Hellstrom Ingegerd, Hellstrom Karl Erik
Dept. of Pathology, Harborview Medical Center, University of Washington Seattle, WA 98104-2490.
Expert Opin Med Diagn. 2011 May 1;5(3):227-240. doi: 10.1517/17530059.2011.559459.
There is a need to improve the diagnosis and prognosis of ovarian carcinoma, particularly the serous type of cancer. Mesothelin and HE4 are two novel biomarkers which are expressed in serous ovarian carcinoma and can be measured in serum and other body fluids, including urine, by using ELISA. The measurement of antibodies to these markers can provide additional useful information. AREAS COVERED: A literature search was performed to as recent as December 1 2010, using the Internet (e.g. PubMed) on articles concerning mesothelin and HE4 for the diagnosis of ovarian carcinoma. The authors also included up to date recent information from the research performed in their own laboratory. EXPERT OPINION: The combination of CA125 with HE4 facilitates the triaging of women with a pelvic mass and detects more stage I/II tumors than CA125, the present 'gold standard', when used alone. Assaying urine for HE4 or mesothelin may detect early ovarian carcinoma more often than assaying serum. Antibodies to mesothelin and HE4 are more frequent in women with ovarian carcinoma or with certain types of infertility than in controls. No presently available biomarker or multi-marker panel lends itself to screening large populations of symptomless women to make possible detection of high grade serous ovarian carcinoma at stage I or II. The authors anticipate, within the next 5 years, that a greater emphasis will be given to the fact that the different subtypes of ovarian carcinoma represent different types of disease. Each different type of disease will require a different diagnostic approach and more efforts will focus on high grade serous ovarian carcinoma for which the clinical need is the greatest.
有必要改善卵巢癌，尤其是浆液性癌的诊断和预后。间皮素和人附睾蛋白4（HE4）是两种新型生物标志物，它们在浆液性卵巢癌中表达，并且可以通过酶联免疫吸附测定法（ELISA）在血清和包括尿液在内的其他体液中进行检测。对这些标志物抗体的检测可以提供额外的有用信息。
通过互联网（如PubMed）对截至2010年12月1日的有关间皮素和HE4用于卵巢癌诊断的文章进行了文献检索。作者还纳入了他们自己实验室最新的研究信息。
CA125与HE4联合使用有助于对有盆腔肿块的女性进行分流，并且与目前单独使用的“金标准”CA125相比，能检测出更多的I/II期肿瘤。检测尿液中的HE4或间皮素可能比检测血清更常发现早期卵巢癌。卵巢癌女性或某些类型不孕症女性中，间皮素和HE4抗体的出现频率高于对照组。目前尚无可用的生物标志物或多标志物组合适用于对大量无症状女性进行筛查，以在I期或II期检测出高级别浆液性卵巢癌。作者预计，在未来5年内，将更加重视卵巢癌的不同亚型代表不同类型疾病这一事实。每种不同类型的疾病都需要不同的诊断方法，并且更多的努力将集中在临床需求最大的高级别浆液性卵巢癌上。
