Ryuji Kawaguchi

Tissue Factor Pathway Inhibitor-2 Expression in Uterine Cervical Clear Cell Carcinoma: A Potential Biomarker for Clinical Diagnosis

Cervical clear cell carcinoma (CCCC) is an extremely rare histologic type of uterine cancer. Tissue factor pathway inhibitor-2 (TFPI2) is a serine protease inhibitor that was recently shown to be expressed in ovarian clear cell carcinoma and endometrial clear cell carcinomas using immunohistological analyses. In this exploratory study, we conducted an immunohistochemical investigation to determine whether TFPI2 is expressed in cervical cancers, especially CCCC. Further, we examined the expression of hepatocyte nuclear factor 1 homeobox B (HNF-1β), a useful marker for immunohistological diagnosis of ovarian clear cell carcinoma. As a control group, we included 22 patients with cervical intraepithelial neoplasia grade 3 (CIN 3) and 40 patients with non-CCCC (21 with squamous cell carcinoma and 19 with adenocarcinoma). Immunohistochemical staining was positive for TFPI2 in all 3 CCCC cases (100%), whereas in non-CCCC, we observed only weak TFPI2 staining in 7 squamous cell carcinoma cases (33.3%), absence of staining in adenocarcinoma (0%), and staining in one CIN 3 case (4.5%). The histoscore for TFPI2 in CCCC was 166.7 ± 13.2 (mean ± SD), which was significantly higher than that in non-CCCC (3.3 ± 8.3) or CIN 3 (1.4 ± 6.4) (P<0.001). Similarly, HNF-1β staining was noted in all 3 CCCC cases and in 63.2% of the adenocarcinomas, whereas it was absent in CCCC and CIN 3. In conclusion, examination of TFPI2 expression, similar to that of HNF-1β, is useful for validating the immunohistological diagnosis of CCCC.

Immunohistochemical Analysis of the Tissue Factor Pathway Inhibitor-2 in Endometrial Clear Cell Carcinoma: A Single-center Retrospective Study

The tissue factor pathway inhibitor-2 (TFPI2) was recently identified as a diagnostic serum marker for ovarian clear cell carcinoma. Moreover, the immunohistochemical expression of TFPI2 in ovarian clear cell carcinoma was recently reported. This single-center retrospective study aimed to evaluate whether TFPI2 can be a specific biomarker for immunohistological diagnosis of endometrial clear cell carcinoma (ECCC). Immunohistochemical staining of TFPI2 in 55 endometrial carcinomas was evaluated at Nara Medical University Hospital. Thirteen ECCC samples were included as cases and 42 samples were included as a control (endometrioid carcinoma grade 1, 11 cases; grade 2, 11 cases; grade 3, 10 cases; serous carcinoma, 10 cases). The mean ± SD TFPI2 histoscore for diagnosing ECCC was 115.4 ± 87.9, which was significantly higher than that of non-ECCC (21.3 ± 45.9, P = 0.002). The best TFPI2 histoscore value obtained from the analyses of receiver operating characteristic curves for immunohistochemical diagnosis of ECCC was 15. With TFPI2 histoscores ≥15.0 as positive and <15.0 as negative, all 13 ECCC cases (100%) were positive for TFPI2, whereas 11 (26.2%) non-ECCC cases were positive for TFPI2. The sensitivity and specificity of TFPI2 for diagnosing ECCC were 100% and 73.8%, respectively. TFPI2 is expressed in ECCC and is useful for histopathological diagnosis.

Tissue factor pathway inhibitor 2: A potential diagnostic marker for discriminating benign from malignant ovarian tumors

AbstractObjectivesCarbohydrate antigen 125 (CA125), CA19‐9, carcinoembryonic antigen (CEA), human epididymis protein 4 (HE4), and the Risk of Ovarian Malignancy Algorithm (ROMA) are widely used as tumor markers and algorithms for the diagnosis of ovarian cancer (OC). Tissue factor pathway inhibitor 2 (TFPI2) has been developed as a potential serodiagnostic marker for OC in Japan. The aim of this study is to evaluate the diagnostic accuracy of the six markers alone and in combination to find the best marker for discriminating between benign and malignant ovarian tumors.MethodsFrozen serum samples collected from 484 patients were divided into three groups based on histopathological results: OC (n = 119), borderline ovarian tumors (BR) (n = 48), and benign ovarian tumors (BN) (n = 317). Diagnostic accuracy was calculated with an area under a receiver operating characteristic (AUC) curve.ResultsTFPI2 achieved the highest discrimination between the OC + BR group versus the BN group (AUC 0.8076). ROMA values best discriminated patients with OC from those with BN (AUC, 0.8966), which was equivalent to TFPI2 (AUC, 0.8937). For discriminating the OC group from the BR + BN group, the highest AUC value was achieved by ROMA values (AUC, 0.8884), and TFPI2 also showed comparable diagnostic accuracy (AUC, 0.8845). Combining TFPI2 with ROMA had the highest AUC (0.8420–0.9357).ConclusionTFPI2 may be a clinically useful single marker comparable to conventional ROMA values for discriminating between benign and malignant ovarian tumors.

Tissue Factor Pathway Inhibitor 2: A Novel Biomarker for Predicting Asymptomatic Venous Thromboembolism in Patients with Epithelial Ovarian Cancer

<b><i>Objectives:</i></b> Patients with asymptomatic venous thromboembolism (VTE) are associated with an increased risk of pulmonary thromboembolism events. However, due to low specificity and high false-positive rates, D-dimer testing cannot be used alone to diagnose VTE. Tissue factor pathway inhibitor 2 (TFPI2), a new serodiagnostic marker for ovarian cancer, plays a role in blood coagulation system regulation. We hypothesized that combining D-dimer and TFPI2 would improve its utility in diagnosing VTE. This study aimed to look into the clinical utility of serum D-dimer and TFPI2 levels in detecting asymptomatic VTE in patients with epithelial ovarian cancer (EOC). <b><i>Design:</i></b> From January 2008 to December 2015, researchers at Nara Medical University Hospital’s Department of Gynecology conducted a single-center retrospective study. The receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of preoperative D-dimer, TFPI2, and D-dimer combined with TFPI2 in distinguishing VTE patients from those who did not have VTE. <b><i>Participants:</i></b> This study included 122 patients with EOC who met the inclusion and exclusion criteria out of 223 admitted to the hospital with EOC. The patients were divided into two groups: VTE (<i>n</i> = 25) and non-VTE (<i>n</i> = 97). <b><i>Results:</i></b> There were significant differences in D-dimer, TFPI2, and CA125 levels and residual tumor between the VTE and non-VTE groups. The D-dimer level was found to be significantly related to age, body mass index, VTE, massive ascites, residual tumor, histology, and Federation of Gynecology and Obstetrics stage, whereas the TFPI2 level was only related to VTE. Multivariate analysis revealed that D-dimer (the optimal cutoff value, 3.5 μg/mL) and TFPI2 (the optimal cutoff value, 400 pg/mL) are independent risk factors for preoperative VTE. ROC analysis revealed that the area under the curve was 0.8266 for D-dimer, 0.7963 for TFPI2, and 0.8495 for the combination of D-dimer and TFPI2. When compared to the D-dimer test alone, the combination of D-dimer and TFPI2 had higher specificity (77.3–96.9%) and positive predictive value (48.8–81.2%) for the diagnosis of VTE. <b><i>Limitations:</i></b> This is a single-center retrospective study. <b><i>Conclusion:</i></b> The combination of D-dimer and TFPI2 may be useful to safely exclude VTE and select patients at high risk of VTE.