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Urinary Polyamines as Biomarkers for Ovarian Cancer
  1. Riikka Johanna Niemi, MD*,
  2. Antti N. Roine, MD, PhD,
  3. Merja R. Häkkinen, PhD,
  4. Pekka S. Kumpulainen, DSc§,
  5. Tuomo A. Keinänen, PhD,
  6. Jouko J. Vepsäläinen, PhD,
  7. Terho Lehtimäki, MD, PhD,
  8. Niku K. Oksala, MD, PhD, DSc,# and
  9. Johanna U. Mäenpää, MD, PhD*,**
  1. * Department of Obstetrics and Gynecology, Tampere University Hospital;
  2. Faculty of Medicine and Life Sciences, University of Tampere, Tampere;
  3. School of Pharmacy, Biocenter Kuopio, University of Eastern Finland, Kuopio;
  4. § Digital Health Solutions;
  5. Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Life Sciences;
  6. Department of Surgery, Faculty of Medicine and Life Sciences, University of Tampere;
  7. # Department of Vascular Surgery, Tampere University Hospital; and
  8. ** Department of Obstetrics and Gynecology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
  1. Address correspondence and reprint requests to Riikka Johanna Niemi, MD, Department of Obstetrics and Gynecology, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland. E-mail: riikka.niemi{at}


Objectives Elevated concentrations of polyamines have been found in urine of patients with malignant tumors, including ovarian cancer. Previous research has suffered from poorly standardized detection methods. Our liquid chromatography–tandem mass spectrometry (LC-MS/MS) method is capable of simultaneous standardized analysis of most known polyamines. Liquid chromatography–tandem mass spectrometry has not previously been used in the differential diagnostics of ovarian tumors in postmenopausal women.

Materials and Methods In this prospective study, postmenopausal women (n = 71) presenting with an adnexal mass and, as controls, women with genital prolapse or urinary incontinence scheduled for surgery (n = 22) were recruited in the study. For analysis of the polyamines, a morning urine sample was obtained before surgery. Preoperative serum CA125 concentrations were determined in the study group.

Results Twenty-three women with benign and 37 with malignant ovarian tumors were eligible. Of all analyzed polyamines, only urinary N1,N12-diacetylspermine showed statistically significant differences between all groups except controls versus benign tumors. N1,N12-diacetylspermine was elevated in malignant versus benign tumors (P < 0.001), in high-grade versus low malignant potential tumors (P < 0.001), in stage III to IV versus stage I to II cancers (P < 0.001), and even in early-stage cancer (stage I–II) versus benign tumors (P = 0.017). N1,N12-diacetylspermine had better sensitivity (86.5%) but lower specificity (65.2%) for distinguishing benign and malignant ovarian tumors than CA125 with a cut-off value of 35 kU/L (sensitivity, 75.7%; specificity, 69.6%).

Conclusions Urinary N1,N12-diacetylspermine seems to be able to distinguish benign and malignant ovarian tumors as well as early and advanced stage, and low malignant potential and high-grade ovarian cancers from each other, respectively.

  • LC-MS/MS
  • Ovarian tumor
  • Ovarian cancer
  • DiAcSpm
  • Polyamine

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  • The authors declare no conflicts of interest.