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Wu W, Wang J, Hu Z, Zhao Y, Wang X, Bai N, Chen L, Gao P. High WFDC3 gene expression is associated with poor prognosis and reduced immune cells infiltration in pancreatic adenocarcinoma: A study using the TCGA database and bioinformatics analysis. Medicine (Baltimore) 2023; 102:e35595. [PMID: 37861515 PMCID: PMC10589585 DOI: 10.1097/md.0000000000035595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023] Open
Abstract
Whey-acidic-protein (WAP) four-disulfide core domain protein 3 (WFDC3) is one of the WAP family proteins. This protein family is associated with the development of solid tumors and affects the tumor immunological microenvironment. However, the prognostic value of WFDC3 in pancreatic adenocarcinoma (PAAD) and its effect on the tumor immune microenvironment is yet to be clarified. The Cancer Genome Atlas database and Genotype-Tissue Expression database were used to analyze the differential expression of WFDC3 between the tumor and adjacent tissues. The clinical significance of WFDC3 was analyzed in The Cancer Genome Atlas and International Cancer Genome Consortium database using WFDC3 transcripts and clinical information. In order to elucidate the underlying mechanisms, gene set enrichment analysis was conducted to determine potential activated pathways. Immune score evaluation and publicly available pharmacogenomics database [the Genomics of Drug Sensitivity in Cancer] were utilized to quantify immune cell infiltration and the effect on chemotherapeutic drug sensitivity. WFDC3 levels were higher in PAAD tissues than in normal pancreatic tissues. High levels of WFDC3 expression progressively increased as PAAD tumor stages progressed. Patients with elevated WFDC3 expression showed a poor prognosis. The gene set enrichment analysis analysis revealed that glutamate, arginine, and proline, and histidine metabolism levels were elevated in patients with a high WFDC3 expression phenotype. B, CD4+ T, and CD8+ T cell infiltration was diminished in PAAD tissues with elevated WFDC3 expression. According to pharmacogenomics, PAAD tissues with high WFDC3 expression are susceptible to gemcitabine. WFDC3 is highly expressed in PAAD, and patients with a high level of WFDC3 expression have a shorter overall survival time, indicating a poorer prognosis. High expression of WFDC3 may lead to the development of PAAD by affecting the amino acid metabolism and the tumor immunological microenvironment. WFDC3 may serve as a potential diagnostic and prognostic biomarker for PAAD patients.
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Affiliation(s)
- Wei Wu
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jiayuan Wang
- Department of Medical Oncology, Peking University Shougang Hospital, Beijing, China
| | - Zhiping Hu
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Yiguo Zhao
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xin Wang
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Nan Bai
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Lei Chen
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing, China
| | - Pengji Gao
- Department of General Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
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Bahadur A, Bhattacharya N, Mundhra R, Khoiwal K, Chawla L, Singh R, Naithani M, Kishore S. Comparison of Human Epididymis Protein 4, Cancer Antigen 125, and Ultrasound Prediction Model in Differentiating Benign from Malignant Adnexal Masses. J Midlife Health 2023; 14:176-183. [PMID: 38312761 PMCID: PMC10836431 DOI: 10.4103/jmh.jmh_77_23] [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: 04/27/2023] [Revised: 07/01/2023] [Accepted: 07/22/2023] [Indexed: 02/06/2024] Open
Abstract
Background This study aimed to compare the diagnostic performance of carcinogenic antigen (CA) 125, (HE)-4 (Human epididymis protein 4), and ultrasound (International Ovarian Tumor Analysis [IOTA]) Simple Rules individually and to derive a composite score in the differentiating ovarian cancer from benign ovarian mass. Subjects and Methods Consecutive patients (n = 100) with pelvic mass admitted during February 2018-August 2019 were included prospectively. Patients with either known case of epithelial ovarian cancer (EOC) or metastatic EOC were excluded. The primary outcome was to assess the sensitivity and specificity of CA-125, HE-4, and IOTA Simple Rules in predicting benign from malignant mass independently, while secondary outcome was derivation of a new model incorporating these variables using multivariate logistic regression analysis to predict benign from malignant lesions. Receiver operator curve (ROC) was drawn to redefine the best-performing cutoff values and difference between area under the ROC (AUROC) were compared by DeLong's method. Results Out of 100 cases of adnexal mass selected, the sensitivity and specificity of CA-125 were 73.8% and 77.6%, HE-4 were 90.5% and 87.9%, and IOTA Simple Rules were 92.9% and 81.0%. CA-125, HE-4, and IOTA Simple Rules were independently associated with the likelihood of malignancy/borderline (P < 0.001). The area under the curve for the "composite score" (AUC = 0.93) was the highest and was significantly better than that of CA-125 (AUC = 0.786) (P = 0.004 using DeLong's test) and comparable with HE-4 (AUROC = 0.90; P = 0.128 using DeLong's Test). Conclusion The sensitivity and specificity of HE-4 and IOTA Simple Rules for predicting malignant ovarian tumor was better than those of CA-125. The diagnostic performance of "composite score" was comparable to those of either HE-4 or IOTA Simple Rules and significantly better than CA-125.
