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Ma S, Yu J, Qin X, Liu J. Current status and challenges in establishing reference intervals based on real-world data. Crit Rev Clin Lab Sci 2023; 60:427-441. [PMID: 37038925 DOI: 10.1080/10408363.2023.2195496] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/29/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
Reference intervals (RIs) are the cornerstone for evaluation of test results in clinical practice and are invaluable in judging patient health and making clinical decisions. Establishing RIs based on clinical laboratory data is a branch of real-world data mining research. Compared to the traditional direct method, this indirect approach is highly practical, widely applicable, and low-cost. Improving the accuracy of RIs requires not only the collection of sufficient data and the use of correct statistical methods, but also proper stratification of heterogeneous subpopulations. This includes the establishment of age-specific RIs and taking into account other characteristics of reference individuals. Although there are many studies on establishing RIs by indirect methods, it is still very difficult for laboratories to select appropriate statistical methods due to the lack of formal guidelines. This review describes the application of real-world data and an approach for establishing indirect reference intervals (iRIs). We summarize the processes for establishing iRIs using real-world data and analyze the principle and applicable scope of the indirect method model in detail. Moreover, we compare different methods for constructing growth curves to establish age-specific RIs, in hopes of providing laboratories with a reference for establishing specific iRIs and giving new insight into clinical laboratory RI research. (201 words).
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Affiliation(s)
- Sijia Ma
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, P.R. China
| | - Juntong Yu
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, P.R. China
| | - Xiaosong Qin
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, P.R. China
| | - Jianhua Liu
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, P.R. China
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2
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Li Y, Li M, Zhang Y, Zhou J, Jiang L, Yang C, Li G, Qu W, Li X, Chen Y, Chen Q, Wang W, Wang S, Liang Xing J, Huang H. Age-stratified and gender-specific reference intervals of six tumor markers panel of lung cancer: A geographic-based multicenter study in China. J Clin Lab Anal 2021; 35:e23816. [PMID: 33982344 PMCID: PMC8183943 DOI: 10.1002/jcla.23816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Serum biomarkers have been widely adopted in clinical practice for assisting lung cancer diagnoses, therapeutic monitoring, and prognostication. The function of a well‐performing tumor biomarker depends on a reliable reference interval (RI) with consideration of the study subjects’ age, gender, and geographical location. This study aimed to establish a RI for each of 6 lung cancer biomarkers for use in the whole country of China on Mindray platform. Methods The levels of serum 6 lung cancer biomarkers—namely progastrin‐releasing peptide (ProGRP), neuron‐specific enolase (NSE), squamous cell carcinoma antigen (SCC), carcinoembryonic antigen (CEA), cytokeratin‐19 fragment (CYFRA21‐1), and human epididymis protein 4 (HE4)—were measured utilizing the chemiluminescence immunoassay on the Mindray CL‐6000i platform following the laboratory standard operating procedures in apparently healthy Chinese individuals on large cohort, multicenter, and geographical consideration bases. The CLSI EP28‐A3C guideline was followed for the enrollment of study subjects. Results The age‐stratified, gender‐specific RIs for ProGRP, NSE, SCC, CEA, CYFRA21‐1, and HE4 lung cancer biomarkers in the Chinese population have been established as described in the results and discussion in this work. In addition, various levels of the six lung cancer biomarkers among nine geographical locations in China have been observed. Conclusions The sample volume of study cohort, age, and geographical location should be considered upon establishing a reliable biomarker RI. A RI for each of six lung cancer biomarkers has been established. The results from this study would be helpful for clinical laboratories in interpreting the analytical results and for clinicians in patient management.
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Affiliation(s)
- Yan Li
- Department of Laboratory Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Li
- Department of Laboratory Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Yi Zhang
- Department of Laboratory Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jianping Zhou
- Department of Radio Immunoassay Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Li Jiang
- Department of Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdou, China
| | - Chen Yang
- Department of Laboratory Medicine, Suzhou Municipal Hospital, Suzhou, China
| | - Gang Li
- Department of Laboratory Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Qu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xinhui Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yong Chen
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China
| | - Qing Chen
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China
| | - Wei Wang
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China
| | - Shukui Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin Liang Xing
- State Key Laboratory of Cancer Biology and Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi'an, China
| | - Huayi Huang
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China.,Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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3
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Schirinzi A, Cazzolla AP, Mascolo E, Palmieri G, Pesce F, Gesualdo L, Santacroce L, Ballini A, Lovero R, Di Serio F. Determination of the Upper Reference Limit of Human Epididymis Secretory Protein 4 (HE4) in Healthy Male Individuals and Correlation with Renal and Fertility Markers. Endocr Metab Immune Disord Drug Targets 2021; 21:912-918. [PMID: 32767951 DOI: 10.2174/1871530320666200807121050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Elevated human epididymis secretory protein 4 (HE4) serum levels have been widely investigated in patients with ovarian cancer. However, high levels of HE4 can be also found in other tumors and in renal fibrosis. To date, the HE4 assay manufacturer features the reference value only for the female pre- and post-menopausal population. The aim of this study was to determine the upper reference limit (URL) of HE4 in a well-defined and large cohort of healthy male individuals and investigate potential factors influencing HE4 levels in healthy subjects. METHODS The study included 307 Italian healthy male individuals. HE4 was measured using a chemiluminescent assay (Abbott Laboratories, Wiesbaden, Germany). The URL was calculated using the non-parametric percentile method. Differences in HE4 concentrations according to age, estimated glomerular filtration rate (eGFR), free and bioavailable testosterone were also evaluated. RESULTS The 97.5th percentile URL of serum HE4 in our study population was 57 pmol/L (90% CI). After stratifying subjects according to age, we found that the URL of HE4 was higher in older (> 50 years) than in younger subjects (18-30 years old), and overlapping with the URL in males from 31 to 50 years old (P=4.769e-16, r=0.44). A strong negative correlation between HE4 and eGFR was observed (P=8.412e-12, r=-0.38). Moreover, a statistically significant negative correlation was also found between HE4 and free and bioavailable testosterone. CONCLUSION This study determined the URL of HE4 in a large cohort of healthy male subjects. Our findings indicate that the HE4 age-dependent differences in males need to be taken into account. The definition of the HE4 URL in males and the correlation observed with eGFR and testosterone should foster the clinical use of HE4 beyond gynecologic cancer.
