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Yu Z, Nian C, Sun W, Liu X, Nian X. Elevated serum HE4 levels as a novel biomarker of disease severity and hepatic fibrosis in autoimmune hepatitis. Clin Chim Acta 2024; 559:119682. [PMID: 38643819 DOI: 10.1016/j.cca.2024.119682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Human epididymis protein 4 (HE4) has been identified as a biomarker for renal fibrosis. This study aimed to evaluate the role of HE4 in the diagnosis and determination of disease severity and hepatic fibrosis in autoimmune hepatitis (AIH). METHODS Serum HE4 levels were determined via electrochemiluminescence immunoassays in 60 healthy controls and 109 AIH patients (43 without liver cirrhosis and 66 with liver cirrhosis). Liver biopsy was performed on 56 of 109 enrolled patients. We conducted a 5-year follow-up survey of 53 enrolled patients. All continuous variables were reported as median (25th-75th percentile). RESULTS Serum HE4 levels were significantly elevated in autoimmune hepatitis with liver cirrhosis (AIH-LC) patients compared with AIH patients and healthy controls [98.60 (74.15-139.08) vs 73.50 (59.88-82.00) vs 48.75 (43.38-52.93) pmol/L, p = 0.004]. The serum HE4 levels showed a positive correlation with the METAVIR scoring system in patients with liver biopsy (r = 0.711, p < 0.001). Serum HE4 levels were significantly elevated in Child-Pugh class C patients compared with Child-Pugh class B patients and Child-Pugh class A patients [106.50 (83.46-151.25) vs 110.00 (73.83-166.75) vs 77.03 (72.35-83.33) pmol/L, p = 0.006]. The diagnostic sensitivity and specificity of serum HE4 for evaluating liver cirrhosis were 69.7 % and 79.07 %, respectively, with a cutoff value of 82.34 pmol/L in enrolled patients. The logistic regression analysis showed that high levels of HE4 (≥82.34 pmol/L) were associated with AIH-LC (OR = 8.751, 95 % CI = 1.412-54.225, p = 0.020). The Kaplan-Meier curves demonstrated that high levels of serum HE4 (≥82.34 pmol/L) were associated with poor outcome (log-rank p = 0.037, HR = 0.372, 95 % CI = 0.146-0.946). CONCLUSIONS Serum HE4 levels were found to be elevated in AIH-LC patients and exhibited a strong correlation with the severity of hepatic fibrosis, thus supporting their potential clinical value as a novel biomarker of disease severity and hepatic fibrosis in AIH.
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Affiliation(s)
- Zhi Yu
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China
| | - Caina Nian
- Department of Interventional Therapy, Yantai Municipal Laiyang Central Hospital, Yantai, Shandong 265200, China
| | - Wenmei Sun
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China
| | - Xinhua Liu
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China.
| | - Xueyuan Nian
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China.
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Yan Q, Wu L, Song J, Ye L, Zhang Q, Che X, Zhang X, Wang L. Serum Human Epididymis Protein 4 as a Prognostic Predictor of New-Onset Heart Failure among Women after Acute Coronary Syndrome: A Single-Center Retrospective Study. Cardiology 2023; 148:230-238. [PMID: 36720203 DOI: 10.1159/000529365] [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: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the prognostic factors among women with acute coronary syndrome (ACS), partly due to the small number of women included in heart failure (HF) clinical trials. Human epididymis protein 4 (HE4) has been proven to be a new biomarker for acute and chronic HF over the years. We hypothesize that HE4 could be a promising predictor. METHODS This retrospective study analyzed data from Zhejiang Provincial People's Hospital. This study included 302 female patients with ACS between January 1, 2021, and December 1, 2021. The primary outcome was new-onset HF after ACS during the 12-month follow-up period. We used a logistic regression model to evaluate the association between serum HE4 levels and the incidence of HF. Serum HE4 levels were measured at baseline (within 24 h after admission). RESULTS Of the 302 female patients, 70 (23.2%) developed new-onset HF within 12 months. Serum HE4 levels in patients with adverse events were significantly higher than those in patients without events (8.9 [7.3-11.5] pmol/dL versus 5.9 [5.0-6.8] pmol/dL, p < 0.001). The levels of HE4, troponin I peak, left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR) were validated as independent predictors, with HE4 being the best laboratory predictor (area under the curve, 0.863; 95% confidence interval, 0.817-0.909). Serum HE4 concentrations of >6.93 pmol/dL distinguished patients at risk of HF with 82.9% sensitivity and 78.0% specificity (maximum Youden index J, 0.609). Moreover, HE4 levels were associated with an increased risk of HF. DISCUSSION We found a strong relationship between HE4 and the occurrence of HF after ACS among women, which might help identify patients at high risk of HF for whom close or intense management should be mandatory.
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Affiliation(s)
- Qiqi Yan
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China,
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China,
| | - Liuyang Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jikai Song
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, China
| | - Lifang Ye
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qinggang Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xiaoru Che
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xin Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lihong Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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New Analytical Approach for the Alignment of Different HE4 Automated Immunometric Systems: An Italian Multicentric Study. J Clin Med 2022; 11:jcm11071994. [PMID: 35407605 PMCID: PMC9000204 DOI: 10.3390/jcm11071994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 02/04/2023] Open
Abstract
Human epididymal secretory protein 4 (HE4) elevation has been studied as a crucial biomarker for malignant gynecological cancer, such us ovarian cancer (OC). However, there are conflicting reports regarding the optimal HE4 cut-off. Thus, the goal of this study was to develop an analytical approach to harmonize HE4 values obtained with different laboratory resources. To this regard, six highly qualified Italian laboratories, using different analytical platforms (Abbott Alinity I, Fujirebio Lumipulse G1200 and G600, Roche Cobas 601 and Abbott Architett), have joined this project. In the first step of our study, a common reference calibration curve (designed through progressive HE4 dilutions) was tested by all members attending the workshop. This first evaluation underlined the presence of analytical bias in different devices. Next, following bias correction, we started to analyze biomarkers values collected in a common database (1509 patients). A two-sided p-value < 0.05 was considered statistically significant. In post-menopausal women stratified between those with malignant gynecological diseases vs. non-malignant gynecological diseases and healthy women, dichotomous HE4 showed a significantly better accuracy than dichotomous Ca125 (AUC 0.81 vs. 0.74, p = 0.001 for age ≤ 60; AUC 0.78 vs. 0.72, p = 0.024 for age > 60). Still, in post-menopausal status, similar results were confirmed in patients with malignant gynecological diseases vs. patients with benign gynecological diseases, both under and over 60 years (AUC 0.79 vs. 0.73, p = 0.006; AUC 0.76 vs. 0.71, p = 0.036, respectively). Interestingly, in pre-menopausal status women over 40 years, HE4 showed a higher accuracy than Ca125 (AUC 0.73 vs. 0.66, p = 0.027), thus opening new perspective for the clinical management of fertile patients with malignant neoplasms, such as ovarian cancer. In summary, this model hinted at a new approach for identifying the optimal cut-off to align data detected with different HE4 diagnostic tools.
