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Zhang T, Chu L, Tan W, Ye C, Dong H. Human epididymis protein 4, a novel potential biomarker for diagnostic and prognosis monitoring of lung cancer. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13774. [PMID: 38742362 DOI: 10.1111/crj.13774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE This study aimed to explore the application value of human epididymis protein 4 (HE4) in diagnosing and monitoring the prognosis of lung cancer. METHODS First, TCGA (The Cancer Genome Atlas) databases were used to analyze whey-acidic-protein 4-disulfide bond core domain 2 (WFDC2) gene expression levels in lung cancer tissues. Then, a total of 160 individuals were enrolled, categorized into three groups: the lung cancer group (n = 80), the benign lesions group (n = 40), and the healthy controls group (n = 40). Serum HE4 levels and other biomarkers were quantified using an electro-chemiluminescent immunoassay. Additionally, the expression of HE4 in tissues was analyzed through immunohistochemistry (IHC). In vitro cultures of human airway epithelial (human bronchial epithelial [HBE]) cells and various lung cancer cell lines (SPC/PC9/A594/H520) were utilized to detect HE4 levels via western blot (WB). RESULTS Analysis of the TCGA and UALCAN (The University of Alabama at Birmingham Cancer Data Analysis Portal) databases showed that WFDC2 gene expression levels were upregulated in lung cancer tissues (p < 0.01). Compared with the control group and the benign group, HE4 was significantly higher in the serum of patients with lung cancer (p < 0.001). Receiver operating characteristic (ROC) analysis confirmed that HE4 had better diagnostic efficacy than classical markers in the differential diagnosis of lung cancer and benign lesions and had the highest diagnostic value in lung adenocarcinoma (area under the ROC curve [AUC] = 0.826). HE4 increased in early lung cancer and positively correlated with poor prognosis (p < 0.001). Moreover, the results of WB and IHC revealed that the expression of HE4 was increased in lung cancer cells (SPC/A549/H520) and lung cancer tissues but decreased in PC9 cells with a lack of exon EGFR19 (p < 0.05). CONCLUSION Serum HE4 emerges as a promising novel biomarker for the diagnosis and prognosis assessment of lung cancer.
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Affiliation(s)
- Tingting Zhang
- Infection Management Department of Zengcheng Campus, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lanhe Chu
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenchong Tan
- Department of Teaching and Research, The Tenth Affiliated Hospital, Southern Medical University, Dongguan, China
| | - Cuiping Ye
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hangming Dong
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Guo L, Song B, Xiao J, Lin H, Chen J, Su X. The Prognostic Value of Biomarkers on Detecting Non-Small Cell Lung Cancer in a Chinese Elderly Population. Int J Gen Med 2021; 14:5279-5286. [PMID: 34522127 PMCID: PMC8434877 DOI: 10.2147/ijgm.s331311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background Survival in non-small cell lung cancer (NSCLC) remains poor. Early detection of NSCLC is of great significance to provide a chance to improve survival. Aim We constructed predictive models to evaluate the predictive value of four tumor biomarkers by including serum human epididymis protein 4 (HE4), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCCA), and cytokeratin 19 fragment (CY21-1) on detecting NSCLC in a Chinese elderly population. Methods A total of 363 patients with NSCLC and 433 subjects without cancer (healthy control group) were admitted to the respiratory department in our hospital. We assessed serum levels of these four tumor biomarkers in the two groups and then the predictive value of predictive models was evaluated. Results Serum median values of HE4 (143.3 pmol/L), CEA (4.60 ng/mL), SCCA (1.52 ng/mL), and CY21-1 (5.36 ng/mL) in patients with NSCLC were significantly higher than the healthy control group, respectively (all P<0.05). A multivariate logistic regression model showed that HE4 (OR=2.10, 95% CI=1.22–4.42, P=0.013), CEA (OR=2.30, 95% CI=1.44–4.53, P=0.004), SCCA (OR=2.20, 95% CI=1.29–4.55, P=0.011), and CY21-1 (OR=2.60, 95% CI=1.56–6.25, P<0.001) were significantly and independently associated with increased risk of NSCLC on admission after confounding factors were corrected. Importantly, the ROC curve suggested HE4 had a good value on predicting NSCLC in the Chinese elderly population. Additionally, the predictive model (CEA+SCCA+CY21-1+HE4) had better idea capability to detecting the existence of NSCLC (AUC=0.954, 95% CI=0.927–0.999, P<0.001). Conclusion Our study showed that several lung cancer-related biomarkers were used to build prediction models, which has good value for early prediction of NSCLC.