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Affiliation(s)
- Anupama Bahadur
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
| | | | - Rajlaxmi Mundhra
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
| | - Kavita Khoiwal
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
| | - Latika Chawla
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
| | - Rajni Singh
- Department of Obstetrics and Gynaecology, AIIMS, Rishikesh, Uttarakhand, India
| | - Manisha Naithani
- Department of Biochemistry, AIIMS, Rishikesh, Uttarakhand, India
| | - Sanjeev Kishore
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
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3
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Anastasi E, Farina A, Granato T, Colaiacovo F, Pucci B, Tartaglione S, Angeloni A. Recent Insight about HE4 Role in Ovarian Cancer Oncogenesis. Int J Mol Sci 2023; 24:10479. [PMID: 37445657 DOI: 10.3390/ijms241310479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
Currently, ovarian cancer (OC) is a target of intense biomarkers research because of its frequent late diagnosis and poor prognosis. Serum determination of Human epididymis protein 4 (HE4) is a very important early detection test. Most interestingly, HE4 plays a unique role in OC as it has been implicated not only in OC diagnosis but also in the prognosis and recurrence of this lethal neoplasm, actually acting as a clinical biomarker. There are several evidence about the predictive power of HE4 clinically, conversely less has been described concerning its role in OC oncogenesis. Based on these considerations, the main goal of this review is to clarify the role of HE4 in OC proliferation, angiogenesis, metastatization, immune response and also in the development of targeted therapy. Through a deeper understanding of its functions as a key molecule in the oncogenetic processes underlying OC, HE4 could be possibly considered as an essential resource not only for diagnosis but also for prognosis and therapy choice.
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Affiliation(s)
- Emanuela Anastasi
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonella Farina
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Teresa Granato
- CNR-IBPM, Institute of Molecular Biology and Pathology, Department of Molecular Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Flavia Colaiacovo
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Beatrice Pucci
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Sara Tartaglione
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Antonio Angeloni
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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4
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Zhang C, Hu H, Wang X, Zhu Y, Jiang M. WFDC Protein: A Promising Diagnosis Biomarker of Ovarian Cancer. J Cancer 2021; 12:5404-5412. [PMID: 34405003 PMCID: PMC8364637 DOI: 10.7150/jca.57880] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/23/2021] [Indexed: 02/06/2023] Open
Abstract
An initial diagnosis of cancer is usually based on symptoms, abnormal physical examination and imaging tests. Ovarian cancer is difficult to be diagnosed timely due to the nonspecific symptoms, thus resulting in the high-risk mortality. Despite of the various diagnostic methods, there is still no reliable diagnostic test. Clinically, carbohydrate antigen 125(CA125) is widely recognized as a diagnosis biomarker of ovary cancer. However, CA125 is not sensitive to detect the ovary cancer at the early stage. It is essential to explore other potential biomarkers. Human epididymis protein 4 (HE4) in the whey/four-disulfide core (WFDC) proteins family shows satisfactory sensitivity in the early diagnosis of ovary cancer. In this present review, we summarized the important effects of WFDC family proteins on the proliferation, apoptosis and migration of ovary cancer and intended to provide more evidence to explore the possibility of WFDC protein as a diagnosis biomarker.
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Affiliation(s)
- Chen Zhang
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Haoyue Hu
- Lung Cancer Center, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoyan Wang
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yajuan Zhu
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ming Jiang
- West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Celik B, Bulut T, Yalcin AD. Tissue HE4 Expression Discriminates the Ovarian Serous Carcinoma but Not the Uterine Serous Carcinoma Patients. A New Adjunct to the Origin of the Tumor Site. Pathol Oncol Res 2020; 26:1145-1151. [PMID: 31165997 DOI: 10.1007/s12253-019-00675-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/23/2019] [Indexed: 02/05/2023]
Abstract
Both uterine serous carcinoma (USC) and ovarian serous carcinoma (OSC) are presented at advanced stage at the first admittion and dissseminated disease makes the anatomical site of the tumor origin imposible. CA125 and p53 are reliable markers that are useful for differentiating both uterine serous and ovarian serous carcinoma from their most common subtypes (endometrioid type carcinoma of ovary and uterus) but so far there is no histopathologic marker that differentiates USC from OSC. On the other hand, Trastuzumab (Herceptin) increases progression-free survival among USC patients, but not OSC patients and makes the histopathologically assigning the origin of the tumor important. So, the aim of this study was to evaluate the immunohistopathological discriminative value of the human epididymis secretory protein 4 (HE4) between OSC and USC patients. Patients with a diagnosis of OSC and UTC were enrolled. HE4 expression was evaluated by immunohistochemistry. The results were compared between groups. Of the tumor tissues studied, HE4 immunostaining was seen in the majority of ovarian serous carcinoma cases (89.65%), while endomatrial serous carcinoma cases were devoid of HE4 immunostaining. HE4 immunostaining was seen in 39.1% uterin serous carcinoma cases and this difference was statistically significant (p = 0.001). Our study demonstrated for the first time the potential of HE4 expression to predict the anatomical site of tumor origin. HE4 is a novel tumor marker that differentiates USC from OSC.
