Dobrzycka Bozena, Mackowiak-Matejczyk Beata, Terlikowska Katarzyna Maria, Kinalski Maciej, Terlikowski Slawomir Jerzy
Department of Obstetrics, Gynecology and Maternity Care, Medical University of Bialystok, Bialystok, Poland.
Department of Gynecologic Oncology, Bialystok Oncology Center, Bialystok, Poland.
Adv Med Sci. 2016 Mar;61(1):23-7. doi: 10.1016/j.advms.2015.07.010. Epub 2015 Aug 9.
The aim of the study was to establish whether preoperative serum levels of HE4 and CA125 could be a good predictor for lymphadenectomy in the early stage of endometrioid adenocarcinoma of the uterus.
Preoperative serum HE4 and CA125 were measured in 78 postmenopausal patients treated surgically. The ROC curves were generated to determine the optimal cutoff values of HE4 and CA125 levels with optimum sensitivity and specificity for the prediction of lymphadenectomy.
Based on ROC curve, we found that the HE4 value of 78pmol/l is the best cutoff to identify candidates who may require lymphadenectomy with the sensitivity of 86.6% and the specificity of 67.2% (NPV=88.4% and PPV=51.2%). The area under the curve (AUC) equals 0.814 (95% CI=0.721-0.886). The cutoff level of CA125 that shows the prognostic indices is 26U/ml, with the sensitivity of 66.6% and the specificity of 61.2% (NPV=69.4% and PPV=44.3%). For CA125 the AUC amounts to 0.671 (95% CI=0.568-0.764). We also found a statistically significant difference, comparing HE4 and CA125 AUC (0.814 vs. 0.671, respectively, p<0.001). The combination of HE4 and CA125 established in our study as the cutoff point has the sensitivity of 81.2% and the specificity of 65.9% with NPV=83.4% and PPV=47.9%.
Our findings indicate that in the early stage of endometrioid endometrial cancer, HE4 can serve as a preoperative tool that can help to identify postmenopausal women who may require lymphadenectomy.
本研究旨在确定术前血清HE4和CA125水平是否可作为子宫子宫内膜样腺癌早期淋巴结清扫术的良好预测指标。
对78例接受手术治疗的绝经后患者术前血清HE4和CA125进行检测。绘制ROC曲线以确定HE4和CA125水平的最佳临界值，用于预测淋巴结清扫术时具有最佳敏感性和特异性。
基于ROC曲线，我们发现78pmol/l的HE4值是识别可能需要淋巴结清扫术患者的最佳临界值，敏感性为86.6%，特异性为67.2%（阴性预测值=88.4%，阳性预测值=51.2%）。曲线下面积（AUC）等于0.814（95%CI=0.721-0.886）。显示预后指标的CA125临界水平为26U/ml，敏感性为66.6%，特异性为61.2%（阴性预测值=69.4%，阳性预测值=44.3%）。对于CA125，AUC为0.671（95%CI=0.568-0.764）。我们还发现，比较HE4和CA125的AUC存在统计学显著差异（分别为0.814和0.671，p<0.001）。本研究确定的HE4和CA125联合临界值的敏感性为81.2%，特异性为65.9%，阴性预测值=83.4%，阳性预测值=47.9%。
我们的研究结果表明，在子宫内膜样子宫内膜癌早期，HE4可作为一种术前工具，有助于识别可能需要淋巴结清扫术的绝经后女性。
