Abstract
Human epididymis protein 4 (HE4) has been suggested to be a novel biomarker of epithelial ovarian cancer (EOC). The present study aimed to evaluate and compare HE4 with the commonly used marker, carbohydrate antigen 125 (CA125), in prediction and therapy-monitoring of EOC. Serum HE4 concentrations from 123 ovarian cancer patients and 174 controls were measured by Roche electrochemiluminescent immunoassay (ECLIA). Risk of ovarian malignancy algorithm (ROMA) values were calculated and assessed. In addition, the prospects of HE4 detection for therapy-monitoring were evaluated in EOC patients. The ROMA score could classify patients into high- and low-risk groups with malignancy. Indeed, lower serum HE4 was significantly associated with successful surgical therapy. Specifically, 38 patients with EOC exhibited a greater decline of HE4 compared with CA125. In contrast, elevation of HE4 better predicted recurrence (of 46, 11 patients developed recurrence, and with it increased HE4 serum concentrations) and a poor prognosis than CA125. This study suggests that serum HE4 levels are closely associated with outcome of surgical therapy and disease prognosis in Chinese EOC patients.
Highlights
Ovarian cancer is a common malignant disease and represents the primary cause of death for gynecological cancers (Ferlay et al, 2010)
This study suggests that serum Human epididymis protein 4 (HE4) levels are closely associated with outcome of surgical therapy and disease prognosis in Chinese epithelial ovarian cancer (EOC) patients
Calculation of the Risk of ovarian malignancy algorithm (ROMA) score The ROMA utilizes the HE4 and carbohydrate antigen 125 (CA125) concentrations obtained by electrochemiluminescent immunoassay (ECLIA) to generate a predictive index (PI) for EOC calculated by the following formulas (Moore et al, 2010): For premenopausal women: PI = -12.0 + 2.38×LN[HE4] + 0.0626×LN[CA125]; For postmenopausal women: PI = -8.09 + 1.04×LN[HE4] + 0.732×LN[CA125]
Summary
Ovarian cancer is a common malignant disease and represents the primary cause of death for gynecological cancers (Ferlay et al, 2010). Carbohydrate antigen 125 (CA125) is the established biomarker for detecting ovarian cancer recurrence and monitoring therapeutic response This glycoprotein is not expressed in up to 20% of ovarian cancer patients and can be elevated in various benign conditions (Rosen et al, 2012; Maggino et al, 2013). Use of HE4 as a single biomarker or in combination with CA125 indicated the highest sensitivity, especially in early stage ovarian cancers (Moore et al, 2008; Ferraro et al, 2013) Detection of both CA125 and HE4 has been implemented in some clinical trial centers to discriminate patients with benign and malignant ovarian tumors preoperatively by calculating the risk of ovarian malignancy algorithm (ROMA) score (Moore et al, 2009; Moore et al, 2010; Ruggeri et al, 2011). Conclusions: This study suggests that serum HE4 levels are closely associated with outcome of surgical therapy and disease prognosis in Chinese EOC patients
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