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Wu Y, Cao L, Qi J. Elevated Serum HE4 Concentrations and Risk of Cardiac Complications among Hospitalized Patients with Burns. Lab Med 2022; 53:320-325. [PMID: 35134974 DOI: 10.1093/labmed/lmab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The decrease in effective blood volume after burns is closely related to abnormal heart function. OBJECTIVE To investigate whether serum human epididymis protein 4 (HE4), an indicator of early renal injury, contributes to increased risk of cardiac complications in patients with burns. METHODS Within 24 hours after hospital admission, clinical condition assessment and biochemical testing in patients with burns were performed. Multivariate analysis was performed by evaluating the relationship between serum HE4 levels and risk of cardiac complications (cardiac insufficiency, arrhythmia, and myocardial infarction) during hospitalization. RESULTS The number (percentage) of cardiac complications in all included patients with burns was 80 (15.6%). The results of sensitivity analysis suggest that elevated serum HE4 levels were related to higher risk of cardiac complications in patients with sepsis (OR = 2.1; 95% CI, 1.19-3.17; P <.001) and in patients without sepsis (OR = 2.29; 95% CI, 1.33-4.71l; P = .005), respectively, after adjustments for clinical confounding factors were made. Sepsis did not have a modification effect on the association between serum and cardiac complications among these patients. Also, the results of ROC curve analysis showed that serum HE4 levels have good predictive value for predicting cardiac complications in patients with burns (AUC = 0.708; 95% CI, 0.61-0.81; P <.001). CONCLUSIONS In the current study, we identified that elevated HE4 levels contributed to increased risk of cardiac complications in the hospital in patients with burns. This novel finding suggests that burn patients with serum HE4 may provide the opportunity to predict cardiac complications before hospital admission.
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Affiliation(s)
- Yangyang Wu
- Department of Burns and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong City, China
| | - Ling Cao
- Department of Burns and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong City, China
| | - Jun Qi
- Department of Burns and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong City, China
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Comparison of Serum Human Epididymis Protein 4 (HE4) Levels in Breast Cancer Patients and Healthy Individuals. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Wang L, Hu N, Jiang Z, Luo P, Yi N, Chen Y, Zhou N, Liu L. Association Between Serum Human Epididymis Protein 4 Levels and Cardiovascular Events in Obese Patients with Breast Cancer. Diabetes Metab Syndr Obes 2021; 14:3703-3710. [PMID: 34456577 PMCID: PMC8387245 DOI: 10.2147/dmso.s320122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with cancer have a higher incidence of cardiovascular diseases (CVDs). We aimed to evaluate the relationship between serum human epididymal protein 4 (HE4) levels and cardiovascular events in obese patients with breast cancer. METHODS Serum HE4 levels in 316 obese patients with breast cancer were measured at baseline and then prospectively followed up for approximately 36 months. The prognostic value of serum HE4 for predicting cardiovascular events was analyzed by the Cox proportional hazard model. RESULTS Serum HE4 was significantly associated with CVD history after adjustment for confounding factors (OR= 1.50; 95% CI 1.23-3.43; P=0.038) using multivariable logistic regression analysis. The multivariable Cox proportional hazard analysis suggested that serum HE4 had an independent prognostic value for predicting cardiovascular events in patients with breast cancer (HR=2.21, 95% CI 1.60-5.13, P<0.001). Additionally, sensitivity analysis showed that the independent association still existed. Stratified analysis showed that this relationship was not affected by chemoradiotherapy. CONCLUSION Serum HE4 is significantly related to cardiovascular events and poses good prognostic value for predicting cardiovascular events in obese patients with breast cancer. Serum HE4 may be a valuable indicator for the early detection of cardiovascular complications in obese patients with breast cancer.
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Affiliation(s)
- Li Wang
- Department of Breast Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Nie Hu
- Department of Breast Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Zhongjun Jiang
- Department of Breast Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Ping Luo
- Department of Breast Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Nian Yi
- Department of Breast Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Yanhua Chen
- Department of General Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Ning Zhou
- Department of General Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
| | - Longfei Liu
- Department of General Surgery, Nanhua Hospital, Nanhua University, Hengyang City, Hunan Province, 421002, People’s Republic of China
- Correspondence: Longfei Liu Department of General Surgery, Nanhua Hospital, Nanhua University, No. 336, Dongfeng South Road, Hengyang City, Hunan Province, 421002, People’s Republic of ChinaTel +86 0734-8399028 Email
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Shu Y, Wang W. Serum Human Epididymal Protein 4 is Associated with Depressive Symptoms in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2020; 15:3417-3422. [PMID: 33408471 PMCID: PMC7779315 DOI: 10.2147/copd.s282214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/11/2020] [Indexed: 01/02/2023] Open
Abstract
Background Previous studies have suggested that patients with chronic obstructive pulmonary disease (COPD) have a higher incidence of depression and an increased risk of developing various depression-related complications. We aimed to elucidate the association between the serum human epididymal protein 4 (HE4) level and depressive symptoms in patients with COPD. Methods The data on 219 participants with COPD from The Irish Longitudinal Study on Ageing (TILDA) were analyzed for the association between serum HE4 levels and depressive symptoms, accounting for relevant confounding factors. All the COPD participants were prospectively followed up for a median period of 48 months. Cox proportional hazards analysis was used to evaluate the predictive value of serum HE4 for predicting depression events in these COPD patients. Results Multivariate linear regression analysis revealed that serum HE4 was independently associated with the depression score after adjusting for age, sex, BMI, current smoking status, current drinking status, admission systolic and diastolic BP, CVD history and laboratory measurements in patients with COPD at baseline (Sβ= 0.149; 95% CI, 0.069–0.201; P<0.001). Multivariate Cox proportional hazards analysis revealed that serum HE4 (HR=2.216, 95% CI 1.691–5.109, P<0.001) was an independent prognostic factor for depression events in these COPD patients. Conclusion Our results showed that serum HE4 is significantly and independently associated with depression events. Serum HE4 may enable the early recognition of depressive symptoms among COPD patients.
