, YKL-40 (AUC=0.898) carried out similarly to SCC antigen and was better than CA 125 and CA19-9. Using a cut-off YKL-40 value of 92.2 ng/ml, sensitivity of YKL-40 in stage I adenocarcinoma (68%) was higher than that of the other three markers (11%-21%). Tumor-associated macrophages showed immunoreactivity for YKL-40 in 2 of 28 adenocarcinoma tissue samples, but adenocarcinoma cells themselves were nonimmunoreactive in all samples. Multivariate Cox regression analysis revealed that elevated pretreatment YKL-40 levels predicted unfavorable prognosis, independent of International Federation of Gynecology and Obstetrics stage and age at diagnosis.


CONCLUSIONS
Pretreatment serum YKL-40 level is a possible prognosticator of cervical adenocarcinoma.
Mitsuhashi
A
A
Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan. antira@faculty.chiba-u.jp
Matsui
H
H
Usui
H
H
Nagai
Y
Y
Tate
S
S
Unno
Y
Y
Hirashiki
K
K
Seki
K
K
Shozu
M
M
D000230:Adenocarcinoma / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D054392:Adipokines; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood* / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D016022:Case-Control Studies; D000071451:Chitinase-3-Like Protein 1; D005260:Female; D006023:Glycoproteins / Q000097:blood* / Q000378:metabolism / Q000592:standards; D006801:Humans; D037102:Lectins; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism
D054392:Adipokines; D014408:Biomarkers, Tumor; C084533:CHI3L1 protein, human; D000071451:Chitinase-3-Like Protein 1; D006023:Glycoproteins; D037102:Lectins