Beruflich Dokumente
Kultur Dokumente
a
Department of Obstetrics and Gynecology, University of Health Sciences, Bakirkoy Dr Sadi Konuk Training and
Research Hospital, Istanbul, Turkey; b Department of Obstetrics and Gynecology, University of Health Sciences,
Bakirkoy Dr Sadi Konuk Training and Research Hospital, Department of Biochemistry, Istanbul, Turkey; c Department
of Obstetrics and Gynecology, VKV American Hospital, Istanbul, Turkey; d Department of Obstetrics and Gynecology,
E-Mail karger@karger.com
TR–34147 Bakirkoy, Istanbul (Turkey)
www.karger.com/goi
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Table 3. Surgery indications, surgical procedures, and histopathology results of the study population
III–IV endometriosis groups (Table 4). Significant differ- with 90% sensitivity and 87% specificity (Fig. 4). In fur-
ences were detected between control and endometriosis ther comparison of control and endometriosis groups,
groups in terms of caspase-3 and ANXA2 levels (p < 0.001 AUC was 79% (95% CI 68–88) at 9.04 ng/mL cut-off lev-
and 0.046; Table 5). After ROC analysis, AUC was 93% el for caspase-3 with 70% sensitivity and 72% specificity
(95% CI 57–82) at 10.7 ng/mL cut-off level for caspase-3 (Tables 6, 7). In the stage III–IV endometriosis group,
130.241.16.16 - 8/2/2018 8:25:14 PM
73
25 60
78
50
20
40
Caspase 3 ng/mL
33
ANXA2 ng/mL
15
30
10
20
5
10
0 0
Control Stage l–ll Stage lll–lV Control Stage l–ll Stage lll–lV
Study groups Study groups
Fig. 1. The boxplot analysis of Caspase 3 levels between study Fig. 2. The boxplot analysis of Annexin A2 (ANXA2) levels be-
groups. tween study groups.
pelvic organ adhesions were evaluated; consequently, 8 involvement. Seven (23.33%) patients had concomitant
(26.6%) patients had <1/3 enclosure, 5 (16.6%) patients adenomyosis and endometriosis. The mean endometrio-
had 1/3–2/3 enclosure, and 17 (56.6%) patients had >2/3 ma size was 61 ± 20.56 mm (30–120 mm) in the stage
enclosure; 13 (43.3%) of these patients had bilateral en- III–IV endometriosis group. Endometrioma size posi-
dometrioma, and 17 (56.6%) had unilateral endometrio- tively correlated with ANXA2 and sFasL levels; however,
ma. Nine (30%) patients had no POD obliteration, 12 the results were not statistically significant (Table 8). Post
(40%) had partial POD obliteration, and 9 (30%) had total hoc power analysis showed 100% power for caspase-3 lev-
POD obliteration. In the stage III–IV endometriosis els between control and stage III–IV groups and between
group, 21 (70%) patients had deep infiltrating endome- stage I–II and stage III–IV groups. A power value of
triosis. As for the location, 15 (50%) of them had perito- 89.9% was calculated for ANXA2 levels between control
neal surface involvement, 4 (13.33%) has a sacrouterine and stage III–IV groups and 80.4% power for ANXA2
ligament nodule, and 2 (6.66%) presented rectal serosal levels between stage I–II and stage III–IV groups.
130.241.16.16 - 8/2/2018 8:25:14 PM
100
Discussion
0
Control Stage l–ll Stage lll–lv The present study demonstrated that serum caspase-3,
Study groups ANXA2, and sFasL levels are higher in patients with stage
III–IV endometriosis than in controls and patients with
stage I–II endometriosis.
Fig. 3. The boxplot analysis of soluble Fas Ligand (sFasL) levels
In daily practice, most gynecologists are not able to dif-
between study groups.
ferentiate between ovarian endometrioma and endome-
triosis with a deep infiltrating disease using currently
available diagnostic modalities, such as vaginal speculum
examination, clinical rectovaginal wall examination, im-
ROC curve
1.0 aging technologies, and laboratory tests [17, 21].
The “immunoescape” theory of endometriosis con-
nects the disease pathogenesis to the failure of apoptotic
0.8 pathways to remove endometriotic cells. These pathways
are described as caspases that act as protease on several
cellular proteins [22]. Two main classes of caspases were
0.6
described: caspases-9, known as initiator caspases, and
caspases-3, known as effector caspases. Apoptosis may be
Sensitivity
Control
Caspase 3, ng/mL 7.72 21 20 51 0.11–0.31
Annexin A2, ng/mL 12.62 36 41 55 0.25–0.48
sFasL, pg/mL 114.32 39 50 55 0.26–0.51
Stage I–II endometriosis
Caspase 3, ng/mL 8.32 34 30 55 0.30–0.55
Annexin A2, ng/mL 11.86 42 38 51 0.22–0.45
sFasL, pg/mL 104.93 43 41 51 0.31–0.55
Stage III–IV endometriosis
Caspase 3, ng/mL 10.7 93 87 90 0.57–0.82
Annexin A2, ng/mL 13.96 69 50 70 0.88–0.98
sFasL, pg/mL 107.76 67 50 63 0.54–0.80
Table 7. ROC curve analysis of caspase 3, Annexin A2, and sFasL levels of the control group and endometriosis group
Control
Caspase 3, ng/mL 7.72 21 20 51 0.11–0.31
Annexin A2, ng/mL 12.62 36 41 55 0.25–0.48
sFasL, pg/mL 114.32 39 50 55 0.26–0.51
Endometriosis group
Caspase 3, ng/mL 9.04 79 72 70 0.68–0.88
Annexin A2, ng/mL 15.21 63 54 55 0.51–0.74
sFasL, pg/mL 122.7 60 52 47 0.48–0.73
Table 8. Correlation analysis of caspase 3, Annexin A2, and sFasL levels and number of affected ovaries, endometrioma size, pouche of
Douglas obliteration and pelvic organ adhesions in the stage III–IV endometriosis group
were not detectable in controls but were very high in moattractant protein-1 were significantly higher in ear-
early stages and decreased with the severity of the endo- ly stages and decreased with the severity of the disease
metriosis. TGF-β levels were significantly higher in pa- [30].
tients than in controls and increased with the severity of CA-125 is the most extensively investigated and
the disease. Serum levels of IL-8 and monocyte che- widely used peripheral biomarker of endometriosis [31].
130.241.16.16 - 8/2/2018 8:25:14 PM
None. CT03020108.
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