Chen Y, Ren Y-L, Li N, Yi X-F, Wang H-Y
Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Huangpu District, Shanghai, China.
Eur Rev Med Pharmacol Sci. 2016 May;20(10):1974-85.
Cancer antigen 125 (CA125) and Human epididymis protein 4 (HE4) appear to be promising predictors for endometrial cancer (EC). However, conflicting results exist in the diagnostic performance comparison among CA125 and HE4.
A systematic review was conducted using PubMed, EMBASE and other databases till December 2015. All studies included were closely assessed with the QUADAS. Diagnostic value of HE4, CA125 and HE4+CA125 was systematically evaluated, and comparison among the predictive performances of HE4, CA125 were conducted. Sensitivity, specificity, DOR (diagnostic odds ratio), and area under the SROC curve were summarized with a random model. Meta-regression was used to explore the heterogeneity.
8 studies including 1832 cases (1129 in the study group and 703 in the control group) were included in our meta-analysis. Mean estimates of HE4 and their 95% CIs were: sensitivity 0.53 (95% CI: 0.50-0.56), specificity 0.91 (95% CI: 0.89-0.93), DOR 17.01 (95% CI: 7.88-36.72). The area under the SROC curve of HE4 in the diagnosis of EC was 0.77. However, CA125 had lower sensitivity, specificity, DOR, and the area under the SROC in diagnosis of EC with sensitivity 0.26 (95% CI: 0.24-0.29), specificity 0.81 (95% CI: 0.78-0.84), DOR 2.61 (95% CI: 0.92-7.41), and the area under the SROC 0.37. In patients with EC diagnosed by HE4+CA125, the overall sensitivity was 0.58 (95% CI: 0.54-0.62) and a specificity of 0.92 (95% CI: 0.89-0.94) in predicting EC. DOR and the area under the SROC curve of HE4+CA125 for diagnosis of EC were 21.86 (95% CI: 11.08-43.15) and 0.83 respectively, which showed a higher level of diagnostic accuracy than HE4 alone.
HE4 is helpful for distinguishing EC from healthy and benign disease. CA125 is not better than HE4 either for EC diagnosis. HE4+CA125 is promising a predictor of EC to replace He4, but its utilization requires further exploration.
癌抗原125（CA125）和人附睾蛋白4（HE4）似乎是子宫内膜癌（EC）很有前景的预测指标。然而，CA125和HE4在诊断性能比较方面存在相互矛盾的结果。
截至2015年12月，使用PubMed、EMBASE和其他数据库进行了系统评价。纳入的所有研究均采用QUADAS进行严格评估。系统评价了HE4、CA125及HE4+CA125的诊断价值，并对HE4和CA125的预测性能进行了比较。采用随机模型总结敏感性、特异性、诊断比值比（DOR）和SROC曲线下面积。采用Meta回归分析探讨异质性。
我们的Meta分析纳入了8项研究，共1832例（研究组1129例，对照组703例）。HE4的平均估计值及其95%可信区间为：敏感性0.53（95%CI：0.50-0.56），特异性0.91（95%CI：0.89-0.93），DOR 17.01（95%CI：7.88-36.72）。HE4诊断EC的SROC曲线下面积为0.77。然而，CA125在诊断EC时敏感性、特异性、DOR较低，SROC曲线下面积为0.37，其敏感性为0.26（95%CI：0.24-0.29），特异性为0.81（95%CI：0.78-0.84），DOR为2.61（95%CI：0.92-7.41）。在HE4+CA125诊断为EC的患者中，预测EC的总体敏感性为0.58（95%CI：0.54-0.62），特异性为0.92（95%CI：0.89-0.94）。HE4+CA125诊断EC的DOR和SROC曲线下面积分别为21.86（95%CI：11.08-43.15）和0.83，显示出比单独使用HE4更高的诊断准确性。
HE4有助于将EC与健康及良性疾病区分开来。CA125在EC诊断方面并不优于HE4。HE4+CA125有望成为替代HE4的EC预测指标，但其应用还需要进一步探索。
