Molecular Diagnostics Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
J Natl Cancer Inst. 2011 Nov 2;103(21):1630-4. doi: 10.1093/jnci/djr359. Epub 2011 Sep 14.
In screening for epithelial ovarian cancer, unnecessary surgery can be reduced by limiting use of transvaginal ultrasound (TVU) to women with increasing CA125 serum levels. Replacing or augmenting TVU with measurement of a serum marker specific for malignancy might further improve screening performance. Serum samples from 112 invasive ovarian cancer patients and 706 matched control subjects from the Prostate, Lung, Colorectal, and Ovarian trial were used to evaluate human epididymis protein 4 (HE4), mesothelin, matrix metalloproteinase 7 (MMP7), SLPI, Spondin2, and insulin-like growth factor binding protein 2 (IGFBP2) for their potential use in screening. TVU results were available for a subset of 84 patients and 516 control subjects used to compare the best marker with TVU. HE4 was found to perform better than TVU as a second-line screen, confirming 27 of 39 cancers with increasing CA125 serum levels compared with 17 cancers confirmed by TVU (P = .03). Serum HE4 levels were found to increase with age and smoking status, suggesting that a longitudinal algorithm might improve its performance.
在筛查上皮性卵巢癌时，通过将经阴道超声（TVU）的使用限制在血清 CA125 水平升高的妇女中，可以减少不必要的手术。用针对恶性肿瘤的特异性血清标志物替代或补充 TVU 可能会进一步提高筛查性能。使用来自前列腺癌、肺癌、结直肠癌和卵巢癌试验的 112 例侵袭性卵巢癌患者和 706 例匹配对照者的血清样本，评估人附睾蛋白 4（HE4）、间皮素、基质金属蛋白酶 7（MMP7）、分泌型白细胞蛋白酶抑制剂（SLPI）、Spondin2 和胰岛素样生长因子结合蛋白 2（IGFBP2）在筛查中的潜在用途。为了比较最佳标志物与 TVU，对 84 例患者和 516 例对照者中的一部分进行了 TVU 结果的评估。发现 HE4 作为二线筛查优于 TVU，与 TVU 相比，它可以确诊 39 例 CA125 血清水平升高的癌症中的 27 例（P =.03）。发现血清 HE4 水平随年龄和吸烟状况而升高，这表明纵向算法可能会提高其性能。
