Advanced
endometrial cancer (EC) often recurs and has a poor prognosis. Various
serum markers have been used for EC but their usefulness as
biomarkers is still unclear; therefore, identifying new
biomarkers is important. The present study aimed to investigate whether the
tissue factor pathway inhibitor-2 (TFPI2) level was elevated in the preoperative serum of patients with EC and if it may be a prognostic factor. The present retrospective study included 207 patients who had a confirmed pathological diagnosis of EC and received surgical
therapy as the initial treatment between January 2011 and December 2017. Survival analysis was performed using Kaplan-Meier analysis and the Cox proportional hazards regression model. The 5-year disease-free survival and overall survival (OS) rates were 73.3 and 83.7%, respectively. The cut-off value for predicting OS for TFPI2 level was 177 pg/ml as determined from the receiver operating characteristic curve. A TFPI2 value ≥177 pg/ml was significantly associated with age ≥65 years (P<0.001), diabetes (P=0.035), stage (P<0.001), myometrial invasion (P<0.001), lymphovascular invasion (P=0.004),
lymph node metastasis (P=0.010), distant
metastasis (P<0.001),
cancer antigen (CA) 125 ≥36 U/ml (P<0.001) and CA 19-9 ≥38 U/ml (P<0.001). In multivariate analysis, high-grade
carcinoma [hazard ratio (HR), 2.439; P=0.041],
lymph node metastasis (HR, 2.116; P=0.038), distant
metastasis (HR, 3.604; P=0.009) and TFPI2 level ≥177 pg/ml (HR, 2.42; P=0.043) were significant prognostic factors affecting OS in patients with EC. These results suggest that the preoperative serum TFPI2 level, along with its histological type,
lymph node metastasis and distant
metastasis, was a prognostic factor for OS in patients with
endometrial cancer.