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Affiliation(s)
- Betul Celik
- Pathology Department, Health Science University, Antalya Hospital, Antalya, Turkey.
- Department of Pathology, Training Hospital, Varlik Mah, 07100, Antalya, Turkey.
| | - Tangul Bulut
- Pathology Department, Health Science University, Antalya Hospital, Antalya, Turkey
| | - Arzu Didem Yalcin
- Immunology Unit, Health Science University, Antalya Hospital, Antalya, Turkey
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6
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Wang J, Deng L, Zhuang H, Liu J, Liu D, Li X, Jin S, Zhu L, Wang H, Lin B. Interaction of HE4 and ANXA2 exists in various malignant cells-HE4-ANXA2-MMP2 protein complex promotes cell migration. Cancer Cell Int 2019; 19:161. [PMID: 31210752 PMCID: PMC6567406 DOI: 10.1186/s12935-019-0864-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/27/2019] [Indexed: 02/06/2023] Open
Abstract
Background The interaction between human epididymis protein 4 (HE4) and annexin A2 (Annexin A2) has been found in ovarian cancer. However, it is dimness whether
the interaction exists in other malignant tumors. Methods Real-time PCR, western blotting and immunocytochemistry were used to detect mRNA and proteins expression. Co-immunoprecipitation and double-labeling immunofluorescence were used to detect the interaction among HE4, ANXA2 and MMP2. MTS assay was used to test cell proliferation. Adhesion test was used to test cell adhesion. Flow cytometry was applied to examine cell cycle. The scratch test and Transwell assay was performed to detect the migration and invasion of various malignant cell lines. Results Here we show that the overexpression of HE4 and ANXA2 in various malignant cells is a common phenomenon. HE4 and ANXA2 are co-localized in the cytoplasm and membrane of various tumor cells. ES-2 cells which had both high expression of HE4 and ANXA2 were much stronger in proliferation, adhesion, invasion, and migration than other tumor cells. HE4–ANXA2–MMP2 could form a triple protein complex. HE4 could mediate the expression of MMP2 via ANXA2 to promote cell migration progress. Conclusions The interaction of HE4 and ANXA2 exists in various types of cancer cells. HE4 and ANXA2 can promote the proliferation, adhesion, invasion, and migration of cancer cells. HE4–ANXA2–MMP2 form a protein complex and ANXA2 plays the role of “bridge”. They performed together to promote cell migration.
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Affiliation(s)
- Jing Wang
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
| | - Lu Deng
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China.,3Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China
| | - Huiyu Zhuang
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China.,4Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Workers' Stadium South Road, Chaoyang District, Beijing, 100020 China
| | - Juanjuan Liu
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
| | - Dawo Liu
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
| | - Xiao Li
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
| | - Shan Jin
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
| | - Liancheng Zhu
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
| | - Huimin Wang
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China.,5Department of Gynecology, Liaoning Cancer Hospital & Institute China Medical University, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110000 Liaoning China
| | - Bei Lin
- 1Department of Obstetrics and Gynaecology, Shengjing Hospital Affiliated To China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004 Liaoning China.,Key Laboratory of Maternal-Fetal Medicine of Liaoning Province, Laboratory of Obstetrics and Gynecology of Higher Education of Liaoning Province, No. 7 Mulan Road, Xihu District, Benxi, 117000 Liaoning China
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Dai C, Zheng Y, Li Y, Tian T, Wang M, Xu P, Deng Y, Hao Q, Wu Y, Zhai Z, Dai Z, Lyu J. Prognostic values of HE4 expression in patients with cancer: a meta-analysis. Cancer Manag Res 2018; 10:4491-4500. [PMID: 30349381 PMCID: PMC6188164 DOI: 10.2147/cmar.s178345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background To evaluate the prognostic impact of HE4 expression in patients with cancer. Materials and methods We searched the PubMed, Web of Science, Chinese National Knowledge Infrastructure and WangFang databases for publications concerning HE4 expression in patients with cancer. The correlation of HE4 expression level with overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) was analyzed. Results In this meta-analysis, 29 studies, with a total of 4,235 patients, were included. Our results showed that HE4 expression was significantly associated with poorer OS (hazard ratio [HR] =2.15, 95% confidence interval [CI] =1.77–2.62, P<0.001). Further subgroup analysis found that this correlation was not affected by race (White: HR =1.92, 95% CI =1.53–2.39, P<0.001; Asian: HR =2.62, 95% CI =2.06–3.35, P<0.001) or tumor types (endometrial cancer: HR =2.91, 95% CI =1.86–4.53, P<0.001; ovarian cancer: HR =1.82, 95% CI =1.50–2.22, P<0.001; lung cancer: HR =2.31, 95% CI =1.54–3.47, P<0.001). Our meta-analysis showed that HE4 overexpression was significantly associated with DFS (HR =2.50, 95% CI =1.86–3.37, P<0.001) and PFS (HR =1.27, 95% CI =1.11–1.45, P=0.001). Conclusion These results suggest that expression of HE4 was associated with a worse prognosis in patients with cancer. HE4 is a potential novel prognostic factor in patients with cancer.