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Affiliation(s)
- Yan Shu
- Health Management Center, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
- Department of Respiratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
| | - Wei Wang
- Department of Respiratory, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi330006, People’s Republic of China
- Correspondence: Wei Wang Department of Respiratory, The Second Affiliated Hospital of Nanchang University, Donghu District, Nanchang City, Jiangxi, People’s Republic of ChinaTel +86 15879853419 Email
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Lin H, Xiao J, Su X, Song B. The Association Between Serum Human Epididymis Protein 4 Level and Cardiovascular Events in Patients with Chronic Obstructive Pulmonary Disease. Lab Med 2020; 52:260-266. [PMID: 33009814 DOI: 10.1093/labmed/lmaa076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Serum human epididymis protein 4 (HE4) is associated with immune and inflammatory responses. This study aimed to assess the performance of serum HE4 in the early detection of cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD). METHODS Serum HE4 levels were measured in 199 patients with COPD, all of whom were prospectively followed up for a median period of 36 months (range = 3 months-38 months). Logistic regression analysis was performed to assess the association between cardiovascular disease (CVD) history and HE4 in patients with COPD. Cox proportional hazard analysis was performed to assess the prognostic value of serum HE4 for predicting CV events. RESULTS Serum HE4 levels were higher in patients with COPD with CV events than in those without CV events (252.6 pmol/L [186.4-366.8] vs 111.0 pmol/L [84.8-157.1]; P <.001). The multivariate logistic regression model revealed that serum HE4 (odds ratio = 1.639; 95% confidence interval [CI], 1.213-2.317; Ptrend =.009) was independently associated with CVD history after adjusting for age, sex, body mass index, current smoking status, current alcohol consumption status, admission systolic blood pressure and diastolic blood pressure, hyperlipidemia, left ventricular ejection fraction, primary diseases, and laboratory measurements in patients with COPD at baseline. The multivariate Cox proportional hazard analysis revealed that serum HE4 (hazard ratio = 2.012; 95% CI, 1.773-4.469; P <.001) was an independent prognostic factor for CV events in these patients. The Kaplan-Meier analysis showed that the rate of CV events was higher in patients with COPD with HE4 levels above the median (187.5 pmol/L) than in those with HE4 levels below the median. CONCLUSION Our results showed that serum HE4 was significantly and independently associated with CVD history and had independent predictive value for CV events in patients with COPD. Serum HE4 may enable early recognition of CV complication development among patients with COPD.
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Affiliation(s)
- Hui Lin
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Jianhong Xiao
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Xianghua Su
- Neurosurgery Department, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Bin Song
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
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Huang Y, Jiang H, Zhu L. Human Epididymis Protein 4 as an Indicator of Acute Heart Failure in Patients with Chronic Kidney Disease. Lab Med 2020; 51:169-175. [PMID: 31245814 DOI: 10.1093/labmed/lmz041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). OBJECTIVE To assess whether human epididymis protein 4 (HE4) can be useful in diagnosing acute heart failure (AHF) in patients with CKD. METHODS A cohort of 139 Han nationality female patients with CKD who were hospitalized at Renmin Hospital of Wuhan University, Wuhan, China from January 2015 through November 2017 were included. RESULTS Multivariable linear regression analysis showed that HE4 levels were significantly associated with N-terminal pro b-type natriuretic peptide (NT-proBNP) after adjustment of kidney function and other confounding factors. In the multivariate logistic regression analysis, HE4 was independently associated with AHF in patients with CKD (odds ratio, 2.120; 95% confidence interval, 1.034-4.344; P = .04). Moreover, according to the optimal cutoff value of 639.6 pmol per L, the area under the curve, sensitivity, and specificity of HE4 were 0.729, 74.2%, and 76.8%, respectively. CONCLUSIONS During hospitalization, HE4 maybe an useful indicator for diagnosing AHF in patients with CKD.
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Affiliation(s)
- Ying Huang
- Department of Cardiology, Renmin Hospital, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Lihua Zhu
- Department of Cardiology, Renmin Hospital, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
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Bai F, Li T, Li B, Li X, Zhu L. Serum Human Epididymis Protein 4 Level is Associated with Cognitive Function in Patients with Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:3919-3924. [PMID: 33122928 PMCID: PMC7591157 DOI: 10.2147/dmso.s274413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous studies have reported that patients with diabetes mellitus (DM) have a higher incidence of cognitive decline and an increased risk of developing all types of dementia. The aim was to elucidate the association between serum human epididymal protein 4 and cognitive function in patients with DM. METHODS Serum levels of HE4 were measured in 205 patients with DM. All DM patients were followed up for a median period of 48 months (range=5-49) prospectively. Cox proportional hazard analysis was used to evaluate the predictive value of serum HE4 for predicting cognitive decline (end point). RESULTS Multivariate linear regression analysis revealed that serum HE4 was independently associated with MOCA score after adjusting for age, gender, BMI, current smoker, current drinker, admission systolic and diastolic BP, CVD history and laboratory measurements in patients with DM at baseline (Sβ= -0.120; 95% CI, -0.151- -0.069; P<0.001). The multivariate Cox proportional hazard analysis revealed that serum HE4 (HR=2.408, 95% CI 1.669-5.238, P<0.001) was an independent prognostic factor for cognitive decline in these DM patients. CONCLUSION Our results showed that serum HE4 was significantly and independently associated with cognitive decline and had independent predictive value for cognitive decline in patients with DM. Serum HE4 might enable early recognition of senile dementia among DM patients.
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Affiliation(s)
- Fengfeng Bai
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Tao Li
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Baozhu Li
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Xiaozheng Li
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Lifeng Zhu
- Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250033, People’s Republic of China
- Correspondence: Lifeng Zhu Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Street, Jinan, Shandong250033, People’s Republic of ChinaTel +86 17660087098 Email
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Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review. J Ovarian Res 2019; 12:28. [PMID: 30917847 PMCID: PMC6436208 DOI: 10.1186/s13048-019-0503-7] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 03/19/2019] [Indexed: 12/25/2022] Open
Abstract
Ovarian cancer is the 5th leading cause of death for women with cancer worldwide. In more than 70% of cases, it is only diagnosed at an advanced stage. Our study aims to give an update on the biological markers for diagnosing ovarian cancer, specifically HE4, CA 125, RMI and ROMA algorithms. Serum CA125 assay has low sensitivity in the early stages and can be increased in certain conditions such as menstruation or endometriosis. The level of HE4 is overexpressed in ovarian tumors. Its specificity is 94% and its level is not affected by endometriosis cysts. The combined measures of CA125 and HE4 have proved to be highly efficient with an area under the curve (AUC) of up to 0.96. Furthermore, this combined measure of CA125 can correct the variations in HE4 which are due to smoking or contraception combining estrogen plus progestin. While the specificity of RMI sometimes reaches 92%, the rather low AUC of 0.86 does not make it the best diagnostic tool. The specificity of ROMA is lower than HE4 (84% compared to 94%). To date, the most efficient biological diagnostic tool to diagnose ovarian cancer is the combination of CA125 and HE4.
