Serum HE4 is correlated to prognostic factors and survival in patients with endometrial cancer

Abstract

The extent of surgery and the decision for adjuvant treatment in patients with endometrial cancer (EC) depend on the presence of risk factors for lymph node metastases and disease recurrence. Postoperative markers such as myometrial infiltration and specific mutations can select patients for adjuvant treatment but will not influence surgical planning. A biomarker stratifying patients into low-risk and high-risk groups before surgery could identify patients who benefit from more extensive surgery. Therefore, we evaluated the correlation of serum biomarker HE4 with clinical and recently identified prognostic pathological variables and survival. Patients treated for endometrial cancer between 1994 and 2014 were included. Serum HE4 concentration was measured in preoperatively obtained samples. A total of 88 patients were eligible for analysis. The majority (64%) was diagnosed with endometrioid-type adenocarcinoma. Serum HE4 concentration is significantly associated with stage of disease (p = 0.001), deep myometrial invasion (p < 0.001), exact depth of myometrial invasion (≥4 mm) (p = 0.01), tumour-free distance to serosa (≤7 mm) (p < 0.001), extensive lymph vascular space invasion (p = 0.04) and cervical involvement (p = 0.001). HE4 concentration and nodal involvement were correlated, although not significant (p = 0.17). Serum HE4 is an independent prognostic factor for recurrence-free survival (HR 5.12 per 10-fold increase in HE4, 95% CI 1.54-17.1) and overall survival (HR 7.48 per 10-fold increase in HE4, 95% CI 1.76-31.7). HE4 is a prognostic marker in endometrial cancer and is helpful in addition to other variables for the preoperative risk stratification of patients with endometrial cancer.

Prognostic significance of annexin II , human epididymis protein (HE-4) and claudin in endometrial carcinoma

“…Current study results are close to Alonso et al [25] who found that Annexin II can be used as a potential marker of endometrial carcinoma recurrence, through the promotion of endometrial carcinoma metastasis and in line with the recent studies by Stiekema et al [26] who observed that HE-4 was an independent prognostic factor for both DFS and OS in patients with EC.…”

Prognostic Biomarkers in Endometrial Cancer: A Systematic Review and Meta-Analysis

“…Notably, MKI67 and PTEN were also validated in tissue samples from imprint smears [51][52][53], as well as CDH1, which was analyzed in uterine aspirates using mass spectrometry-based approaches [54]. MUC16 and WFDC2 have been extensively studied in serum samples by antibody-based techniques such as ELISA or chemiluminescence techniques [50,[55][56][57] and L1CAM was also validated in serum but just in one study [58].…”

Cyclooxygenase-2 and β-Catenin as Potential Diagnostic and Prognostic Markers in Endometrial Cancer

“…However, the number of studies on the exploration of biomarkers that could help early diagnosis and predict the prognosis of patients with EC is still limited. Although there have been several studies in EC patients examining serum indices, such as cancer antigen 125 (CA125), human epididymis protein (HE4), and VEGF (25,(31)(32)(33), their reliability and repeatability still lack consensus.…”