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Affiliation(s)
- Lianghua Guo
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Bin Song
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Jianhong Xiao
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Hui Lin
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Junhua Chen
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Xianghua Su
- Department of Neurosurgery, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
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Li Y, Li M, Zhang Y, Zhou J, Jiang L, Yang C, Li G, Qu W, Li X, Chen Y, Chen Q, Wang W, Wang S, Liang Xing J, Huang H. Age-stratified and gender-specific reference intervals of six tumor markers panel of lung cancer: A geographic-based multicenter study in China. J Clin Lab Anal 2021; 35:e23816. [PMID: 33982344 PMCID: PMC8183943 DOI: 10.1002/jcla.23816] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Serum biomarkers have been widely adopted in clinical practice for assisting lung cancer diagnoses, therapeutic monitoring, and prognostication. The function of a well‐performing tumor biomarker depends on a reliable reference interval (RI) with consideration of the study subjects’ age, gender, and geographical location. This study aimed to establish a RI for each of 6 lung cancer biomarkers for use in the whole country of China on Mindray platform. Methods The levels of serum 6 lung cancer biomarkers—namely progastrin‐releasing peptide (ProGRP), neuron‐specific enolase (NSE), squamous cell carcinoma antigen (SCC), carcinoembryonic antigen (CEA), cytokeratin‐19 fragment (CYFRA21‐1), and human epididymis protein 4 (HE4)—were measured utilizing the chemiluminescence immunoassay on the Mindray CL‐6000i platform following the laboratory standard operating procedures in apparently healthy Chinese individuals on large cohort, multicenter, and geographical consideration bases. The CLSI EP28‐A3C guideline was followed for the enrollment of study subjects. Results The age‐stratified, gender‐specific RIs for ProGRP, NSE, SCC, CEA, CYFRA21‐1, and HE4 lung cancer biomarkers in the Chinese population have been established as described in the results and discussion in this work. In addition, various levels of the six lung cancer biomarkers among nine geographical locations in China have been observed. Conclusions The sample volume of study cohort, age, and geographical location should be considered upon establishing a reliable biomarker RI. A RI for each of six lung cancer biomarkers has been established. The results from this study would be helpful for clinical laboratories in interpreting the analytical results and for clinicians in patient management.
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Affiliation(s)
- Yan Li
- Department of Laboratory Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ming Li
- Department of Laboratory Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Yi Zhang
- Department of Laboratory Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jianping Zhou
- Department of Radio Immunoassay Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Li Jiang
- Department of Laboratory Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdou, China
| | - Chen Yang
- Department of Laboratory Medicine, Suzhou Municipal Hospital, Suzhou, China
| | - Gang Li
- Department of Laboratory Medicine, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Qu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xinhui Li
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Yong Chen
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China
| | - Qing Chen
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China
| | - Wei Wang
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China
| | - Shukui Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jin Liang Xing
- State Key Laboratory of Cancer Biology and Department of Physiology and Pathophysiology, Fourth Military Medical University, Xi'an, China
| | - Huayi Huang
