Knific Tamara, Osredkar Joško, Smrkolj Špela, Tonin Irena, Vouk Katja, Blejec Andrej, Frković Grazio Snježana, Rižner Tea Lanišnik
Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia.
Gynecol Oncol. 2017 Oct;147(1):126-132. doi: 10.1016/j.ygyno.2017.07.130. Epub 2017 Jul 21.
To evaluate the diagnostic and prognostic potential of preoperative serum CA-125 and HE4 levels in patients with endometrial cancer.
Prospective case-control study of 133 women who underwent surgical treatment at the University Medical Centre Ljubljana (64 patients with endometrial cancer, 69 control patients with prolapsed uterus or myoma). Serum CA-125 and HE4 levels were determined using electrochemiluminescent assays.
Serum CA-125 and HE4 levels were significantly higher in patients with endometrial cancer, compared to the controls (p=2.67×10, 1.36×10, respectively). A diagnostic model that combines serum CA-125 and HE4 levels and body mass index separated patients with endometrial cancer from controls, with AUC of 0.804, sensitivity of 66.7%, and specificity of 84.6%. Serum HE4 levels showed good prognostic potential and stratified the patients according to presence/absence of deep myometrial invasion (p=0.001) or lymphovascular invasion (p=0.003), with AUCs of 0.78 and 0.81, respectively. In low-risk patients with grade 1 and 2 endometrioid cancer for whom lymphadenectomy can be avoided, HE4 allowed stratification according to deep myometrial invasion (p=3.39×10), with AUC of 0.84. Although median HE4 levels were higher in patients with lymphovascular invasion, this difference did not reach significance (p=0.06).
A model based on preoperative serum CA-125 and HE4 levels and body mass index has good diagnostic accuracy for separation of patients with endometrial cancer and control patients. In patients with endometrial cancer, serum HE4 levels allow prediction of deep myometrial and lymphovascular invasion.
评估术前血清CA - 125和HE4水平在子宫内膜癌患者中的诊断及预后价值。
对在卢布尔雅那大学医学中心接受手术治疗的133名女性进行前瞻性病例对照研究（64例子宫内膜癌患者，69例子宫脱垂或肌瘤对照患者）。采用电化学发光法测定血清CA - 125和HE4水平。
与对照组相比，子宫内膜癌患者血清CA - 125和HE4水平显著更高（分别为p = 2.67×10，1.36×10）。结合血清CA - 125、HE4水平和体重指数的诊断模型可区分子宫内膜癌患者与对照患者，曲线下面积（AUC）为0.804，灵敏度为66.7%，特异度为84.6%。血清HE4水平显示出良好的预后价值，可根据是否存在深肌层浸润（p = 0.001）或淋巴管浸润（p = 0.003）对患者进行分层，AUC分别为0.78和0.81。对于可避免行淋巴结切除术的1级和2级子宫内膜样癌低风险患者，HE4可根据深肌层浸润进行分层（p = 3.39×10），AUC为0.84。虽然淋巴管浸润患者的HE4中位数水平较高，但差异无统计学意义（p = 0.06）。
基于术前血清CA - 125、HE4水平和体重指数的模型在区分子宫内膜癌患者与对照患者方面具有良好的诊断准确性。在子宫内膜癌患者中，血清HE4水平可预测深肌层和淋巴管浸润。
