Consideration should be given to smoking, endometriosis, renal function (eGFR) and age when interpreting CA125 and HE4 in ovarian tumor diagnostics

Maria Lycke, Benjamin Ulfenborg, Jacob Malchau Lauesgaard, Björg Kristjansdottir, Björg Kristjánsdóttir, Karin Sundfeldt
Clinical chemistry and laboratory medicine · 2021 · vol. 59(12) , pp. 1954–1962 · doi:10.1515/cclm-2021-0510 · PMID:34388324 · W3191037831
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Smoking, impaired renal function, age, and endometriosis independently influence CA125 and HE4 levels, impacting ovarian tumor diagnostic accuracy.

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Abstract

OBJECTIVES: To evaluate the impact of different biologic, histopathologic and lifestyle factors on serum levels of human epididymis protein 4 (HE4) and Cancer antigen 125 (CA125) in the diagnostic work up of women with an ovarian cyst or pelvic tumor. METHODS: The statistical evaluation was performed on a population of 445 women diagnosed with a benign ovarian disease, included in a large Swedish multicenter trial (ClinicalTrials.gov NCT03193671). Multivariable logistic regression analyses were performed to distinguish between the true negatives and false positives through adjusting for biologic, histopathologic and lifestyle factors on serum samples of CA125 and HE4 separately. The likelihood ratio test was used to determine statistical significance and Benjamini-Hochberg correction to adjust for multiple testing. RESULTS: A total of 31% of the women had false positive CA125 but only 9% had false positive results of HE4. Smoking (OR 6.62 95% CI 2.93-15.12) and impaired renal function, measured by eGFR (OR 0.18 95% CI 0.08-0.39), were independently predictive of falsely elevated serum levels of HE4. Endometriosis was the only variable predictive of falsely elevated serum levels of CA125 (OR 7.96 95% CI 4.53-14.39). Age correlated with increased serum levels of HE4. CONCLUSIONS: Smoking, renal failure, age and endometriosis are factors that independently should be considered when assessing serum levels of HE4 and CA125 in women with an ovarian cyst or pelvic mass to avoid false indications of malignant disease.

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Condition tags

endometriosis

MeSH descriptors

Aging CA-125 Antigen CA-125 Antigen Endometriosis Endometriosis Glomerular Filtration Rate Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Smoking WAP Four-Disulfide Core Domain Protein 2 WAP Four-Disulfide Core Domain Protein 2 Biomarkers, Tumor Biomarkers, Tumor Female Humans Kidney Kidney

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