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Affiliation(s)
- Cong Dai
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China, .,Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Yi Zheng
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Yuanjie Li
- Department of Human Anatomy, Histology and Embryology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Tian Tian
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Meng Wang
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Peng Xu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Yujiao Deng
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Qian Hao
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Ying Wu
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Zhen Zhai
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Zhijun Dai
- Department of Oncology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, People's Republic of China,
| | - Jun Lyu
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, People's Republic of China,
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Luo CH, Zhao M, Tang YX, Shahabi S, Fang KN, Chen Y, Tang Y, Chen XY, Wang J, Zhou HH. Increased HE4 mRNA Expression Correlates with High Level Of eIF3a mRNA And Better Survival in Women with Epithelial Ovarian Cancer. J Cancer 2018; 9:1088-1095. [PMID: 29581788 PMCID: PMC5868176 DOI: 10.7150/jca.23639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/14/2018] [Indexed: 12/20/2022] Open
Abstract
Human epididymis protein 4 (HE4) is one of the most promising biomarkers for epithelial ovarian cancer (EOC). The majority of previous studies utilized the serum level or tissue protein expression of HE4 based upon immunohistochemistry (IHC) to evaluate the role of HE4 in the diagnosis, prognosis, and surveillance of EOC, but very little is known about HE4 mRNA expression. Eukaryotic translation initiation factor 3a (eIF3a) is implicated in oncogenesis and has been investigated extensively as a potential biomarker for malignancy. We previously reported a positive correlation between IHC expressions of eIF3a and HE4 in EOC. In the present study, we performed RT-PCR to determine mRNA expressions of HE4 and eIF3a in 30 normal ovarian tissues, 45 benign, 20 borderline and 94 malignant ovarian tumors. The association of HE4 and eIF3a mRNA expressions with clinicopathological characteristics and patient survivals was investigated. IHC was also performed in the same participants to investigate the correlation between mRNA and protein levels of HE4. HE4 mRNA level was found to be 48.42 ± 74.55 (mean ± SD, range: 0.01-343.99), significantly higher in primary EOC than in the borderline tumor, benign tumor, and normal ovarian tissue (P<0.001). The cutoff value was 13.99 for HE4 to discriminate malignant from benign tumors at 68.1% sensitivity and 93.0% specificity. By Spearman's correlation test, HE4 mRNA expression was indicated to positively correlate with serum CA125 level (r=0.530, P<0.001). Higher HE4 mRNA expression was associated with decreased frequency of lymph node metastasis (P=0.038) and better overall survival (OS) (P=0.007) in primary EOC. Multivariable analysis showed an independent prognostic value of the relative mRNA level of HE4 greater than one for OS (Hazard Ratio, 0.069, 95%CI, 0.009-0.530, P=0.010). eIF3a mRNA expression in women with primary EOC was 0.95 ± 1.19 (mean ± SD, range: 0.06-7.46), which was in a positive linear correlation with HE4 mRNA expression (r=0.310, P=0.002). In the present study, the HE4 mRNA level was unparalleled with IHC expression of HE4 (P>0.05). Collectively, our study revealed that increased HE4 mRNA expression correlates with high level of eIF3a mRNA and better survival in women with EOC, which calls for further investigations.
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Affiliation(s)
- Chen-Hui Luo
- Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.,Laboratory Animal Research Center, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Min Zhao
- Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yu-Xi Tang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Shohreh Shahabi
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Prentice Women's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kai-Ning Fang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Yan Chen
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Yan Tang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Xiao-Yan Chen
- Department of Pathology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Jing Wang
- Department of Gynecologic Oncology, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, People's Republic of China
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Institute of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
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Chen P, Yang Q, Li X, Qin Y. Potential association between elevated serum human epididymis protein 4 and renal fibrosis: A systemic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7824. [PMID: 28885334 PMCID: PMC6392936 DOI: 10.1097/md.0000000000007824] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human epididymis protein 4 (HE4), a matrix metalloprotease 2 (MMP2), and a matrix metalloprotease 9 (MMP9) inhibitor, promotes renal fibrosis by inhibiting the degradation of type I collagen. However, the predictive value of HE4 for renal fibrosis remains controversial, even though it has been identified as one of the most upregulated genes in cultured fibrosis-associated myofibroblasts. This systematic review and meta-analysis was conducted to investigate the potential association between circulating HE4 and renal fibrosis. METHODS Original and review articles published until January 2017 that analyzed the performance of serum HE4 in renal fibrosis were systematically searched for in PubMed (1966-2017.1), Cochrane Library, Web of Science, EMBASE (1980-2017.1), China National Knowledge Infrastructure, Wanfang Database, and VIP (Weipu Database). The meta-analysis was performed using RevMan 5.3 version. Pertinent studies were reviewed and the standardized mean difference (SMD) with 95% confidence interval was extracted. A total of 5 studies reporting 460 participants were included in the final analysis. Subgroup and sensitivity analyses were performed to explore the potential sources of between-study heterogeneity. RESULTS The results demonstrated that elevated serum HE4 favored the diagnosis of renal fibrosis across all trials (SMD = 1.41; 95% confidence interval, 0.82-2.01; P < .001). The bubble graph indicated statistically robust result. The pooled SMD was similar after removing any single study for sensitivity analysis. CONCLUSION The present study suggests a positive association between circulating HE4 and renal fibrosis. Further studies are needed to investigate the effects of interventions on HE4, and the value of HE4 as a biomarker.
