Association of Serum HE4 with Primary Tumor Diameter and Depth of Myometrial Invasion in Endometrial Cancer Patients at Rajavithi Hospital.

Nisa Prueksaritanond,Marut Yanaranop,Patchara Cheanpracha

doi:10.7314/apjcp.2016.17.3.1489

Nisa Prueksaritanond, Marut Yanaranop + Show 1 more

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https://doi.org/10.7314/apjcp.2016.17.3.1489

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Abstract

Although there are no biomarkers that are routinely used in endometrial cancer (EC) management, many studies have found that serum human epididymis protein 4 (HE4) is superior to cancer antigen 125 (CA125) in the detection of EC. The correlation of HE4 with two prognostic factors for EC, primary tumor diameter (PTD) and depth of myometrial invasion (DMI) may be useful in identifying EC patients at high risk of lymphatic dissemination. To evaluate the correlation of serum HE4 with PTD and DMI in patients with EC. A cross-sectional study was conducted on 70 EC patients who were scheduled for elective surgery at Rajavithi Hospital between 1st September 2013 and 30th May 2014. Preoperative serum levels of HE4 and CA125 were investigated, and then gross measurement of PTD was taken and postoperative pathologic slides were reviewed for DMI including histologic types, grading and staging. Preoperative serum HE4 levels were strongly correlated with PTD (r=0.65, p<0.001) and moderately correlated with DMI (r=0.46, p<0.001). Moreover, serum HE4 levels were significantly elevated in EC patients with PTD >2 cm (p<0.001) and DMI > 50% (p=0.004). The performance of serum HE4 in identifying EC patients at low risk and high risk of lymph node metastasis was significantly better than that of CA125 (AUC 0.88 vs. 0.65, p=0.003). At an optimal cut-off value of 70 pM/L, serum HE4 had a sensitivity of 83.3% and a specificity of 80.0%. In EC patients, preoperative serum HE4 is significantly correlated with PTD and DMI. Serum HE4 levels could be useful in identifying endometrial cancer patients at high risk of lymphatic spread who would benefit from systemic lymphadenectomy at the cut-off value of 70 pM/L.

Highlights

Endometrial cancer (EC) is the second most common gynecological malignancy worldwide (Jemal et al, 2008) and the third most common after cervical and ovarian cancer in Thailand (Cancer of Thailand, 2010)
Serum cancer antigen 125 (CA125) is the tumor marker that is most commonly used in the management of endometrial cancer (EC)
A prior study has suggested that elevated serum CA125 is correlated with advanced-stage EC (Jhang et al, 2003; Powell et al, 2005) another study found that only 10% of patients with stages I and II EC had elevated serum CA125 (Takeshima et al, 1994)

Summary

Introduction

Endometrial cancer (EC) is the second most common gynecological malignancy worldwide (Jemal et al, 2008) and the third most common after cervical and ovarian cancer in Thailand (Cancer of Thailand, 2010). Measurement of serum Cancer Antigen 125 (CA125) is recommended in the preoperative evaluation of EC patients, as high levels of CA125 are associated with advanced-stage EC. The correlation of HE4 with two prognostic factors for EC, primary tumor diameter (PTD) and depth of myometrial invasion (DMI) may be useful in identifying EC patients at high risk of lymphatic dissemination. The performance of serum HE4 in identifying EC patients at low risk and high risk of lymph node metastasis was significantly better than that of CA125 (AUC 0.88 vs 0.65, p=0.003). Serum HE4 levels could be useful in identifying endometrial cancer patients at high risk of lymphatic spread who would benefit from systemic lymphadenectomy at the cut-off value of 70 pM/L

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