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Affiliation(s)
| | - Angela Pia Cazzolla
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Elisa Mascolo
- Clinic Pathology Unit, Polyclinic University Hospital, Bari, Italy
| | | | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, DETO, University "Aldo Moro", Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, DETO, University "Aldo Moro", Bari, Italy
| | - Luigi Santacroce
- Ionian Department (DJSGEM), Microbiology and Virology Laboratory, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario "Ernesto Quagliariello", University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Lovero
- Clinic Pathology Unit, Polyclinic University Hospital, Bari, Italy
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4
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Ferraro S, Panteghini M. Making new biomarkers a reality: the case of serum human epididymis protein 4. Clin Chem Lab Med 2020; 57:1284-1294. [PMID: 30511925 DOI: 10.1515/cclm-2018-1111] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
Background Measurement of human epididymis protein 4 (HE4) in serum has recently been proposed for clinical use in the framework of ovarian cancer (OvCa). We sought to retrace the translational phase and the clinical implementation steps boosting HE4's clinical value and discuss the effects of its introduction on the diagnostic and management pathways. Methods Meta-analyses of running evidence have preliminarily suggested that HE4 may overcome carbohydrate antigen 125 (CA125) in identifying OvCa, showing however several gaps that need to be considered, i.e. definition of biomarker diagnostic performance in the early detection of OvCa, added diagnostic value, biological and lifestyle factors of variation, and optimal interpretative criteria. Investigation of the influencing factors has shown that renal impairment represents a major limitation for HE4's diagnostic power. On the other hand, the demonstration of the substantial equivalence of results obtained by commercially available assays allows recommending harmonized thresholds for diagnostic purpose, even if the study of HE4's biological variation has clarified that the longitudinal interpretation of the biomarker changes according to the reference change value could be more appropriate. Summary We used HE4 as an example for describing the long and bumpy road for making a new biomarker a reality, and the issues that should be checked and the information that should be provided in moving a novel biomarker from its discovery to an effective clinical adoption.
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Affiliation(s)
- Simona Ferraro
- UOC Patologia Clinica, Ospedale "Luigi Sacco", Via GB Grassi 74, 20157 Milano, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Mauro Panteghini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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5
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Yang J, Yang H, Tang A, Liu X, Sun X, Ma J, Zhao J, Ming L. Trimester-specific reference intervals for kaolin-activated thromboelastography (TEG®) in healthy Chinese pregnant women. Thromb Res 2019; 184:81-85. [DOI: 10.1016/j.thromres.2019.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/28/2019] [Indexed: 12/29/2022]
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6
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Serum Human Epididymis Protein 4 is Associated with Renal Function and Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4831459. [PMID: 31815140 PMCID: PMC6878769 DOI: 10.1155/2019/4831459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
Abstract
Human epididymis protein 4 (HE4) is an available tumor biomarker mainly for detecting ovarian cancer. However, it is unknown whether it can be a novel indicator for diagnosis of diabetic kidney disease (DKD). The aim of this study was to investigate the possibility of serum HE4 as a novel biomarker for DKD in patients with type 2 diabetes mellitus (T2DM). We enrolled 236 patients with T2DM and 82 healthy individuals. Serum HE4 was detected by ARCHITECT i2000 and compared between T2DM patients and healthy controls. The relationships between various variables and HE4 were analyzed by univariate or multivariate linear regression analyses. The receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of HE4 for DKD. The association between HE4 and DKD was analyzed by logistic regression analysis. The serum HE4 level was significantly increased in T2DM patients (median, interquartile range (IQR), 69.7, 46.5–153.9, pM) compared with healthy control (median, IQR, 40.3 33.2–46.3, pM) (P < 0.001). Furthermore, it was higher in those with DKD (median, IQR, 211.1, 141.6–367.4, pM) than those without DKD (median, IQR, 55.5, 42.7–79.6, pM) (P < 0.001). The multivariable analysis showed that age, eGFR, HDL, CRP, and urea significantly independently correlated with HE4 level, while other variables did not. The ROC curve showed that the diagnostic performance of serum HE4 for DKD with 82.9 pM as the optimal cutoff value was good (AUC = 0.917, 95% CI: 0.872–0.961, P < 0.001, with a sensitivity and specificity of 92.1% and 76.9%, respectively) in T2DM patients. Multivariable logistic regression analysis showed that increased HE4 level was a significant, independent risk factor for DKD (OR, 95% CI, 57.7, 3.0–1112.9, P < 0.001) after adjusting for factors associated with HE4. Increased serum HE4 level is associated with decreased renal function and increased risks of DKD in patients with DM. It displays a good diagnostic value for DKD.
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7
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Yang J, Tang A, Ma J, Sun X, Ming L. The reference intervals for CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:71-74. [PMID: 30727773 DOI: 10.1080/00365513.2018.1555855] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Tumor markers are noninvasive diagnostic tools for cancer. Their abnormal expression often occurs earlier than clinical symptoms or other detection signals. Appropriate reference intervals (RIs) of tumor markers are important for health evaluation, cancer diagnosis, therapy monitoring and prognosis assessment. In this study, we aimed to establish the RIs of cancer antigen 125 (CA125), CA15-3, CA19-9, CA72-4, alpha fetoprotein (AFP), carcino-embryonic antigen (CEA), neuron-specific enolase (NSE) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) in apparently healthy Henan population. A total of 1705 apparently healthy participants (21-89 years) were recruited from five representative geographical regions in Henan province. Nonparametric 95th percentile intervals were used to define the RIs of CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1. The test results of CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1 can traceable to reference measurement procedures. The age- and gender-specific RIs of the tumor markers were established. We established age- and gender-specific RIs for CA125, CA15-3, CA19-9, CA72-4, AFP, CEA, NSE and CYFRA21-1. The newly established RIs should be more suitable for Henan population. It will be valuable for clinicians to make a medical diagnosis, therapeutic management decision and other physiological assessment.