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Zhong H, Qian Y, Fang S, Yang L, Li L, Gu W. HE4 expression in lung cancer, a meta-analysis. Clin Chim Acta 2017; 470:109-114. [PMID: 28499820 DOI: 10.1016/j.cca.2017.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The prognostic role of Human epididymis protein 4 (HE4) expression in lung cancer remains controversial. We performed this meta-analysis to assess the prognostic value of HE4 expression in lung cancer. METHODS A systematic literature search was conducted to identify eligible studies in PubMed, Embase and Wanfang databases. The pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to assess the relationship. RESULTS A total of 1412 patients from 8 studies were included in this meta-analysis. The results of univariate analysis (HR=1.73, 95% CI: 1.19-2.52, P=0.004) and multivariate analysis (HR=2.49, 95% CI: 1.89-3.28, P<0.001) demonstrated that high HE4 expression in lung cancer patients was correlated with poor overall survival (OS). We observed through further stratified analysis of the results of the univariate analysis that high HE4 expression was associated with worse OS in Asian lung cancer patients (HR=2.48, 95% CI: 1.88-3.26, P<0.001). However, there was no significant association between high HE4 expression and poor OS in Caucasian patients (HR=1.12, 95% CI: 0.80-1.55, P=0.513). CONCLUSION High serum HE4 level was a marker of poor prognosis in lung cancer patients, particularly in Asian patients with lung cancer.
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Affiliation(s)
- Hai Zhong
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, People's Republic of China
| | - Yingying Qian
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, People's Republic of China
| | - Surong Fang
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, People's Republic of China
| | - Linfei Yang
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, People's Republic of China
| | - Lingzhi Li
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, People's Republic of China
| | - Wei Gu
- Department of Respiration, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, Jiangsu 210006, People's Republic of China.
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Lee S, Choi S, Lee Y, Chung D, Hong S, Park N. Role of human epididymis protein 4 in chemoresistance and prognosis of epithelial ovarian cancer. J Obstet Gynaecol Res 2016; 43:220-227. [PMID: 27862665 DOI: 10.1111/jog.13181] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/18/2016] [Accepted: 08/16/2016] [Indexed: 11/26/2022]
Abstract
AIM Human epididymis protein 4 (HE4) is a novel biomarker for epithelial ovarian cancer. This study was designed to evaluate the role of HE4 in chemo-response against anti-cancer drugs and prognosis of epithelial ovarian cancer. METHODS HE4-depleted cells and HE4-overexpressing cells were generated. The effect of HE4 gene silencing and overexpression was examined using a cell viability assay after exposure to chemotherapeutic agents and the signaling pathway. We studied the expression of HE4 in ovarian cancer tissue and the prognostic significance. Cytoplasmic staining was graded for intensity and percentage of positive cells. The grades were multiplied to determine an H-score. RESULTS Knockdown of HE4 in OVCAR-3 cells resulted in reduction in cell growth and increased sensitivity to paclitaxel and cisplatin compared to control cells. This effect originated from the decreased activation of cell-growth-related signaling, such as AKT and Erk mediated by epidermal growth factor (EGF), while overexpression of HE4 resulted in enhanced cell growth and suppressed the anti-tumorigenic activity of paclitaxel. Activation of AKT and Erk pathways was enhanced in HE4-overexpressing cells compared to control cells. Based on the results of multivariate analysis, the risk of death was significantly higher in patients with an H-score > 4. CONCLUSION HE4 induces chemoresistance against anti-cancer drugs and activates the AKT and Erk pathways to enhance tumor survival. HE4 expression in ovarian cancer tissue is associated with a worse prognosis for epithelial ovarian cancer patients.