- Division of in vitro Diagnostics, Shenzhen Mindray Bio-Medical Electronics Corporation, Shenzhen, China.,Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Schirinzi A, Cazzolla AP, Mascolo E, Palmieri G, Pesce F, Gesualdo L, Santacroce L, Ballini A, Lovero R, Di Serio F. Determination of the Upper Reference Limit of Human Epididymis Secretory Protein 4 (HE4) in Healthy Male Individuals and Correlation with Renal and Fertility Markers. Endocr Metab Immune Disord Drug Targets 2021; 21:912-918. [PMID: 32767951 DOI: 10.2174/1871530320666200807121050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Elevated human epididymis secretory protein 4 (HE4) serum levels have been widely investigated in patients with ovarian cancer. However, high levels of HE4 can be also found in other tumors and in renal fibrosis. To date, the HE4 assay manufacturer features the reference value only for the female pre- and post-menopausal population. The aim of this study was to determine the upper reference limit (URL) of HE4 in a well-defined and large cohort of healthy male individuals and investigate potential factors influencing HE4 levels in healthy subjects. METHODS The study included 307 Italian healthy male individuals. HE4 was measured using a chemiluminescent assay (Abbott Laboratories, Wiesbaden, Germany). The URL was calculated using the non-parametric percentile method. Differences in HE4 concentrations according to age, estimated glomerular filtration rate (eGFR), free and bioavailable testosterone were also evaluated. RESULTS The 97.5th percentile URL of serum HE4 in our study population was 57 pmol/L (90% CI). After stratifying subjects according to age, we found that the URL of HE4 was higher in older (> 50 years) than in younger subjects (18-30 years old), and overlapping with the URL in males from 31 to 50 years old (P=4.769e-16, r=0.44). A strong negative correlation between HE4 and eGFR was observed (P=8.412e-12, r=-0.38). Moreover, a statistically significant negative correlation was also found between HE4 and free and bioavailable testosterone. CONCLUSION This study determined the URL of HE4 in a large cohort of healthy male subjects. Our findings indicate that the HE4 age-dependent differences in males need to be taken into account. The definition of the HE4 URL in males and the correlation observed with eGFR and testosterone should foster the clinical use of HE4 beyond gynecologic cancer.
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Affiliation(s)
| | - Angela Pia Cazzolla
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Elisa Mascolo
- Clinic Pathology Unit, Polyclinic University Hospital, Bari, Italy
| | | | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, DETO, University "Aldo Moro", Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, DETO, University "Aldo Moro", Bari, Italy
| | - Luigi Santacroce
- Ionian Department (DJSGEM), Microbiology and Virology Laboratory, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario "Ernesto Quagliariello", University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Lovero
- Clinic Pathology Unit, Polyclinic University Hospital, Bari, Italy
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Lv M, Wang F, Wang X, Zhang C. Diagnostic value of human epididymis protein 4 in malignant pleural effusion in lung cancer. Cancer Biomark 2020; 26:523-528. [PMID: 31658049 DOI: 10.3233/cbm-190840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to assess the diagnostic value of human epididymis protein 4 (HE4) in the pleural effusion of lung cancer patients. METHODS HE4 protein in the pleural effusion of 60 lung cancer patients was measured by electrochemiluminescence, in parallel with those from 56 patients with benign lung disease, and the association with malignant pleural effusion was evaluated. RESULTS The level of HE4 in samples from lung cancer patients was significantly higher than the level for those with benign lung lesions (P= 0.001) and patients with lung adenocarcinoma showed significantly higher levels of HE4 than those with squamous cell carcinoma and small cell carcinoma (P= 0.002 and P= 0.034, respectively). Using an optimal threshold of 652.2 pmol/L, the HE4 level distinguished malignant lung cancer from benign lesions with a sensitivity of 78.3% and a specificity of 75.0%. Moreover, the HE4 level differentiated adenocarcinoma from benign lesions with a sensitivity of 75.9% and a specificity of 85.7% when a threshold of 744.05 pmol/L was used. However, there was no significant difference in the 2 year survival rates of lung cancer patients with high and low HE4 concentrations in pleural fluid (P= 0.882). In addition, there was no significant difference in HE4 levels between tuberculous and inflammatory pleural effusions (P= 0.309). CONCLUSION HE4 in the pleural fluid of lung cancer patients can be valuable in the diagnosis of malignant pleural effusion; however, it does not correlate with the prognosis of patients.