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Affiliation(s)
- Jingjing Yang
- a Department of Clinical Laboratory , The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Laboratory Medicine , Zhengzhou , Henan , China
| | - Aiguo Tang
- b Department of Clinical Laboratory , The Second Xiangya Hospital, Central South University , Changsha , Hunan , China
| | - Junfen Ma
- a Department of Clinical Laboratory , The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Laboratory Medicine , Zhengzhou , Henan , China
| | - Xiaoxu Sun
- a Department of Clinical Laboratory , The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Laboratory Medicine , Zhengzhou , Henan , China
| | - Liang Ming
- a Department of Clinical Laboratory , The First Affiliated Hospital of Zhengzhou University, Henan Key Laboratory of Laboratory Medicine , Zhengzhou , Henan , China
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8
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Wang Z, Zhou F, Xiao X, Ying C. Serum levels of human epididymis protein 4 are more stable than cancer antigen 125 in early and mid-term pregnancy. J Obstet Gynaecol Res 2018; 44:2053-2058. [PMID: 30125422 DOI: 10.1111/jog.13764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Zhiheng Wang
- Clinical Laboratory; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Fangfang Zhou
- Department of Nephrology; Ruijin Hospital of Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Xirong Xiao
- Department of Obstetrics; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
| | - Chunmei Ying
- Clinical Laboratory; Obstetrics and Gynecology Hospital of Fudan University; Shanghai China
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9
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Zhao B, Zhang M, Lin F, Xie J, Liang Y, Yang Z. Establishment of the reference interval for serum pro-gastrin-releasing peptide in healthy adults of Chinese Han ethnicity. Int J Biol Markers 2018; 33:487-491. [PMID: 29978740 DOI: 10.1177/1724600818783416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: The aim of this study is to establish the reference interval for serum pro-gastrin-releasing peptide (proGRP) determined by electrochemiluminescence immunoassay (ECLIA) in healthy Chinese Han ethnic adults. Methods: After screening, 9932 healthy Chinese Han adults (age range 18–95 years) were enrolled in this study, including 6220 men and 3712 women. Serum proGRP levels were measured by ECLIA. The reference interval was defined by non-parametric 95th percentile interval. Results: Serum proGRP levels conformed to a non-Gussian distribution. The reference interval for healthy Chinese Han adults calculated by the non-parametric method was 0–73.90 ng/mL in this study. Since serum proGRP levels were significantly correlated with age (r=0.226, P<0.001), the participants were divided into six age groups: 18–39, 40–49, 50–59, 60–69, 70–79, and ⩾80 years. No significant difference for serum proGRP levels was found between the sexes at each of six age groups. The reference intervals were gradually increased with age (65.35 ng/mL, 68.65 ng/mL, 74.10 ng/mL, 77.65 ng/mL, 84.57 ng/mL, and 98.03 ng/mL in 18–39, 40–49, 50–59, 60–69, 70–79, and ⩾80 years, respectively). Conclusions: We established the reference interval for serum proGRP, which was determined by ECLIA in the healthy Chinese Han population. Furthermore, our study suggests that it is necessary to establish the age-specific reference intervals for serum proGRP.
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Affiliation(s)
- Bing Zhao
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People’s Hospital, Zhejiang, China
| | - Miaomiao Zhang
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People’s Hospital, Zhejiang, China
| | - Feng Lin
- Department of General Surgery, Huangyan Hospital of Wenzhou Medical University, Taizhou First People’s Hospital, Zhejiang, China
| | - Jing Xie
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People’s Hospital, Zhejiang, China
| | - Yan Liang
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zaixing Yang
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People’s Hospital, Zhejiang, China
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10
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Zhao B, Zhang M, Liu D, Ren Y, Xie J, Liang Y, Yang Z. Establishment of reference interval for the tumour marker serum CYFRA 21-1 in healthy Chinese Han ethnic adults. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:171-174. [PMID: 29336188 DOI: 10.1080/00365513.2018.1426105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Our aim was to establish the reference interval (RI) for serum CYFRA 21-1 in healthy Chinese Han ethnic adults, since there has been no report about it. METHODS After screening, 9954 healthy Chinese Han adults (age range 18-95 years) were recruited, including 6639 (66.7%) males and 3315 (33.3%) females. Electrochemiluminescence immunoassay was used to measure serum CYFRA21-1. The RI was defined by nonparametric 95% percentile interval. RESULTS The distribution for serum CYFRA21-1 level was non-Gaussian. The RI for healthy Chinese Han adults calculated by nonparametric method was 0-4.47 ng/ml in this study, higher than that recommended by Roche Diagnostics GmbH (≤3.3 ng/ml). The reference values were higher in males than females before 50 years of age, although the difference was hardly seen after 50 years of age. The reference value increased with age in both males and females. Of slight difference, the increase of male reference value was obvious at 60-69 and more than 80 years of age, while that of female obvious at 50-69 and more than 80 years of age. CONCLUSIONS We establish the RI for serum CYFRA21-1 in healthy Chinese Han population, which is higher than that recommended by Roche Diagnostics GmbH. Furthermore, our study suggests that it is necessary to establish the age- and sex-specific RIs for serum CYFRA21-1.
