Serum HE4 Is Correlated To Prognostic Factors And Survival In Patients With Endometrial Cancer

[Objectives] The extent of surgery and the decision for adjuvant treatment in patients with endometrial cancer(EC)depend on the presence of risk factors for lymph node metastases and disease recurrence.Postoperative markers such as myometrial infiltration and specific mutations can select patients for adjuvant treatment but will not influence surgical planning.A biomarker stratifying patients into low-risk and high-risk groups before surgery could identify patients who benefit from more extensive surgery.Through the detection preoperative serum human epididymis secretory protein 4(HE4)levels of endometrial cancer patients,determination of value for preoperative evaluation and predicting the prognosis of EC.[Methods]A retrospective study was performed on 134 cases with diagnosis of endometrial cancer in the biopsy treated at the Department of Obstetrics and Gynecology,Wuxi maternal and child health care hospital,between 2011 and 2014.Spearman’s rank correlation was used to analyse the association between serum CA125 and serum HE4 values and between serum HE4 and age.Performance of HE4 as dichotomous variable(normal versus elevated)in predicting myometrial invasion was alsoanalysed using a cut-off 70pmol/L.Comparison of serum HE4 concentration between patient groups based on clinical and pathological variables was performed using either independent sample t test or ANOVA test when appropriate.Serum CA125 was also included into the analysis.With the Cox proportional hazard analysis,the prognostic effect of various factors on different survival endpoints was calculated.[Results](1)Preoperative serum HE4 levels and endometrial cancer patients’ age,preoperative serum CA125 levels were positively correlated(Spearman’s rho 0.28,0.25 respectively,p values < 0.05).(2)the correlation between serum HE4 concentration and various clinical and pathological variables.Serum HE4 concentration was significantly associated with known prognostic risk factors in EC such as stage of disease,depth of invasion(percentage of myometrial invasion,DOI and TFD),presence of LVSI and cervical involvement(p values < 0.05),No correlation was found between serum HE4 and Lymph node involvemen(p values 0.13).(3)With a cut-off value of 70 pmol/L regardless of age,a sensitivity of 85% was reached with a specificity of 85%,PPV of 46% and NPV of 87% in predicting deep myometrial invasion.(4)Serum HE4 is an independent prognostic factor for progress-free survival(HR 6.23 per 10-fold increase in HE4,95% CI 1.74–16.1,p values 0.006)and overall survival(HR 7.57 per 10-fold increase in HE4,95% CI1.93–32.4,p values 0.007).[Conclusions] HE4 is a prognostic marker in endometrial cancer and is helpful in addition to other variables for the preoperative risk stratification of patients with endometrial cancer.