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Affiliation(s)
- Min Lv
- Department of Molecular Biology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Molecular Biology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fen Wang
- Department of Oncology, Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Molecular Biology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyan Wang
- Department of Clinic Laboratory, Nanjing Jiangning Hospital The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cuilan Zhang
- Department of Clinical Laboratory, Nanjing Jiangning Hospital The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Wang Y, Wang Z, Ding Y, Sun F, Ding X. The Application Value of Serum HE4 in the Diagnosis of Lung Cancer. Asian Pac J Cancer Prev 2019; 20:2405-2407. [PMID: 31450913 PMCID: PMC6852827 DOI: 10.31557/apjcp.2019.20.8.2405] [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: 03/26/2019] [Indexed: 11/25/2022] Open
Abstract
Background: To investigate the clinical value of HE4 detection in the diagnosis of lung cancer and the clinical significance of combined detection with CEA, NSE and CYFRA21-1. Methods: 90 cases of lung cancer, 30 cases of pulmonary tuberculosis, 30 cases of pneumonia and 30 cases of health physical examination were selected. The levels of serum HE4, CYFRA21-1, CEA and NSE were detected by electrochemiluminescence method. Statistical analysis was performed to observe the sensitivity and specificity. Results: The levels of serum HE4, CEA, NSE and CYFRA21-1 in lung cancer group were significantly higher than those in tuberculosis group and health physical examination group. There was no significant difference in the levels of HE4, CEA and NSE between the lung cancer group and the pneumonia group, the difference of CYFRA21-1 level was statistically significant (p<0.05).With health physical examination group as normal controls, the sensitivity and specificity of combined detection of HE4, CEA, NSE and CYFRA21-1 in the diagnosis of lung cancer were 82.2% and 90.0%,and the area under the curve (AUC) was 0.907, followed by HE4 (0.867), CYFRA21-1 (0.787), CEA (0.752) and NSE (0.747). Conclusion: HE4 can be used as a serological marker for the diagnosis of lung cancer. The combined detection of HE4, CEA, NSE and CYFRA21-1 can improve the diagnosis of lung cancer. Serum HE4 levels are highly specific in distinguishing between lung cancer patients and normal population, and are equivalent to CYFRA21-1; but they are less specific than CYFRA21-1 in distinguishing lung cancer patients from pneumonia patients.
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Affiliation(s)
- Yuhui Wang
- Weifang City People's Hospital, Weifang, China.
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Yan L, Hu ZD. Diagnostic accuracy of human epididymis secretory protein 4 for lung cancer: a systematic review and meta-analysis. J Thorac Dis 2019; 11:2737-2744. [PMID: 31463101 DOI: 10.21037/jtd.2019.06.72] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Several studies have assessed the diagnostic accuracy of serum human epididymis secretory protein 4 (HE4) for lung cancer, but their results were heterogeneous. The aim of this study was to systematically review the available studies and pool their results using meta-analysis. Methods PubMed, EMBASE and Web of Science databases were searched up to January 1, 2019 to identify studies investigating the diagnostic accuracy of HE4 for lung cancer. We assessed the quality of eligible studies with the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The overall diagnostic sensitivity, specificity, positive and negative likelihood ratios were pooled using a bivariate model. Deeks's test was applied to detect the degree of publication bias. Results A total of 16 studies with 18 cohorts (1,756 lung cancers and 1,446 controls) were included. HE4 had a pooled sensitivity of 0.65 (95% CI: 0.54-0.75), specificity of 0.88 (95% CI: 0.82-0.92), positive likelihood ration of 5.3 (95% CI: 3.7-7.6) and negative likelihood ratio of 0.40 (95% CI: 0.30-0.52). Patient selection bias and partial verification bias were the major design weaknesses of available studies. No publication bias was observed. Conclusions HE4 has moderate diagnostic accuracy for lung cancer. Its result should be interpreted in parallel with clinical findings and the results of other conventional tests. Further studies are still needed to rigorously evaluate the diagnostic accuracy of HE4 for lung cancer.
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Affiliation(s)
- Li Yan
- Department of Respiratory and Critical Care Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, the Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
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