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Affiliation(s)
- Bing Zhao
- a Department of Laboratory Medicine , Taizhou First People's Hospital, Huangyan Hospital Affiliated to Wenzhou Medical University , Zhejiang , China
| | - Miaomiao Zhang
- a Department of Laboratory Medicine , Taizhou First People's Hospital, Huangyan Hospital Affiliated to Wenzhou Medical University , Zhejiang , China
| | - Donghong Liu
- a Department of Laboratory Medicine , Taizhou First People's Hospital, Huangyan Hospital Affiliated to Wenzhou Medical University , Zhejiang , China
| | - Yingpeng Ren
- a Department of Laboratory Medicine , Taizhou First People's Hospital, Huangyan Hospital Affiliated to Wenzhou Medical University , Zhejiang , China
| | - Jing Xie
- a Department of Laboratory Medicine , Taizhou First People's Hospital, Huangyan Hospital Affiliated to Wenzhou Medical University , Zhejiang , China
| | - Yan Liang
- b Department of Laboratory Diagnostics , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Zaixing Yang
- a Department of Laboratory Medicine , Taizhou First People's Hospital, Huangyan Hospital Affiliated to Wenzhou Medical University , Zhejiang , China
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11
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Lu J, Zheng Z, Zhang Q, Li G, Li F, Le Z, Huang J, Xie X, Zhang J. Measurement of HE4 and CA125 and establishment of reference intervals for the ROMA index in the sera of pregnant women. J Clin Lab Anal 2017; 32:e22368. [PMID: 29194801 DOI: 10.1002/jcla.22368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) are biomarkers for ovarian cancer. Their specificity and sensitivity are often limited during pregnancy as a result of great fluctuations. The risk of ovarian malignancy algorithm (ROMA) score, which combines CA125, HE4, and menopausal status, may improve diagnostic performance. There are no reports regarding the ROMA index in pregnant women. Therefore, the aim of our study was to establish appropriate reference intervals (RIs) for the ROMA index in pregnant Chinese women and compare them with those of CA125 and HE4 during pregnancy. METHODS Serum concentrations of CA125 and HE4 were simultaneously measured in healthy pregnant women via electrochemiluminescence immunoassay (ECLIA). The ROMA index was calculated using premenopausal algorithms. RESULTS The RIs for the ROMA index calculated by premenopausal algorithms were substantially closer to the normal range in the first 2 trimesters. For pregnant women, the great misclassifications identified in CA125 may be reversed by the use of ROMA index. CONCLUSIONS We established the RIs for HE4 and CA125, as well as the ROMA index, in pregnant women at different gestational periods. The ROMA index is suggested to be a more promising tumor marker for pregnant women diagnosed with malignance.
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Affiliation(s)
- Jie Lu
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhipeng Zheng
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guoli Li
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengying Li
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhian Le
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Huang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyou Xie
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Zhang
- Clinical Laboratory, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Biomedical Research Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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12
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Shen F, Lu S, Peng Y, Yang F, Chen Y, Lin Y, Yang C, Wu L, Li H, Zheng Y. Performance of ROMA based on Architect CA 125 II and HE4 values in Chinese women presenting with a pelvic mass: A multicenter prospective study. Clin Chim Acta 2017; 471:119-125. [PMID: 28549533 DOI: 10.1016/j.cca.2017.05.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND We evaluated the performance of human epididymis protein 4 (HE4), cancer antigen 125(CA 125) and Risk of Ovarian Malignancy Algorithm (ROMA) in distinguishing between benign and malignant pelvic masses in Chinese women. METHOD From April to December 2012, women with a pelvic mass scheduled to have surgery were enrolled in a prospective, multi-center study conducted in 5 different regions in China. Preoperative serum concentrations of HE4 and CA 125 were examined and ROMA was calculated. RESULTS A total of 684 women with a pelvic mass were included, of which 482 were diagnosed with benign conditions and 202 were diagnosed with malignant ovarian tumors. At cutoffs of 7.4% and 25.3% for ROMA, the sensitivities and specificities were 85.6% and 81.7% for all patients, 85.7% and 81.5% for premenopausal women, and 85.6% and 83.9% for postmenopausal women, respectively. The ROC-AUC of ROMA was significantly better than that of HE4 (P=0.0003) or CA 125 (P<0.0001) for all malignant diseases (including EOC, Non-EOC, LMP, metastases and other pelvic malignancy with no involvement of the ovaries) compared with benign diseases for all patients. CONCLUSIONS We demonstrated the efficiency of ROMA in the distinction of ovarian cancers from benign disease in a multiple-regions Chinese population, especially in premenopausal women.
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Affiliation(s)
- Fengxian Shen
- Woman's Hospital, School of Medicine, Zhejiang University, Xueshi Road #2, Hangzhou 310006, China
| | - Shiming Lu
- Woman's Hospital, School of Medicine, Zhejiang University, Xueshi Road #2, Hangzhou 310006, China.
| | - Yibing Peng
- Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Ruijin 2nd Road #197, Shanghai 200025, China
| | - Fan Yang
- Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Ruijin 2nd Road #197, Shanghai 200025, China
| | - Yan Chen
- Fujian Provincial Cancer Hospital, Fuma Road #420, Jin'an District, Fuzhou 350014, China
| | - Yingying Lin
- Fujian Provincial Cancer Hospital, Fuma Road #420, Jin'an District, Fuzhou 350014, China
| | - Chen Yang
- Suzhou Municipal Hospital, Daoqian Street #26, Suzhou 215002, China
| | - Li Wu
- Suzhou Municipal Hospital, Daoqian Street #26, Suzhou 215002, China
| | - Huijun Li
- Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1095, Wuhan 430030, China
| | - Yijie Zheng
- Medical Scientific Affairs, Abbott Diagnostics Division, Abbott Laboratories, Shanghai 200003, China
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Ferraro S, Pasqualetti S, Carnevale A, Panteghini M. Cystatin C provides a better estimate of the effect of glomerular filtration rate on serum human epididymis protein 4 concentrations. Clin Chem Lab Med 2017; 54:1629-34. [PMID: 27092650 DOI: 10.1515/cclm-2015-1272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/10/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND We evaluated the effect of kidney glomerular function on serum concentrations of human epididymis protein 4 (HE4) using creatinine (Cr), cystatin C (CysC) and related chronic kidney disease epidemiology collaboration (CKD-EPI) equations. METHODS We enrolled 101 women aged ≤56 years with a glomerular filtration rate (GFR) (estimated by CKD-EPI eGFRCr) ranging from 60 to 120 mL/min/1.73 m2, free of any disease and biological and life-style factors known to influence serum HE4 concentrations, and we measured serum Cr, CysC and HE4 concentrations. Cr and CysC values were included in the three CKD-EPI equations to obtain GFR estimates. RESULTS A statistically significant increase in HE4 median concentrations was detected in subjects with an eGFRCr between 60 and 74 mL/min/1.73 m2 when compared with those with an eGFR >90 mL/min/1.73 m2 (54.2 vs. 42.2 pmol/L, p=0.003). Regression models showed that CysC measurement per se and eGFRCysC were the most sensitive markers to catch HE4 increases due to a mild decrease in renal function [adjusted r2, 0.38 (p=0.00003) and 0.37 (p=0.0004), respectively]. By assuming baseline CysC and eGFRCysC at 0.80 mg/L and 101.5 mL/min/1.73 m2, an increase of 0.10 mg/L in CysC concentrations and a decrease of 10 mL/min of eGFRCysC implied an average (±SE) increase in serum HE4 concentrations of 9.2 (±1.2) and 8.8 (±1.1) pmol/L, respectively. CONCLUSIONS Our study shows that a better estimate of the effect of GFR on serum HE4 is obtained by measuring CysC in serum or using CKD-EPI eGFRCysC equation.
