Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland..
Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China.
Gynecol Oncol. 2021 Feb;160(2):514-519. doi: 10.1016/j.ygyno.2020.11.004. Epub 2020 Nov 16.
To investigate whether HE4 and CA125 could identify endometrioid adenocarcinoma patients who might most benefit from full staging surgery with lymphadenectomy.
Sequential patients with a preoperative banked serum and histology of endometrioid adenocarcinoma of endometrium who had undergone surgical staging with lymph node dissection over a 5-year period between 2011 and 2016 were included from a tertiary Gynaecological Cancer Centre, Dublin, Ireland. Preoperative serum HE4 and CA125 were measured using ELISA, with the cut-offs HE4 81 pmol/L and CA125 35 U/ml. Predictive values were estimated using AUC, sensitivity, specificity and odds ratios.
9.5% of the cohort had lymph node metastases. A HE4 cut-off of 81 pmol/L yielded a sensitivity of 78.6% and specificity of 53.4% for predicting lymph node metastases. Sensitivity of CA125 at 35 U/ml was 57% and specificity 91.4%. The AUC was 0.66 (0.52-0.80) for HE4 and 0.74 (0.58-0.91) for CA125. Sensitivity was 92.8% and specificity 51.1% when an elevation of either HE4 or CA125 was included, AUC was 0.72 (0.61-0.83), this combination yielded the highest NPV of 98.6%. Sensitivity was 42.9% and specificity 93.8% if both markers were elevated simultaneously, AUC was 0.68 (0.51-0.86). Preoperative clinical predictors of high-grade preoperative histology and radiology had sensitivities of 21.4% and 41.7%, respectively. Patients with a HE4 above 81 pmol/L had an odds ratio of 4.2 (1.12-15.74), p < 0.05, of lymph node metastases and CA125 had an odds ratio of 14.2 (4.16-48.31), p < 0.001.
Serum HE4 and CA125 improved on existing methods for risk stratification of endometrioid carcinomas and warrant further investigation.
研究 HE4 和 CA125 是否可识别出可能从全面分期手术伴淋巴结清扫中获益最多的子宫内膜样腺癌患者。
纳入 2011 年至 2016 年期间在爱尔兰都柏林的一家三级妇科癌症中心接受手术分期伴淋巴结清扫的术前储存血清和子宫内膜样腺癌组织学的连续患者。使用 ELISA 测量术前血清 HE4 和 CA125，HE4 的截断值为 81pmol/L，CA125 的截断值为 35U/ml。使用 AUC、敏感性、特异性和优势比估计预测值。
队列中有 9.5%的患者有淋巴结转移。HE4 截断值为 81pmol/L 时，预测淋巴结转移的敏感性为 78.6%，特异性为 53.4%。CA125 的截断值为 35U/ml 时，敏感性为 57%，特异性为 91.4%。HE4 的 AUC 为 0.66（0.52-0.80），CA125 的 AUC 为 0.74（0.58-0.91）。当包括 HE4 或 CA125 升高时，敏感性为 92.8%，特异性为 51.1%，AUC 为 0.72（0.61-0.83），该组合的阴性预测值最高为 98.6%。如果同时升高两种标志物，敏感性为 42.9%，特异性为 93.8%，AUC 为 0.68（0.51-0.86）。术前高分级术前组织学和影像学的临床预测因子的敏感性分别为 21.4%和 41.7%。HE4 高于 81pmol/L 的患者发生淋巴结转移的优势比为 4.2（1.12-15.74），p<0.05，CA125 的优势比为 14.2（4.16-48.31），p<0.001。
血清 HE4 和 CA125 提高了子宫内膜样癌的风险分层现有方法，并值得进一步研究。
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