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Affiliation(s)
- Seungho Lee
- Department of Obstetrics and Gynecology, Gachon University, Gil Medical Center, Incheon, Republic of Korea
| | - Seowon Choi
- Laboratory of Cancer Cell Biology, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Republic of Korea
| | - Yookyung Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Seoul, Republic of Korea
| | - Donghae Chung
- Department of Pathology, Gachon University, Gil Medical Center, Incheon, Republic of Korea
| | - Suntaek Hong
- Laboratory of Cancer Cell Biology, Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Republic of Korea
| | - Nohhyun Park
- Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul, Republic of Korea
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Kotowicz B, Fuksiewicz M, Sobiczewski P, Spiewankiewicz B, Jonska-Gmyrek J, Skrzypczak M, Kowalska M. Clinical value of human epididymis protein 4 and the Risk of Ovarian Malignancy Algorithm in differentiating borderline pelvic tumors from epithelial ovarian cancer in early stages. Eur J Obstet Gynecol Reprod Biol 2015; 194:141-6. [PMID: 26398337 DOI: 10.1016/j.ejogrb.2015.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The clinical value of human epididymis protein 4 (HE4) and the possibility of its use in the differential diagnosis in patients with benign, borderline and epithelial ovarian cancer in early International Federation of Gynaecology and Obstetrics (FIGO) stages. STUDY DESIGN The study group consisted of 205 women, including 60 with ovarian cancer, 18 with borderline tumors, 77 with benign lesions and 50 healthy subjects. In all the patients, before the treatment and in control groups, we determined CA 125 and HE4 in serum by electrochemiluminescence on the basis of the COBAS e601 system. For comparison of two independent groups, we used the U Mann-Whitney test. The analysis of the diagnostic power of the assessed parameters has been determined using the MedCalc statistical program. The probability of disease free survival (DFS) was evaluated using the log-rank test and Cox regression model. RESULTS Concentrations of HE4, CA 125 and Risk of Ovarian Malignancy Algorithm (ROMA) value were significantly higher in early ovarian cancer than in patients with benign (P<0.0001) and borderline tumors (P<0.002), the receiver operating characteristics (ROC) curves, demonstrated the highest diagnostic sensitivity for the ROMA score, as well post (AUC=0.817) as pre-menopausal (AUC=0.806). HE4 concentrations (P<0.021) and the value of the ROMA score (P<0.004) were significantly higher in patients with relapse than in patients in remission. There was no connection between concentrations of the studied tumor markers and DFS. CONCLUSIONS Determination of HE4 serum concentrations has a significant clinical value, especially in patients with benign lesions and elevated CA 125 levels. The combined assessment of HE4, CA 125 and the ROMA algorithm is helpful in differentiating benign tumors and borderline pelvic tumors from epithelial ovarian cancer in early FIGO stages. Determination of HE4, CA 125 and ROMA algorithm is not helpful in differentiating patients with borderline from benign lesions.
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Affiliation(s)
- Beata Kotowicz
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Roentgen Street 5, 02-781 Warsaw, Poland.
| | - Malgorzata Fuksiewicz
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Roentgen Street 5, 02-781 Warsaw, Poland
| | - Piotr Sobiczewski
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gynecologic Oncology, Roentgen Street 5, 02-781 Warsaw, Poland
| | - Beata Spiewankiewicz
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gynecologic Oncology, Roentgen Street 5, 02-781 Warsaw, Poland
| | - Joanna Jonska-Gmyrek
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Urooncology, Roentgen Street 5, 02-781 Warsaw, Poland
| | - Maciej Skrzypczak
- Second Department of Gynecology, Prof. F. Skubiszewski University School of Medicine, Lublin, Poland
| | - Maria Kowalska
- The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Laboratory of Tumor Markers, Department of Pathology and Laboratory Diagnostics, Roentgen Street 5, 02-781 Warsaw, Poland
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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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Langhe R. microRNA and Ovarian Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 889:119-51. [DOI: 10.1007/978-3-319-23730-5_8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Wang H, Zhu L, Gao J, Hu Z, Lin B. Promotive role of recombinant HE4 protein in proliferation and carboplatin resistance in ovarian cancer cells. Oncol Rep 2014; 33:403-12. [PMID: 25354091 DOI: 10.3892/or.2014.3549] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/18/2014] [Indexed: 11/06/2022] Open
Abstract
Available evidence on the proliferation-promoting effect of HE4 remains controversial, and few studies have been carried out on the molecular mechanism of chemoresistance mediated by HE4. The aim of the present study was to investigate the influence of exogenous recombinant HE4 protein on proliferation and resistance to carboplatin in ovarian cancer cells. The human ovarian cancer cell line (SKOV-3) was exposed to recombinant HE4 protein (0-1 µg/ml) for different durations based on the schemes. Cell viability was evaluated by Cell Counting Kit-8 and colony formation assays. Cell cycle distribution and apoptosis were analyzed by flow cytometry. Markers of apoptosis (Bax and Bcl-2) were assessed by western blotting. Furthermore, Affymetrix microarray analysis was performed to investigate transcriptome profiling. The differential expression of four genes was verified by quantitative real-time PCR. The HE4 protein enhanced cell viability, promoted accumulation of cells in the G2/M phase and attenuated carboplatin-induced apoptosis. HE4 markedly decreased the Bax/Bcl-2 ratio. Candidate genes (387) (236 upregulated and 151 downregulated) were obtained by microarray analysis. Among those upregulated, several Gene Ontology (GO) terms related to cell cycle regulation and proliferation were significantly overrepresented and those within the downregulated dataset included genes involved in several aspects of the DNA damage response such as positive regulation of apoptosis. No information concerning the EGFR-MAPK pathways in a recent report on HE4 was acquired. The mRNA expression of the candidate genes determined by quantitative real-time PCR was significantly correlated with the microarray data. The present study indicates that the HE4 protein plays a promotive role in the proliferation and resistance to carboplatin in ovarian cancer cells, implicating the value of HE4 to predict tumor growth potential and resistance to platinum-based chemotherapy in epithelial ovarian cancer (EOC).