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Diagnostic Value of Serum Angiogenesis Markers in Ovarian Cancer Using Multiplex Immunoassay. Int J Mol Sci 2017; 18:ijms18010123. [PMID: 28075407 PMCID: PMC5297757 DOI: 10.3390/ijms18010123] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 12/14/2022] Open
Abstract
As cancer development involves pathological vessel formation, 16 angiogenesis markers were evaluated as potential ovarian cancer (OC) biomarkers. Blood samples collected from 172 patients were divided based on histopathological result: OC (n = 38), borderline ovarian tumours (n = 6), non-malignant ovarian tumours (n = 62), healthy controls (n = 50) and 16 patients were excluded. Sixteen angiogenesis markers were measured using BioPlex Pro Human Cancer Biomarker Panel 1 immunoassay. Additionally, concentrations of cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) were measured in patients with adnexal masses using electrochemiluminescence immunoassay. In the comparison between OC vs. non-OC, osteopontin achieved the highest area under the curve (AUC) of 0.79 (sensitivity 69%, specificity 78%). Multimarker models based on four to six markers (basic fibroblast growth factor-FGF-basic, follistatin, hepatocyte growth factor-HGF, osteopontin, platelet-derived growth factor AB/BB-PDGF-AB/BB, leptin) demonstrated higher discriminatory ability (AUC 0.80-0.81) than a single marker (AUC 0.79). When comparing OC with benign ovarian tumours, six markers had statistically different expression (osteopontin, leptin, follistatin, PDGF-AB/BB, HGF, FGF-basic). Osteopontin was the best single angiogenesis marker (AUC 0.825, sensitivity 72%, specificity 82%). A three-marker panel consisting of osteopontin, CA125 and HE4 better discriminated the groups (AUC 0.958) than HE4 or CA125 alone (AUC 0.941 and 0.932, respectively). Osteopontin should be further investigated as a potential biomarker in OC screening and differential diagnosis of ovarian tumours. Adding osteopontin to a panel of already used biomarkers (CA125 and HE4) significantly improves differential diagnosis between malignant and benign ovarian tumours.
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Qu W, Li J, Duan P, Tang Z, Guo F, Chen H, Zhu X, Jiang SW. Physiopathological factors affecting the diagnostic value of serum HE4-test for gynecologic malignancies. Expert Rev Mol Diagn 2016; 16:1271-1282. [PMID: 27784171 DOI: 10.1080/14737159.2016.1251317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Serum epididymis protein 4 (HE4) represents a useful biomarker for the management of ovarian cancer and endometrial cancer patients. However, HE4 levels are affected by many physiopathological conditions or disorders that should be taken into consideration for an efficient application of this biomarker. Areas covered: The review provides an up-to-date reference on the multiple physiopathological factors that cause fluctuation of HE4 serum levels, and evaluates their impact on HE4-test in clinical settings. Potential mechanisms underlying the regulation of HE4 expression are also discussed. The review is based on data from literature search of PubMed and the author's opinions. Expert commentary: Studies have shown that physiopathological factors such as age, infection/inflammation, renal function, menopause and hormonal levels impose significant impacts on HE4 serum levels. HE4 amount shed into the circulation is related to HE4 expression and secretion by tumor as well as normal tissues, which is affected by cancer heterogeneity, vascular permeability, renal clearance and HE4 degradation. Investigation on interfering factors builds a basis for the construction of a quantitative logarithm for individualized application of HE4-test in clinical settings.
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Affiliation(s)
- Wanglei Qu
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Jinping Li
- b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
| | - Ping Duan
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Zuoqing Tang
- c Department of Medical Genetics, School of Basic Medical Sciences , Capital Medical University , Beijing , China
| | - Fengbiao Guo
- b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
- d Department of Histology and Embryology , Shantou University Medical College , Shantou , Guangdong , China
| | - Haibin Chen
- d Department of Histology and Embryology , Shantou University Medical College , Shantou , Guangdong , China
| | - Xueqiong Zhu
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Shi-Wen Jiang
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
- b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
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Yang J, Tang A, Zhang S, Sun X, Ming L. The age-specific reference intervals for tPSA, fPSA, and %fPSA in healthy Han ethnic male. J Clin Lab Anal 2016; 31. [PMID: 27645821 DOI: 10.1002/jcla.22062] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/16/2016] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Prostate cancer (PC) is one of the most common malignancies in male, and has become the fastest growing malignancy in recent years. Prostate specific antigen (PSA) is widely used as a tumor marker to screen for PC. Many studies have been performed to define the reference intervals (RIs) for total circulating PSA (tPSA). The results were different among different nations and races, even in the same race. Few researches have been performed on the RIs of free PSA (fPSA) and the ratio of free to total PSA (%fPSA). In this study, we aimed to simultaneously determine the age-specific RIs for tPSA, fPSA, and %fPSA in the healthy Han ethnic male. METHODS A total of 1862 apparently healthy male aged from 21 to 94 years were included in our study. Nonparametric 95th percentile intervals were used to define the RIs. RESULTS The reference limits in different age groups (21-50, 51-60, 61-70, 71-80, and ≥81 years) were 2.07, 3.59, 4.93, 6.83, and 7.73 ng/mL for tPSA, and 0.60, 0.76, 0.83, 1.30, and 2.41 ng/mL for fPSA. The RIs of %fPSA were ≥0.16 for 21-50 years and ≥0.13 for male over 50 years old. CONCLUSIONS We established age-specific RIs for tPSA, fPSA and %fPSA. The newly established RIs should be more suitable for Chinese Han ethnic male. It will be valuable for physicians to make exact medical decision and appropriate medical intervention.