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Zhang M, Yuan L, Yao F, Cao P, Rong J, Zhang B, Su J. Human epididymis protein 4 concentration is not associated with liver fibrosis and cirrhosis in a case control study. Clin Chim Acta 2018; 484:213-217. [PMID: 29864404 DOI: 10.1016/j.cca.2018.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Human epididymis protein 4 (HE4) is an emerging fibrotic biomarker which has been studied in chronic kidney disease cohorts. However, it is unclear if the serum level of HE4 may be altered in patients with liver fibrosis and cirrhosis. METHODS we assessed serum HE4 concentrations in patients (n = 366) with chronic liver diseases (CLD) and compared to matched healthy controls (n = 366). Liver stiffness measurement (LSM) by transient elastography (TE, FibroScan) was also performed on all patients. Liver biopsy was performed on 34 of 366 subjects. Moreover, we analysed a subgroup of patients with confirmed cirrhosis to validate the correlation between HE4 and the severity of cirrhosis. Child-Pugh (CP) score was evaluated in this subgroup. RESULTS No statistically significant differences were observed in the median HE4 level between patients with fibrosis and cirrhosis and controls (median: 56.2 vs. 55 pmol/L, p = .562). Neither were any significant differences found among different groups with Child-Pugh Classes A, B and C (median: 56.9, 58.3 and 52.1 pmol/L, respectively; p = .842). Correlation analysis did not show a significant correlation between HE4 and degree of liver fibrosis according to LSM values or histological assessment (r = 0.159, p = .239; r = 0.045, p = .788). CONCLUSIONS Serum HE4 level does not appear to be associated with fibrotic and cirrhotic liver, suggesting that HE4 may not serve as a valuable clinical biomarker for liver fibrosis and cirrhosis.
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Affiliation(s)
- Mingxia Zhang
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China.
| | - Lili Yuan
- Department of Gastroenterology, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Fucheng Yao
- Department of Ultrasound, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Ping Cao
- Department of Gastroenterology, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Jianrong Rong
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Bin Zhang
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Jie Su
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
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Plotti F, Capriglione S, Scaletta G, Luvero D, Lopez S, Nastro FF, Terranova C, De Cicco Nardone C, Montera R, Angioli R. Implementing the Risk of Endometrial Malignancy Algorithm (REM) adding obesity as a predictive factor: Results of REM-B in a single-center survey. Eur J Obstet Gynecol Reprod Biol 2018; 225:51-56. [DOI: 10.1016/j.ejogrb.2018.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/17/2018] [Accepted: 03/22/2018] [Indexed: 01/05/2023]
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14
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Luo J, Wang F, Wan J, Ye Z, Huang C, Cai Y, Liu M, Wu BQ, Li L. Serum human epididymis secretory protein 4 as a potential biomarker of renal fibrosis in kidney transplantation recipients. Clin Chim Acta 2018; 483:216-221. [PMID: 29738696 DOI: 10.1016/j.cca.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Renal fibrosis remains an important cause of kidney allograft failure. The objective of this study was to evaluate the performance of serum human epididymis secretory protein 4 (HE4) as a biomarker for renal fibrosis in kidney transplant recipients. METHODS A total of 103 kidney transplantation patients were enrolled in this study, and serum HE4 concentrations were detected using the chemiluminescent microparticle immunoassay. Renal biopsy was carried out, and histological findings were assessed by immunohistochemistry. RESULTS Median serum HE4 concentrations were significantly increased in kidney transplant recipients (186.2 pmol/l, interquartile range [IQR] 125.6-300.2) compared with control subjects (34.3 pmol/l, IQR 30.4-42.3, p < 0.0001). Meanwhile, serum HE4 concentrations were significantly increased along with disease severity (p < 0.0001). In addition, we found serum HE4 concentrations to be strongly correlated with the severity of fibrosis (IF/TA 0, 1, 2, and 3: 114.3, 179.0, 197.8, and 467.8 pmol/l, respectively; p < 0.0001) and serum HE4 concentrations significantly correlated with HE4 tissue expression concentrations in renal biopsy. CONCLUSIONS Serum HE4 was increased in kidney transplant recipients with decreased kidney function and renal fibrosis and was correlated with the severity of the disease, suggesting that HE4 has the potential to be used as a novel clinical biomarker for evaluating kidney function and predicting renal fibrosis in kidney transplant recipients.
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Affiliation(s)
- Jinmei Luo
- Departments of Internal Medicine, Medical Intensive Care Unit, Division of Respiratory Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People's Republic of China; Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-en University, Guangzhou 510630, People's Republic of China
| | - Fen Wang
- Departments of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People's Republic of China
| | - Jianxin Wan
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-en University, Guangzhou 510630, People's Republic of China
| | - Zhuangjian Ye
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-en University, Guangzhou 510630, People's Republic of China
| | - Chumei Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-en University, Guangzhou 510630, People's Republic of China
| | - Yuesu Cai
- Department of Laboratory Medicine, The Hospital of Shantou Central Hospital, Shantou 515000, People's Republic of China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-en University, Guangzhou 510630, People's Republic of China
| | - Ben-Quan Wu
- Departments of Internal Medicine, Medical Intensive Care Unit, Division of Respiratory Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People's Republic of China.
| | - Laisheng Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-en University, Guangzhou 510630, People's Republic of China.
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15
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Wan J, Wang Y, Cai G, Liang J, Yue C, Wang F, Song J, Wang J, Liu M, Luo J, Li L. Elevated serum concentrations of HE4 as a novel biomarker of disease severity and renal fibrosis in kidney disease. Oncotarget 2018; 7:67748-67759. [PMID: 27589683 PMCID: PMC5356516 DOI: 10.18632/oncotarget.11682] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/26/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Human epididymis protein 4 (HE4), has recently been reported as a mediator of renal fibrosis. However, serum HE4 levels appear in a large number of patient samples with chronic kidney disease (CKD), and the relationship of these levels to disease severity and renal fibrosis is unknown. METHODS In 427 patients at different stages of CKD excluding gynecologic cancer and 173 healthy subjects, serum HE4 concentrations were tested by chemiluminescent microparticle immunoassay. Renal biopsy was performed on 259 of 427 subjects. Histological findings were evaluated using standard immunohistochemistry. RESULTS The levels of serum HE4 were higher in CKD patients than in healthy subjects, and higher levels were associated with more severe CKD stages. Patients with more severe renal fibrosis tended to have higher HE4 levels, and correlation analysis showed a significant correlation between HE4 and degree of renal fibrosis (r = 0.938, P < 0.0001). HE4 can be a predictor of renal fibrosis in CKD patients; the area under the receiver-operating characteristic curve (AUC-ROC) was 0.99, higher than the AUC-ROC of serum creatinine (0.89). CONCLUSION Elevated levels of serum HE4 are associated with decreased kidney function, and also with an advanced stage of renal fibrosis, suggesting that HE4 may serve as a valuable clinical biomarker for renal fibrosis of CKD.