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Affiliation(s)
- Huan Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Heping, Shenyang, Liaoning 110004, P.R. China
| | - Liancheng Zhu
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Heping, Shenyang, Liaoning 110004, P.R. China
| | - Jian Gao
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Heping, Shenyang, Liaoning 110004, P.R. China
| | - Zhenhua Hu
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Heping, Shenyang, Liaoning 110004, P.R. China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital Affiliated to China Medical University, Heping, Shenyang, Liaoning 110004, P.R. China
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Wilailak S, Chan KKL, Chen CA, Nam JH, Ochiai K, Aw TC, Sabaratnam S, Hebbar S, Sickan J, Schodin BA, Charakorn C, Sumpaico WW. Distinguishing benign from malignant pelvic mass utilizing an algorithm with HE4, menopausal status, and ultrasound findings. J Gynecol Oncol 2014; 26:46-53. [PMID: 25310857 PMCID: PMC4302285 DOI: 10.3802/jgo.2015.26.1.46] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/24/2014] [Accepted: 10/06/2014] [Indexed: 12/03/2022] Open
Abstract
Objective The purpose of this study was to develop a risk prediction score for distinguishing benign ovarian mass from malignant tumors using CA-125, human epididymis protein 4 (HE4), ultrasound findings, and menopausal status. The risk prediction score was compared to the risk of malignancy index and risk of ovarian malignancy algorithm (ROMA). Methods This was a prospective, multicenter (n=6) study with patients from six Asian countries. Patients had a pelvic mass upon imaging and were scheduled to undergo surgery. Serum CA-125 and HE4 were measured on preoperative samples, and ultrasound findings were recorded. Regression analysis was performed and a risk prediction model was developed based on the significant factors. A bootstrap technique was applied to assess the validity of the HE4 model. Results A total of 414 women with a pelvic mass were enrolled in the study, of which 328 had documented ultrasound findings. The risk prediction model that contained HE4, menopausal status, and ultrasound findings exhibited the best performance compared to models with CA-125 alone, or a combination of CA-125 and HE4. This model classified 77.2% of women with ovarian cancer as medium or high risk, and 86% of women with benign disease as very-low, low, or medium-low risk. This model exhibited better sensitivity than ROMA, but ROMA exhibited better specificity. Both models performed better than CA-125 alone. Conclusion Combining ultrasound with HE4 can improve the sensitivity for detecting ovarian cancer compared to other algorithms.
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Affiliation(s)
- Sarikapan Wilailak
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Karen K L Chan
- Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong
| | - Chi An Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Joo Hyun Nam
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kazunori Ochiai
- Department of Obstetrics and Gynecology, The Jikei University, Tokyo, Japan
| | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Subathra Sabaratnam
- Department of Pathology, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia
| | | | | | | | - Chuenkamon Charakorn
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Walfrido W Sumpaico
- Department of Obstetrics and Gynecology, MCU-FDT Medical Foundation, Caloocan, Philippines
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Chudecka-Głaz AM, Cymbaluk-Płoska AA, Menkiszak JL, Sompolska-Rzechuła AM, Tołoczko-Grabarek AI, Rzepka-Górska IA. Serum HE4, CA125, YKL-40, bcl-2, cathepsin-L and prediction optimal debulking surgery, response to chemotherapy in ovarian cancer. J Ovarian Res 2014; 7:62. [PMID: 25018782 PMCID: PMC4094548 DOI: 10.1186/1757-2215-7-62] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/30/2014] [Indexed: 01/07/2023] Open
Abstract
Background The most important prognostic factor in the ovarian cancer is optimal cytoreduction. The neoadjuvant chemotherapy, an only optional method of treatment in this case and is still the subject of debate. The object of this study was to evaluate the usefulness of markers: CA 125, HE4, YKL-40 and bcl-2 as well as cathepsin L in predicting optimal cytoreduction and response to chemotherapy. Methods Sera were secured preoperatively. The division into groups was performed retrospectively depending on the method of treatment (surgery vs neoadjuvant chemotherapy) as well as on response to chemotherapy (sensitive vs resistant vs refractory). Comparisons were made between groups, and the diagnostic usefulness of tested proteins was examined. Results We found that statistically significant differences between primary operated patients and patients undergoing neoadjuvant chemotherapy were applicable only to the tumour markers (CA125 1206.79 vs 2432.38, p = 0.000191; HE4 78.87 vs 602.45, p = 0.000004; YKL-40 108.13 vs 203.96, p = 0.003991). Cathepsin-L and Bcl-2 were statistically insignificant. The cut-off point values were determined for the CA 125 (345 mIU/ml), HE4 (218.43 pmol/L) and YKL-40 (140.9 ng/ml). The sensitivity, specificity, PPV and NPV were as follows: CA125 (83.3%; 75%; 80.6%; 78.3%), HE4 (86.6%; 91.3%; 92.9%; 84%) and YKL-40 (75%; 83.3%; 84%; 74.1%). Conclusion Among the tested proteins the HE4 marker appears to be helpful in forecasting of optimal cytoreduction and possibly also of the prediction of response to platinum analogues used in first-line treatment of ovarian cancer.