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Affiliation(s)
- Jingjing Yang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory Medicine of Henan provinces, Zhengzhou, Henan, China
| | - Aiguo Tang
- Department of Clinical Laboratory, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijie Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory Medicine of Henan provinces, Zhengzhou, Henan, China
| | - Xiaoxu Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory Medicine of Henan provinces, Zhengzhou, Henan, China
| | - Liang Ming
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Key Clinical Laboratory Medicine of Henan provinces, Zhengzhou, Henan, China
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Chudecka-Głaz A, Cymbaluk-Płoska A, Luterek-Puszyńska K, Menkiszak J. Diagnostic usefulness of the Risk of Ovarian Malignancy Algorithm using the electrochemiluminescence immunoassay for HE4 and the chemiluminescence microparticle immunoassay for CA125. Oncol Lett 2016; 12:3101-3114. [PMID: 27899969 PMCID: PMC5103905 DOI: 10.3892/ol.2016.5058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 05/13/2016] [Indexed: 11/08/2022] Open
Abstract
The present study aimed to investigate the usefulness of the Risk of Ovarian Malignancy Algorithm (ROMA) in the preoperative stratification of patients with ovarian tumors using a novel combination of laboratory tests. The study group (n=619) consisted of 354 premenopausal and 265 postmenopausal patients. The levels of carbohydrate antigen 125 (CA125) and human epididymis protein 4 (HE4) were determined, and ROMA calculations were performed for each pre- and postmenopausal patient. HE4 levels were determined using an electrochemiluminescence immunoassay, while CA125 levels were determined by a chemiluminescence microparticle immunoassay. A contingency table was applied to calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Receiver operating characteristic curves were also constructed, and areas under the curves (AUCs) were compared between the marker determinations and ROMA algorithms. In terms of distinguishing between ovarian cancer and benign disease, the sensitivity of ROMA was 88.3%, specificity was 88.2%, PPV was 75.3% and NPV was 94.9% among all patients. The respective parameters were 71.1, 90.1, 48.2 and 91.1% in premenopausal patients and 93.6, 82.9, 86.6 and 91.6% in postmenopausal patients. The AUC value for the ROMA algorithm was 0.926 for the ovarian cancer vs. benign groups in all patients, 0.813 in premenopausal patients and 0.939 in postmenopausal patients. The respective AUC values were 0.911, 0.879 and 0.934 for CA125; and 0.879, 0.783 and 0.889 for HE4. In this combination, the ROMA algorithm is characterized by an extremely high sensitivity of prediction of ovarian cancer in women with pelvic masses, and may constitute a precise tool with which to support the qualification of patients to appropriate surgical procedures. The ROMA may be useful in diagnosing ovarian endometrial changes in young patients.
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Affiliation(s)
- Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin PL-70-111, Poland
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin PL-70-111, Poland
| | - Katarzyna Luterek-Puszyńska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin PL-70-111, Poland
| | - Janusz Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin PL-70-111, Poland
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Yu S, Lee JK, Kim JH, Park H, Lee MY, Ryu S, Kwon MJ, Woo HY. Diagnostic performance and establishment of reference limits of HE4 in Korean healthy women. Gynecol Oncol 2016; 143:128-134. [PMID: 27426308 DOI: 10.1016/j.ygyno.2016.07.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/27/2016] [Accepted: 07/10/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We aimed to establish distribution and reference limits of HE4 and risk of ovarian malignancy algorithm (ROMA) in healthy Korean women and investigated the factors influencing HE4 levels. We also investigated the diagnostic performances of HE4 and ROMA score, compared with CA125. METHODS We collected specimens from 1809 healthy Korean women, 140 specimens from patients with ovarian cancers (OCs) and 123 specimens from patients with benign ovarian tumor. Serum HE4 and CA125 concentrations were measured using an electrochemiluminescence immunoassay. The receiver operator characteristic (ROC) curve analysis was done for ROMA, HE4, CA125 and combining of HE4 and CA125. RESULTS HE4 level was influenced by age, not by menopausal status. The 97.5th percentile upper reference limit of HE4 of subjects <50years and ≥50year-old was 63.87pmol/L and 88.28pmol/L, respectively. The 97.5th percentile upper reference limits of ROMA score were 13.66 in premenopausal and 19.30 in postmenopausal women. The serum HE4 level was even lower in the patients with benign tumor compared to those in healthy controls. HE4 had significantly higher concentrations in OCs than benign ovarian tumor (P<0.001). ROMA and HE4 combined with CA125 or not performed better diagnostically than CA125 alone for distinguishing OCs, with AUCs of 0.844 for ROMA, 0.827 for combining of HE4 and CA125, 0.825 for HE4, and 0.795 for CA125. CONCLUSIONS The reference limit of HE4 was different from those reported by other studies, suggesting racial or regional difference. HE4 and ROMA were better than CA125 for differentiation normal and benign ovarian tumor from OCs. (Word count: 253).
