The role of HE4 and CA125 in differentiation between malignant and non-malignant endometrial pathologies

Nabil Abdalla, Monika Pazura, Anna Słomka, Robert Piórkowski, Włodzimierz Sawicki, Krzysztof Cendrowski
In: Ginekologia Polska · 2016 · vol. 87(12) , pp. 781–786 · doi:10.5603/gp.2016.0088 · PMID:28098927 · W2571625060
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Serum HE4 levels were significantly higher in patients with endometrial cancer and reliably differentiated malignant from non-malignant pathologies, unlike CA125.

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This retrospective study evaluated serum HE4 and CA125 as biomarkers to differentiate malignant from non-malignant endometrial pathologies in 87 patients, with tumor marker levels measured about two weeks before surgical intervention and final diagnoses based on endometrial histopathology. HE4 was significantly higher in endometrial cancer overall and in early stages compared with non-malignant conditions, and its diagnostic performance at a 70 pmol/L cutoff showed sensitivity of 73.08% and specificity of 85.71% with an AUC of 0.875; CA125 did not meaningfully distinguish malignant from non-malignant pathologies (AUC 0.552, p = 0.414). The main limitation explicitly inherent to the study is its retrospective design. Relevance to endometriosis: the paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via keyword overlap with gynecologic pathology and malignant/non-malignant differentiation.

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Abstract

OBJECTIVES: The aim of the study was to assess the role of HE4 and CA125 in differentiation between malignant and non-malignant endometrial pathologies. MATERIAL AND METHODS: A retrospective study of 87 patients with endometrial pathologies was conducted. Tumor markers were assessed two weeks before surgical intervention in each subject. The final diagnosis was established on the basis of the histopathological examination of the endometrium. RESULTS: Serum HE4 levels were significantly higher in patients with endometrial cancer (EC) as compared to non-malignant endometrial pathologies (p < 0.001), patients with stage I EC as compared to non-malignant endometrial pathologies (p < 0.001), and patients with stage Ia EC as compared to non-malignant endometrial pathologies (p = 0.003). Serum CA125 levels were not significantly different as far as these groups of patients were concerned. Both tumor markers were significantly higher in patients with stage II-III as compared to stage I EC and non-malignant endometrial pathologies (p < 0.001 for both markers). Sensitivity and specificity of HE4 at the cut-off level of 70 pmol/L for detecting endometrial malignancies were 73.08% and 85.71%, respectively. Sensitivity and specificity of CA125 at the cut-off level of 35 U/mL were 29.41% and 94.29%, respectively. The area under the curve (AUC) for HE4 was 0.875, suggesting that this marker reliably differentiates malignant from non-malignant endometrial pathologies (p < 0.001). AUC for CA125 was 0.552, suggesting that this marker does not reliably differentiate between malignant and non-malignant endometrial pathologies (p = 0.414). CONCLUSION: HE4, in contrast to CA125, might be a useful tool for detecting malignant endometrial pathologies.
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Abstract

Objectives: The aim of the study was to assess the role of HE4 and CA125 in differentiation between malignant and non-malignant endometrial pathologies.

Material and methods

A retrospective study of 87 patients with endometrial pathologies was conducted. Tumor markers were assessed two weeks before surgical intervention in each subject. The final diagnosis was established on the basis of the histopathological examination of the endometrium.

Results

Serum HE4 levels were significantly higher in patients with endometrial cancer (EC) as compared to non-malignant endometrial pathologies (p < 0.001), patients with stage I EC as compared to non-malignant endometrial pathologies (p < 0.001), and patients with stage Ia EC as compared to non-malignant endometrial pathologies (p = 0.003). Serum CA125 levels were not significantly different as far as these groups of patients were concerned. Both tumor markers were significantly higher in patients with stage II-III as compared to stage I EC and non-malignant endometrial pathologies (p < 0.001 for both markers). Sensitivity and specificity of HE4 at the cut-off level of 70 pmol/L for detecting endometrial malignancies were 73.08% and 85.71%, respectively. Sensitivity and specificity of CA125 at the cut-off level of 35 U/mL were 29.41% and 94.29%, respectively. The area under the curve (AUC) for HE4 was 0.875, suggesting that this marker reliably differentiates malignant from non-malignant endometrial pathologies (p < 0.001). AUC for CA125 was 0.552, suggesting that this marker does not reliably differentiate between malignant and non-malignant endometrial pathologies (p = 0.414).

Conclusion

HE4, in contrast to CA125, might be a useful tool for detecting malignant endometrial pathologies.

Keywords

HE4CA125endometrial cancerendometrial hyperplasiaendometrial polyp

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