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Affiliation(s)
- Jianxin Wan
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanhong Wang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Gaorong Cai
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianbo Liang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Caifeng Yue
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fen Wang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Junli Song
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianfeng Wang
- Institute of Laboratory Medicine, Guangdong Medical College, Dongguan, People's Republic of China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jinmei Luo
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Laisheng Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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16
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The Role of HE4, a Novel Biomarker, in Predicting Optimal Cytoreduction After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer. Int J Gynecol Cancer 2018; 27:696-702. [PMID: 28406844 DOI: 10.1097/igc.0000000000000944] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate serum human epididymis protein 4 (HE4) changes during neoadjuvant chemotherapy (NACT) to establish HE4 predebulking surgery cutoff values and to demonstrate that CA125, HE4, and computed tomography (CT) taken together are better able to predict complete cytoreduction after NACT in advanced ovarian cancer patients. METHODS From January 2006 to November 2015, patients affected by epithelial advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III-IV), considered not optimally resectable, were included in this prospective study. After 3 cycles of NACT, all patients underwent debulking surgery and were allocated, according to residual tumor (RT), into group A (RT = 0) and group B (RT > 0). Serum CA125, HE4, and CT images were recorded during NACT and compared singularly and with each other in term of accuracy, sensitivity, specificity, and positive and negative predictive value. RESULTS A total of 94 and 20 patients were included in group A and group B, respectively. The HE4 values recorded before debulking surgery correlated with RT. The identified HE4 cutoff value of 226 pmol/L after NACT was able to classify patients at high or low risk of suboptimal surgery, with a sensitivity of 75% and a specificity of 85% (positive predictive value, 0.87; negative predictive value, 0.70). The combination of CA125, HE4, and CT imaging resulted in the best combination with a sensitivity of 96% and a specificity of 92% (positive predictive value, 0.96; negative predictive value, 0.94). CONCLUSIONS The novel biomarker HE4, in addition to CA125 and CT, is better able to predict the RT at debulking surgery and the prognosis of patients.
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17
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Chovanec J, Selingerova I, Greplova K, Antonsen SL, Nalezinska M, Høgdall C, Høgdall E, Søgaard-Andersen E, Jochumsen KM, Fabian P, Valik D, Zdrazilova-Dubska L. Adjustment of serum HE4 to reduced glomerular filtration and its use in biomarker-based prediction of deep myometrial invasion in endometrial cancer. Oncotarget 2017; 8:108213-108222. [PMID: 29296235 PMCID: PMC5746137 DOI: 10.18632/oncotarget.22599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/28/2017] [Indexed: 01/21/2023] Open
Abstract
Background We investigated the efficacy of circulating biomarkers together with histological grade and age to predict deep myometrial invasion (dMI) in endometrial cancer patients. Methods HE4ren was developed adjusting HE4 serum levels towards decreased glomerular filtration rate as quantified by the eGFR-EPI formula. Preoperative HE4, HE4ren, CA125, age, and grade were evaluated in the context of perioperative depth of myometrial invasion in endometrial cancer (EC) patients. Continuous and categorized models were developed by binary logistic regression for any-grade and for G1-or-G2 patients based on single-institution data from 120 EC patients and validated against multicentric data from 379 EC patients. Results In non-cancer individuals, serum HE4 levels increase log-linearly with reduced glomerular filtration of eGFR ≤ 90 ml/min/1.73 m2. HE4ren, adjusting HE4 serum levels to decreased eGFR, was calculated as follows: HE4ren = exp[ln(HE4) + 2.182 × (eGFR-90) × 10-2]. Serum HE4 but not HE4ren is correlated with age. Model with continuous HE4ren, age, and grade predicted dMI in G1-or-G2 EC patients with AUC = 0.833 and AUC = 0.715, respectively, in two validation sets. In a simplified categorical model for G1-or-G2 patients, risk factors were determined as grade 2, HE4ren ≥ 45 pmol/l, CA125 ≥ 35 U/ml, and age ≥ 60. Cumulation of weighted risk factors enabled classification of EC patients to low-risk or high-risk for dMI. Conclusions We have introduced the HE4ren formula, adjusting serum HE4 levels to reduced eGFR that enables quantification of time-dependent changes in HE4 production and elimination irrespective of age and renal function in women. Utilizing HE4ren improves performance of biomarker-based models for prediction of dMI in endometrial cancer patients.
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Affiliation(s)
- Josef Chovanec
- Clinic of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Regional Centre of Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Iveta Selingerova
- Regional Centre of Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Kristina Greplova
- Regional Centre of Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Sofie Leisby Antonsen
- Gynecologic Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Monika Nalezinska
- Clinic of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Claus Høgdall
- Gynecologic Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Estrid Høgdall
- Department of Pathology, Danish Cancer Biobank, Herlev University Hospital, Herlev, Denmark
| | - Erik Søgaard-Andersen
- Department of Gynecology and Obstetrics, Aalborg University Hospital, Aalborg, Denmark
| | - Kirsten M Jochumsen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Pavel Fabian
- Department of Oncological Pathology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Dalibor Valik
- Regional Centre of Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Lenka Zdrazilova-Dubska
- Regional Centre of Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Laboratory Medicine, Masaryk Memorial Cancer Institute, Brno, Czech Republic
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18
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Vezzoli M, Ravaggi A, Zanotti L, Miscioscia RA, Bignotti E, Ragnoli M, Gambino A, Ruggeri G, Calza S, Sartori E, Odicino F. RERT: A Novel Regression Tree Approach to Predict Extrauterine Disease in Endometrial Carcinoma Patients. Sci Rep 2017; 7:10528. [PMID: 28874808 PMCID: PMC5585365 DOI: 10.1038/s41598-017-11104-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/14/2017] [Indexed: 12/15/2022] Open
Abstract
Some aspects of endometrial cancer (EC) preoperative work-up are still controversial, and debatable are the roles played by lymphadenectomy and radical surgery. Proper preoperative EC staging can help design a tailored surgical treatment, and this study aims to propose a new algorithm able to predict extrauterine disease diffusion. 293 EC patients were consecutively enrolled, and age, BMI, children’s number, menopausal status, contraception, hormone replacement therapy, hypertension, histological grading, clinical stage, and serum HE4 and CA125 values were preoperatively evaluated. In order to identify before surgery the most important variables able to classify EC patients based on FIGO stage, we adopted a new statistical approach consisting of two-steps: 1) Random Forest with its relative variable importance; 2) a novel algorithm able to select the most representative Regression Tree (RERT) from an ensemble method. RERT, built on the above mentioned variables, provided a sensitivity, specificity, NPV and PPV of 90%, 76%, 94% and 65% respectively, in predicting FIGO stage > I. Notably, RERT outperformed the prediction ability of HE4, CA125, Logistic Regression and single cross-validated Regression Tree. Such algorithm has great potential, since it better identifies the true early-stage patients, thus providing concrete support in the decisional process about therapeutic options to be performed.