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Affiliation(s)
- Shinae Yu
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Kyung Lee
- KIRAMS Radiation Biobank, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyosoon Park
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Yeon Lee
- Department of Biostatistics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Jung Kwon
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hee-Yeon Woo
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Zhang Q, Wang CR, Yu JP, Ma Q, Xu WW. The Establishment of an HE4-CLIA Method and the Combined Analysis of HE4 and CA125 in Ovarian Cancer. J Clin Lab Anal 2016; 30:709-18. [PMID: 26990679 DOI: 10.1002/jcla.21926] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 11/29/2015] [Accepted: 12/12/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The human epididymal secretory protein 4 (HE4) is a novel, verified biomarker for the early diagnosis of ovarian cancer. METHODS Magnetic beads were coated with capture antibodies and were used with acridinium ester labeled detection antibodies in a sandwich-type immunoassay. The patient's HE4 serum levels were measured simultaneously with the chemiluminescence immunoassay (CLIA) kit we developed and electrochemiluminescence immunoassay (ECLIA) kit from Roche (Mannheim, Germany). CA125 was also detected by time-resolved fluoroimmunoassay. The diagnostic value was analyzed. RESULTS The assay demonstrated a linear range from 2.5 to 2,000 pmol/l, with an analytical sensitivity of 2.5 pmol/l. The reproducibility, recovery, and specificity of the immunoassay were demonstrated to be acceptable. Compared with the ECLIA kit from Roche in 124 serum samples (40 patients with ovarian cancer, 35 patients with benign gynecological diseases, and 49 health controls), there is a satisfied correlation coefficient of 0.875. The area under the receiver-operating curve (ROC-AUC) was 0.903 (95% CI was 0.839-0.966, P < 0.001) for HE4, 0.787 (95% CI was 0.694-0.879, P < 0.001) for CA125, and 0.914 (95% CI was 0.866-0.962, P < 0.001) for combined analysis of HE4 and CA125. CONCLUSIONS A quantitative method (HE4-CLIA) for detecting HE4 in serum was successfully established. Preliminary clinical sample analysis showed HE4-CLIA has a certain clinical value in the screening and diagnosis of ovarian cancer. Moreover, in distinguishing benign from malignant ovarian lesions, HE4 has higher demonstrated accuracy than CA125.
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Affiliation(s)
- Qiong Zhang
- Institute of Antibody Engineering School of Biotechnology, Southern Medical University, Guangdong, Guangzhou, PR China.,Department of Laboratory Medicine, Zhengzhou Second People's Hospital, Zhengzhou, PR China
| | - Cong-Rong Wang
- Department of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Juan-Ping Yu
- Institute of Antibody Engineering School of Biotechnology, Southern Medical University, Guangdong, Guangzhou, PR China.,Da An Gene Co, Ltd. of Zhongshan, Guangzhou, PR China
| | - Qiang Ma
- Institute of Antibody Engineering School of Biotechnology, Southern Medical University, Guangdong, Guangzhou, PR China
| | - Wei-Wen Xu
- Institute of Antibody Engineering School of Biotechnology, Southern Medical University, Guangdong, Guangzhou, PR China.
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Hui L, Rixv L, Xiuying Z. A system for tumor heterogeneity evaluation and diagnosis based on tumor markers measured routinely in the laboratory. Clin Biochem 2015. [DOI: 10.1016/j.clinbiochem.2015.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jia LT, Zhang YC, Li J, Tian Y, Li JF. The role of human epididymis protein 4 in the diagnosis of epithelial ovarian cancer. Clin Transl Oncol 2015. [PMID: 26220095 DOI: 10.1007/s12094-015-1365-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Epithelial ovarian cancer is one of the most lethal female genital tract cancers. Early diagnosis of EOC would benefit the patients a lot. Human epididymis protein 4 (HE4) has been regarded as a new powerful biomarker in diagnosis of EOC; we hope to obtain system knowledge of HE4 and understand the role of HE4 in diagnosis of epithelial ovarian cancer (EOC). METHODS We searched Pubmed, Embase, Medline, and Chinese National Knowledge Infrastructure (CNKI) for articles that included HE4's origin, characteristics, detection methods, clinical efficacy alone or combined with CA125, the risk of malignancy index, and the risk of ovarian malignancy algorithm. The diagnostic performance for the EOC and the role in the recurrence and procession in EOC were also discussed. RESULTS We got 83 most related articles and found that there were significantly difference existing among the studies, such as the clinical characteristics of patients, the methodology for measuring HE4, the different cut-offs for HE4 and so on. CONCLUSION HE4 is a promising biomarker for the early diagnosis of EOC. However, each lab should establish its own reference internal of HE4.
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Affiliation(s)
- L-T Jia
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Kangfuqian Street 7, Zhengzhou, 450052, People's Republic of China.
| | - Y-C Zhang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Kangfuqian Street 7, Zhengzhou, 450052, People's Republic of China
| | - J Li
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Kangfuqian Street 7, Zhengzhou, 450052, People's Republic of China
| | - Y Tian
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Kangfuqian Street 7, Zhengzhou, 450052, People's Republic of China
| | - J-F Li
- Department of Clinical Laboratory, The Third Affiliated Hospital of Zhengzhou University, Kangfuqian Street 7, Zhengzhou, 450052, People's Republic of China
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Lidao B, Yi W, Ruilian M, Xianhua R, Haijun L, Agula B. Effect of puerarin on human choriocarcinoma cells. Open Med (Wars) 2015; 10:267-277. [PMID: 28352705 PMCID: PMC5152980 DOI: 10.1515/med-2015-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/19/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To discuss the effect of puerarin on human choriocarcinoma cells. METHODS Survival rates under puerarin monotherapy, fluorouracil (5-FU) monotherapy and puerarin in combination with 5-FU were detected by MTT assay. Apoptotic morphology was observed with Hoechst 33258 staining. Apoptosis rates were detected with flow cytometry. Expressions of AKT, mechanistic target of rapamycin (mTOR), and P70S6K mRNAs and phosphorylated proteins were detected by RT-PCR and Western blot. Tumor-bearing mice were administered puerarin and puerarin+5-FU, and serum levels of β-human chorionic gonadotropin (β-HCG) were measured. RESULTS Proliferation inhibition and apoptosis rates of JEG-3 cells were positively correlated with puerarin concentration, which increased in the puerarin+5-FU group. Expression levels of AKT, mTOR, P70S6K mRNAs, and phosphorylated proteins decreased significantly after action of puerarin at different concentrations. With increasing puerarin concentration, expression of cleaved-caspase-3 in JEG-3 cells increased, whereas that of Bcl-2 decreased. Puerarin significantly inhibited tumor growth in choriocarcinoma-bearing SCID mice. Serum β-HCG levels were significantly lower than those of control group after administration. Magnitude of β-HCG decline was positively correlated with concentration.. CONCLUSION Puerarin+5-FU inhibited proliferation of JEG-3 choriocarcinoma cells and promoted their apoptosis, being associated with the mTOR signaling pathway.