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Affiliation(s)
- Anita Monika Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Aneta Alicja Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | - Janusz Leszek Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
| | | | | | - Izabella Anna Rzepka-Górska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Szczecin, Poland
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Chudecka-Głaz A, Cymbaluk-Płoska A, Menkiszak J, Sompolska-Rzechuła A, Byra E, Rzepka-Górska I. HE4 tumor marker concentration in neoplastic peritoneal effusion and in peritoneal fluid associated with benign gynecological diseases. J Ovarian Res 2014; 7:22. [PMID: 24528554 PMCID: PMC3940276 DOI: 10.1186/1757-2215-7-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/11/2014] [Indexed: 11/24/2022] Open
Abstract
Background The aim of our study was to evaluate the behaviour of the human epididymis protein 4 (HE4) in the peritoneal fluid encountered in various female genital diseases. Methods We enrolled 139 patients, 40 with ovarian cancer (group I), 82 with benign diseases (group II), and 17 with other malignant neoplasms (group III). The HE4 tumor marker concentrations were determined in serum, in the peritoneal effusion and ovarian cyst/ tumor fluids, CA125 in the serum only. We compared the groups, examined correlations and determined corresponding ROC curves. We evaluated the relationship between the HE4 marker concentration in the peritoneal effusion in the group I, depending on the selected prognostic parameters. Results The HE4 median value between the study groups did not differ statistically significantly and were as follows: in group I 3322 pmol/L, in the group II 2150 pmol/L and in the group III 627 pmol/L (p = 0.206376 for the groups I and II, p = 0.05929 for the groups I and III and p = 0.0797 for the groups II and III. In group I there were no differences found in the HE4 concentrations in the peritoneal fluid, depending on the stage, grade, the presence of neoplastic cells and the peritoneal dissemination. Conclusions The HE4 marker concentrations in the peritoneal fluid are highly irrespective of the pathology observed in the female sexual organ. Therefore, it seems that its determinations in the peritoneal fluid are completely useless in terms of diagnostics. More research is needed on the role of the HE4 marker, especially the place of its formation and possible use in the targeted therapy.
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Affiliation(s)
- Anita Chudecka-Głaz
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al, Powstańców Wielkopolskich 72, Szczecin PL-70-111, Poland.
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Azzam AZ, Hashad DI, Kamel NAF. Evaluation of HE4 as an extrabiomarker to CA125 to improve detection of ovarian carcinoma: is it time for a step forward? Arch Gynecol Obstet 2013; 288:167-72. [DOI: 10.1007/s00404-013-2722-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 01/15/2013] [Indexed: 12/18/2022]
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Zhang W, Gan N, Zhou J. Immunohistochemical investigation of the correlation between LIM kinase 1 expression and development and progression of human ovarian carcinoma. J Int Med Res 2013; 40:1067-73. [PMID: 22906279 DOI: 10.1177/147323001204000325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES LIM kinase 1 (LIMK1) is implicated in cellular mechanisms regulating tumour cell invasion and may be involved in ovarian carcinoma progression. This retrospective study, therefore, investigated expression of the LIMK1 gene in primary ovarian tumour tissue samples and evaluated the correlation between LIMK1 gene expression and progression of ovarian carcinoma. METHODS LIMK1 protein levels were detected by immunohistochemistry in ovarian tissue samples from 57 patients with primary ovarian epithelial tumours (benign, n = 13; borderline, n = 14; carcinoma, n = 30) and 10 patients with normal ovaries. LIMK1 protein levels were evaluated by calculating the product of the scores for stain intensity and percentage of cells stained. RESULTS There was a significant correlation between increasing LIMK1 protein levels and increasing disease severity, from normal ovarian tissues through benign and borderline tumours to ovarian carcinoma. There was also a significant correlation between increasing LIMK1 protein levels and increasingly poor levels of differentiation of ovarian carcinoma. CONCLUSIONS LIMK1 is associated with the development of ovarian cancer and with the level of tumour differentiation in patients with ovarian carcinoma.
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Affiliation(s)
- W Zhang
- Department of Gynaecology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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