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Affiliation(s)
- Marika Vezzoli
- Department of Molecular and Translational Medicine, Unit of Biostatistics, University of Brescia, Brescia, Italy.
| | - Antonella Ravaggi
- "Angelo Nocivelli" Institute of Molecular Medicine, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.
| | - Laura Zanotti
- "Angelo Nocivelli" Institute of Molecular Medicine, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | | | - Eliana Bignotti
- Division of Obstetrics and Gynecology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Monica Ragnoli
- Division of Obstetrics and Gynecology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Angela Gambino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | | | - Stefano Calza
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Enrico Sartori
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
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Capriglione S, Luvero D, Plotti F, Terranova C, Montera R, Scaletta G, Schirò T, Rossini G, Benedetti Panici P, Angioli R. Ovarian cancer recurrence and early detection: may HE4 play a key role in this open challenge? A systematic review of literature. Med Oncol 2017; 34:164. [PMID: 28825178 DOI: 10.1007/s12032-017-1026-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
Despite the improvement in overall survival for ovarian cancer (OC) patients, a fraction of patients with advanced-stage disease fails to respond to primary therapy and relapses in 70% of cases. For this reason, new predictive and monitoring tools are needed to identify OC recurrence and new biomarkers were studied, among which human epididymis 4 (HE4), primarily expressed in the reproductive and respiratory tracts, is one of the most promising, reporting a good sensitivity and specificity in detecting OC, overcoming the traditional role of carbohydrate antigen 125 (CA-125). In this review, we aim to discuss the latest evidence reported in the literature about the use of HE4 to monitor ovarian cancer treatment and to detect OC recurrence. We searched MEDLINE (PubMed), EMBASE, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, congress abstracts, and Grey literature (Google Scholar; British Library) from January 1952 to June 2017. The search identified seven papers in line with eligibility criteria for this systematic review; all of them demonstrated a good performance of HE4 in OC recurrence. The challenge to anticipate the diagnosis of OC recurrence and to translate this early diagnosis of relapse in a survival and quality of life improvement is still open, and as reported in this review, HE4 may play a key role in this scenario. More studies are needed to validate and reinforce the role of HE4 in ovarian cancer recurrence and in its early detection.
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Affiliation(s)
- Stella Capriglione
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy.
| | - Daniela Luvero
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Corrado Terranova
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Roberto Montera
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy.,Unit of Obstetrics and Gynecology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Scaletta
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Teresa Schirò
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Gianmarco Rossini
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynaecology, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200 - 00128, Rome, Italy
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20
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Jeong TD, Cho EJ, Ko DH, Lee W, Chun S, Kwon HJ, Hong KS, Kim YM, Min WK. A new strategy for calculating the risk of ovarian malignancy algorithm (ROMA). Clin Chem Lab Med 2017; 55:1209-1214. [PMID: 28107166 DOI: 10.1515/cclm-2016-0582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/05/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reliable quantitative measurements of HE4 and CA125 levels are required to calculate the risk of ovarian malignancy algorithm (ROMA) value. We suggest a new reporting strategy for interpreting ROMA values based on analytical measurement range (AMR) and qualified-intervals of the HE4 and CA125 results. METHODS HE4 and CA125 assays from Abbott and Roche were used. The AMRs and the qualified-intervals were as follows: Architect HE4 assay, 20-1500 and 17.2-2637.8 pmol/L; Architect CA125 II assay, 1-1000 and 3.9-14,163.0 U/mL; Elecsys HE4 assay, 15-1500 and 28.8-3847 pmol/L; Elecsys CA125 II assay, 0.6-5000 and 6.5-5000 U/mL. These values were used to simulate the ROMA values. RESULTS Reporting algorithm for the ROMA value could be classified into three categories. (1) If quantitative HE4 and CA125 levels are reliable, the numerical ROMA value can be reported. (2) If HE4 value is <20 and <28.8 for Abbott and Roche in premenopausal woman, the ROMA value should be reported as "low risk" regardless of the CA125 result. In postmenopausal woman, however, it should be reported as "low risk" (CA125<203.0 and <165.8 for Abbott and Roche) or "undetermined" (vice-versa value). (3) If CA125 value is <3.9 and <6.5 for Abbott and Roche, it should be reported as "low risk" (premenopausal HE4<51.5 and <62.2, postmenopausal HE4<323.0 and <281.5 for Abbott and Roche) or "undetermined" (vice-versa value). CONCLUSIONS New reporting strategy will provide more informative reporting of ROMA values in clinical practice.
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21
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Kemal YN, Demirag GN, Bedir AM, Tomak L, Derebey M, Erdem DL, Gör U, Yücel I. Serum human epididymis protein 4 levels in colorectal cancer patients. Mol Clin Oncol 2017; 7:481-485. [PMID: 28894584 DOI: 10.3892/mco.2017.1332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/04/2017] [Indexed: 01/12/2023] Open
Abstract
Tumour markers are widely used for the diagnosis, staging and monitoring of colorectal cancer (CRC) patients in clinical practice. Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most frequently used biomarkers in CRC patients. A number of studies have recently investigated the presence of human epididymis protein 4 (HE4) overexpression in certain cancer types. Its significance in ovarian and endometrial cancer has been well-demonstrated. The aim of the present study was to evaluate the significance of serum HE4 levels in CRC patients. A total of 46 newly diagnosed CRC patients and 36 age- and gender-matched healthy subjects were included in the study. The concentrations of CEA and CA19-9 were also determined and compared according to HE4 levels. HE4 positivity was determined in 13 of the 46 cases (28.3%) in the CRC group, but no HE4-positive subjects were identified in the control group (0%; P=0.009). The area under the receiver operating characteristic curve for HE4 positivity was 0.641 (95% CI: 0.523-0.760). HE4 was statistically significantly positive in patients with stage III-IV disease and in those with high CA 19-9 levels (all P<0.01). To the best of our knowledge, this is the first study to investigate HE4 expression in CRC patients, and the findings suggest that it may be a useful biomarker, particularly in stage III-IV patients.
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Affiliation(s)
- Yasemi N Kemal
- Department of Medical Oncology, Samsun Training and Research Hospital, Samsun 55100, Turkey
| | - Guzi N Demirag
- Department of Medical Oncology, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Abdulkeri M Bedir
- Department of Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Leman Tomak
- Department of Biostatistics, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Murat Derebey
- Department of General Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Di Lek Erdem
- Department of Medical Oncology, Medical Park Samsun Hospital, Samsun 55200, Turkey
| | - Ufuk Gör
- Department of Biochemistry, Faculty Of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
| | - Idris Yücel
- Department of Medical Oncology, Faculty Of Medicine, Ondokuz Mayis University, Samsun 55270, Turkey
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22
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Validation of REM score to predict endometrial cancer in patients with ultrasound endometrial abnormalities: results of a new independent dataset. Med Oncol 2017; 34:82. [DOI: 10.1007/s12032-017-0945-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/04/2017] [Indexed: 01/08/2023]
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23
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Capriglione S, Plotti F, Miranda A, Lopez S, Scaletta G, Moncelli M, Luvero D, De Cicco Nardone C, Terranova C, Montera R, Angioli R. Further insight into prognostic factors in endometrial cancer: the new serum biomarker HE4. Expert Rev Anticancer Ther 2016; 17:9-18. [PMID: 27892774 DOI: 10.1080/14737140.2017.1266263] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endometrial cancer (EC) is one of the most common gynecological cancer worldwide. To date, no good markers are routinely used in clinical practice for prognosis and monitoring. Areas covered: During the last years, an increasing interest in literature has been growing on HE4 (Human epididimis 4). Therefore, we aimed to gather all the evidence reported in literature analysing the potential prognostic value of HE4, compared to the well know tumor's features (histological type and grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement). Expert commentary: The analysis of data suggests that HE4 seems to have a good performance in prognosis and monitoring of the disease, helping to schedule the appropriste timing of imaging and surgery in a more individualized fashion. However, these findings surely require a validation in a larger cohorts of patients. Probably, in the next five years, prospective randomized trials will be performed to confirm the prognostic role of HE4 in EC and to find a tailored EC management strategy.