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Affiliation(s)
- Bao Lidao
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, PR China
| | - Wang Yi
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, PR China
| | - Ma Ruilian
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, PR China
| | - Ren Xianhua
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, PR China
| | - Lv Haijun
- Department of Scientific Research, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010059, PR China
| | - B Agula
- College of Mongolian Medicine, Inner Mongolia Medical University, Hohhot 010059, PR China
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ROMA, an algorithm for ovarian cancer. Clin Chim Acta 2015; 440:143-51. [DOI: 10.1016/j.cca.2014.11.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 11/03/2014] [Accepted: 11/14/2014] [Indexed: 11/23/2022]
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Human epididymis protein 4: Factors of variation. Clin Chim Acta 2015; 438:171-7. [DOI: 10.1016/j.cca.2014.08.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/13/2014] [Accepted: 08/19/2014] [Indexed: 11/20/2022]
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Reference intervals for plasma pro-gastrin releasing peptide (ProGRP) levels in healthy adults of Chinese Han ethnicity. Int J Biol Markers 2014; 29:e436-9. [PMID: 24723213 DOI: 10.5301/jbm.5000084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the upper limits of the 95th percentile reference intervals (RIs) for the detection of the pro-gastrin releasing peptide (ProGRP) in plasma according to the Clinical and Laboratory Standards Institute (CLSI) C28-A3 guideline in a population of adult Chinese of Han ethnicity. METHODS Plasma samples were collected from 578 healthy adults. Plasma ProGRP values were measured by chemiluminescent microparticle immunoassay (CMIA) on Abbot ARCHITECT i2000 system analyzers. RESULTS Plasma ProGRP values did not conform to a Gaussian distribution, and thus non-parametric statistical methods were used to calculate RIs. Plasma ProGRP levels significantly increased with age, thus age-dependent RIs were determined. The upper limit of the 95th percentile RIs for plasma ProGRP was ≤57.26 pg/mL for young adults (18-50 years) and ≤81.42 pg/mL for old adults (>50 years). CONCLUSIONS By CMIA, we established distinct age-dependent RIs for plasma ProGRP in healthy adults of Chinese Han ethnicity, thus generating a valuable reference for future clinical and laboratory studies.
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Development of a multimarker assay for differential diagnosis of benign and malignant pelvic masses. Clin Chim Acta 2014; 440:57-63. [PMID: 25447698 DOI: 10.1016/j.cca.2014.11.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/27/2014] [Accepted: 11/13/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND HE4, a novel tumor marker for detecting ovarian cancer, has been recently applied to clinical practice. However, the comprehensive evaluation of HE4 combined with other markers is still missing. We evaluated an optimal mode of HE4 employment for differential diagnosis of benign and malignant pelvic masses. METHODS Serum HE4, CA125, CA153, CA199, CA211 and CA724 were measured from 232 patients with pelvic messes (100 malignant masses, 132 benign diseases), and the risk of ovarian malignancy algorithm (ROMA) was also calculated. Receiver operating characteristic curves (ROC), the area under the curve (AUC), sensitivity and specificity were estimated. RESULTS The combination of HE4 and CA125 (AUC of 0.963, sensitivity of 96.6%, specificity of 65.7%) provided the best differential power in diagnosing ovarian cancer. ROMA performed better in the diagnosis of pelvic masses (AUC of 0.917, sensitivity of 82.0%, specificity of 78.8%) and uterine cancer (AUC of 0.838, sensitivity of 82.0%, specificity of 60.0%) compared with applying HE4 and CA125 individually. CONCLUSION The optimal cut-off values (CA125: 93.2U/ml, HE4: 87.6 pmol/l, ROMA: 18.1% for pre- and 31.5% for postmenopausal women), simultaneous use of CA125 and HE4 complemented by ROMA showed better performance than the traditional detection modes for differential diagnosis of ovarian cancer. We also observed that ROMA added more accuracy for differentiating the benign and malignant pelvic masses and auxiliary diagnosis of uterine cancer.
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Karlsen NS, Karlsen MA, Høgdall CK, Høgdall EVS. HE4 tissue expression and serum HE4 levels in healthy individuals and patients with benign or malignant tumors: a systematic review. Cancer Epidemiol Biomarkers Prev 2014; 23:2285-95. [PMID: 25169975 DOI: 10.1158/1055-9965.epi-14-0447] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Human epididymis protein 4 (HE4) has received major attention as a potential tumor marker in epithelial ovarian cancer; however, evidence of significant overexpression of HE4 in several other human cancers is expanding. To assess the possible limitations or benefits of HE4 in a clinical setting, this review aims to systematically outline published results of HE4 tissue expression and serum HE4 levels in healthy individuals and patients with benign or malignant tumors. Our findings suggest scientific basis for a potential diagnostic ability of HE4 in gynecologic cancer and lung cancer, and further research is needed regarding other cancers. Yet, it is important to recognize that other malignancies can cause increased HE4 levels. Furthermore, attention should be paid to the influence of age and renal function on HE4 serum levels in future studies as well as in the clinic for proper interpretation of serum HE4 test results. Cancer Epidemiol Biomarkers Prev; 23(11); 2285-95. ©2014 AACR.
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Affiliation(s)
- Nikoline S Karlsen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev, Denmark
| | - Mona A Karlsen
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev, Denmark. Gynecologic Department, The Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Claus K Høgdall
- Gynecologic Department, The Juliane Marie Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Estrid V S Høgdall
- Molecular Unit, Department of Pathology, Herlev University Hospital, Herlev, Denmark.
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