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Affiliation(s)
- Stella Capriglione
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Francesco Plotti
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Andrea Miranda
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Salvatore Lopez
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Giuseppe Scaletta
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Michele Moncelli
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Daniela Luvero
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Carlo De Cicco Nardone
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Corrado Terranova
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Roberto Montera
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
| | - Roberto Angioli
- a Department of Obstetrics and Gynaecology, Campus Bio Medico , University of Rome , Rome , Italy
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Chudecka-Głaz A, Cymbaluk-Płoska A, Jastrzębska J, Menkiszak J. Can ROMA algorithm stratify ovarian tumor patients better when being based on specific age ranges instead of the premenopausal and postmenopausal status? Tumour Biol 2016; 37:8879-87. [PMID: 26753953 PMCID: PMC4990599 DOI: 10.1007/s13277-015-4733-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/21/2015] [Indexed: 12/26/2022] Open
Abstract
After several years of research, HE4 was found to be characterized by slightly worse sensitivity but significantly higher specificity as compared with CA125. Further studies led to the diagnostic potential of both markers (CA125 and HE4) being combined in a single risk of malignancy algorithm (ROMA) algorithm. The objective of this study was to assess the diagnostic capabilities of the ROMA algorithm using age ranges instead of dichotomization of patients according to the pre- and postmenopausal status. A total of 413 female patients were included in the study, including 162 premenopausal and 251 postmenopausal women. Calculation of the final ROMA values was achieved by means of stepwise reduction of coefficients in the proposed formula of: %ROMA = exp(PI)/[1-exp(PI)]*100) and PI = A + W(HE4)*ln(HE4) + W(CA125)*ln (CA125) and the arrangement of values with consideration to the age group, HE4 level, differentiation of modification, and directional coefficients as well as determination of individual deviations affecting the widening of the median. The cutoff value of modified algorithm ROMA P for the entire study population was calculated from receiver operating characteristic (ROC) curve and DeLong method at the levels of 23.5 %. Marked higher sensitivity and negative predictive value (NPV) values are observed for the standard ROMA algorithm while higher specificity and positive predictive value (PPV) values are observed for the modified algorithm ROMA P. The proposed age-related modification of algorithm calculation does not require the patients being dichotomized according to their pre- or postmenopausal status, and satisfactory diagnostic values may be obtained using a single cutoff point for the entire population.
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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, 70-111, Szczecin, Poland.
| | - Aneta Cymbaluk-Płoska
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | | | - Janusz Menkiszak
- Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
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Serum HE4 detects recurrent endometrial cancer in patients undergoing routine clinical surveillance. BMC Cancer 2015; 15:33. [PMID: 25655024 PMCID: PMC4342867 DOI: 10.1186/s12885-015-1028-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/20/2015] [Indexed: 01/09/2023] Open
Abstract
Background The purpose of this study was to evaluate serum HE4 as a biomarker to detect recurrent disease during follow-up of patients with endometrial adenocarcinoma (EAC). Methods We performed a retrospective analysis of 98 EAC patients treated at Innsbruck Medical University, between 1999 and 2009. Twenty-six patients developed recurrent disease. Median follow-up was 5 years. Serum HE4 and CA125 levels were analyzed using the ARCHITECT assay (Abbott, Wiesbaden, Germany) pre-operatively (baseline), post-operative (interval) and after histological confirmation of recurrent disease or when patients returned for clinical review with no evidence of recurrent disease (recurrence/final)). Receiver operator curves (ROC), Spearman rank correlation coefficient, chi-squared and Mann–Whitney tests were used for statistical analysis. Results HE4 levels decreased after initial treatment (p = 0.001) and increased again at recurrence (p = 0.002). HE4 was elevated (>70 pmol/L) in 21 of 26 (81%) and CA125 was elevated (>35 U/ml) in 12 of 26 (46%) patients at recurrence. In endometrioid histology (n = 69) serum HE4 measured during follow up (Area under the curve (AUC) = 0.87, 95%CI 0.79-0.95) was a better indicator of recurrence than CA125 (AUC = 0.67, 95%CI 0.52-0.83). A HE4 level of 70 pmol/L was associated with a sensitivity of 84%, a specificity of 74% and a negative predictive value of 93% when assessing for recurrent endometrioid EAC. Conclusion This is a preliminary description of HE4 serum levels measured during routine follow up of EAC patients. Serum HE4 measured during clinical follow-up may identify recurrent disease particularly in patients with endometrioid histology. Further prospective validation of HE4 is warranted.
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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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Borderline ovarian tumors and diagnostic dilemma of intraoperative diagnosis: could preoperative He4 assay and ROMA score assessment increase the frozen section accuracy? A multicenter case-control study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:803598. [PMID: 25431767 PMCID: PMC4238177 DOI: 10.1155/2014/803598] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 08/11/2014] [Accepted: 09/03/2014] [Indexed: 11/18/2022]
Abstract
The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P < 0.05), and overdiagnosis in 11.6% versus 0% (P < 0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.
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Kappelmayer J, Antal-Szalmás P, Nagy B. Human epididymis protein 4 (HE4) in laboratory medicine and an algorithm in renal disorders. Clin Chim Acta 2014; 438:35-42. [PMID: 25127713 DOI: 10.1016/j.cca.2014.07.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 01/20/2023]
Abstract
Over the past three decades, cancer antigen (CA) 125 has been utilized for monitoring women who were treated for ovarian cancer. However, this tumor marker showed several limitations such as false elevation in benign pelvic diseases and, in turn, no alterations in ovarian tumors at early stages with a relatively high ratio. For more than ten years, the human epididymis protein 4 (HE4) has become available for the routine laboratory repertoire, showing a higher sensitivity and specificity compared to that of CA125 in ovarian malignancies, but also in other types of tumors based on recently accumulated clinical data. Despite its remarkable diagnostic characteristics, in certain cases, the evaluation of HE4 results may be problematic when patients suffer from additional conditions that may alter HE4 level. Besides the direct effects of age and smoking, menopause status and decreased renal function also show a substantial impact on HE4 values, which should be considered in each patient. For this purpose, we attempted to create a new formula and an algorithm that may be helpful to predict the probability of the presence of ovarian tumor by using the concentrations of HE4 and CA125.
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Affiliation(s)
- János Kappelmayer
- Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary.
| | - Péter Antal-Szalmás
- Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Béla Nagy
- Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
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Bie Y, Zhang Z. Diagnostic value of serum HE4 in endometrial cancer: a meta-analysis. World J Surg Oncol 2014; 12:169. [PMID: 24885319 PMCID: PMC4050396 DOI: 10.1186/1477-7819-12-169] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/09/2014] [Indexed: 12/22/2022] Open
Abstract
Background Endometrial cancer (EC) is a common female malignant cancer. The age of incidence has become younger than before. If the diagnosis is during stage I, then the survival rate is about 90%. To date, there are no specific tumor markers for endometrial cancer. We usually use serum CA125 to help in diagnosing it. However, a serum biomarker CA125 greater than 35 U/ml is not useful in diagnosing EC at an early stage. Now, human epididymis protein 4 (HE4) has been intensively studied, and has been described as a new marker for ovarian cancer. The goal of this study was to evaluate the clinical value of serum HE4 in the diagnosis of endometrial cancer by meta-analysis. Methods We used MEDLINE, EMBASE, Cochrane Library and CBM databases to search the literature. The meta-analysis was performed by using Meta-Disc 1.4 software. Results All data we obtained showed that the major advantage of HE4 lies in its specificity in endometrial cancer diagnosis. Its sensitivity in serum was not as high as expected. But this evidence is not enough. Conclusions Additional studies, particularly to evaluate HE4’s capability in identifying EC at an early stage, will be needed.
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Affiliation(s)
| | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijng Chao-yang Hospital affiliated to Capital Medical University, 100020 Beijing, P, R, China.
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Melichar B. Laboratory medicine and medical oncology: the tale of two Cinderellas. Clin Chem Lab Med 2014; 51:99-112. [PMID: 22987835 DOI: 10.1515/cclm-2012-0496] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 11/15/2022]
Abstract
Cancer represents a leading cause of death in the developed countries. The past 50 years have witnessed major progress in both laboratory medicine and clinical oncology that has translated into improved prognosis of cancer patients. From the humble beginnings as unrelated specialties, major advances in the understanding of molecular bases of cancer progression led to increased interactions between laboratory medicine and clinical (mostly medical) oncology. Laboratory medicine is now an integral part of the management of cancer patients. The many aspects of the role of laboratory medicine in clinical oncology include the determination of biomarkers that are used in establishing the diagnosis, predicting response to therapy or prognosis, study of the host response to tumor growth, detection of treatment toxicity and determining the concentrations of anticancer drugs.
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Affiliation(s)
- Bohuslav Melichar
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Fakultní nemocnice, Olomouc, Czech Republic.
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Brennan DJ, Hackethal A, Metcalf AM, Coward J, Ferguson K, Oehler MK, Quinn MA, Janda M, Leung Y, Freemantle M, Webb PM, Spurdle AB, Obermair A. Serum HE4 as a prognostic marker in endometrial cancer--a population based study. Gynecol Oncol 2013; 132:159-65. [PMID: 24211402 DOI: 10.1016/j.ygyno.2013.10.036] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/23/2013] [Accepted: 10/29/2013] [Indexed: 12/26/2022]
Abstract
OBJECTIVE HE4 has emerged as a promising biomarker in gynaecological oncology. The purpose of this study was to evaluate serum HE4 as a biomarker for high-risk phenotypes in a population-based endometrial cancer cohort. METHODS Peri-operative serum HE4 and CA125 were measured in 373 patients identified from the prospective Australian National Endometrial Cancer Study (ANECS). HE4 and CA125 were quantified on the ARCHITECT instrument in a clinically accredited laboratory. Receiver operator curves (ROC), Spearman rank correlation coefficient, and chi-squared and Mann-Whitney tests were used for statistical analysis. Survival analysis was performed using Kaplan-Meier and Cox multivariate regression analyses. RESULTS Median CA125 and HE4 levels were higher in stage III and IV tumours (p<0.001) and in tumours with outer-half myometrial invasion (p<0.001). ROC analysis demonstrated that HE4 (area under the curve (AUC)=0.76) was a better predictor of outer-half myometrial invasion than CA125 (AUC=0.65), particularly in patients with low-grade endometrioid tumours (AUC 0.77 vs 0.64 for CA125). Cox multivariate analysis demonstrated that elevated HE4 was an independent predictor of recurrence-free survival (HR=2.40, 95% CI 1.19-4.83, p=0.014) after adjusting for stage and grade of disease, particularly in the endometrioid subtype (HR=2.86, 95% CI 1.25-6.51, p=0.012). CONCLUSION These findings demonstrate the utility of serum HE4 as a prognostic biomarker in endometrial cancer in a large, population-based study. In particular they highlight the utility of HE4 for pre-operative risk stratification to identify high-risk patients within low-grade endometrioid endometrial cancer patients who might benefit from lymphadenectomy.
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Affiliation(s)
- Donal J Brennan
- Queensland Centre for Gynaecological Oncology, University of Queensland, School of Medicine, Central Clinical Division, Brisbane, Australia
| | - Andreas Hackethal
- Queensland Centre for Gynaecological Oncology, University of Queensland, School of Medicine, Central Clinical Division, Brisbane, Australia
| | - Alex M Metcalf
- Queensland Institute of Medical Research, Genetics and Computational Biology Division, 300 Herston Rd, Herston, Brisbane 4006, Australia
| | - Jermaine Coward
- Mater Medical Research Institute, South Brisbane, QLD, Australia
| | - Kaltin Ferguson
- Queensland Institute of Medical Research, Genetics and Computational Biology Division, 300 Herston Rd, Herston, Brisbane 4006, Australia
| | - Martin K Oehler
- Department of Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michael A Quinn
- Women's Cancer Research Centre, Royal Women's Hospital, Victoria, Australia
| | - Monika Janda
- School of Public Health, Queensland University of Technology, Brisbane, Australia
| | - Yee Leung
- School of Women's and Infants' Health, University of Western Australia, Perth, Australia
| | - Michael Freemantle
- Sullivan Nicolaides Pathology, Cnr Whitmore St & Seven Oaks St, Taringa, QLD 4068, Australia
| | | | - Penelope M Webb
- Queensland Institute of Medical Research, Genetics and Computational Biology Division, 300 Herston Rd, Herston, Brisbane 4006, Australia
| | - Amanda B Spurdle
- Queensland Institute of Medical Research, Genetics and Computational Biology Division, 300 Herston Rd, Herston, Brisbane 4006, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Oncology, University of Queensland, School of Medicine, Central Clinical Division, Brisbane, Australia.
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Gizzo S, Ancona E, Saccardi C, D’Antona D, Nardelli GB, Plebani M. Could kidney glomerular filtration impairment represent the “Achilles heel” of HE4 serum marker? A possible further implication. ACTA ACUST UNITED AC 2013; 52:e45-6. [DOI: 10.1515/cclm-2013-0660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/19/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Salvatore Gizzo
- Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padua, Italy
| | - Emanuele Ancona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | - Donato D’Antona
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | - Mario Plebani
- Department of Laboratory Medicine, University of Padua, Padua, Italy
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