1
|
Behrouzi R, Barr CE, Crosbie EJ. HE4 as a Biomarker for Endometrial Cancer. Cancers (Basel) 2021; 13:4764. [PMID: 34638250 DOI: 10.3390/cancers13194764] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/10/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary There are currently no blood biomarkers approved for routine clinical use in endometrial cancer. Serum human epididymis protein 4 (HE4) is significantly higher in patients with endometrial cancer compared to patients without endometrial cancer and is associated with a poorer prognosis. This makes HE4 an attractive candidate for clinical use in endometrial cancer. The aim of this review is to summarise the evidence for the use of serum HE4 in the detection, prognosis, prediction of therapy response and recurrence monitoring in endometrial cancer. The utility of combining HE4 with other biomarkers or imaging and clinical variables, and its detection in other biofluids is also discussed, as well as potential challenges for clinical use and recommended areas for future research. Abstract There are currently no blood biomarkers in routine clinical use in endometrial carcinoma (EC). Human epididymis protein 4 (HE4) is a glycoprotein that is overexpressed in the serum of patients with EC, making it a good candidate for use as a diagnostic and/or prognostic biomarker. HE4 is correlated with poor prognostic factors, including stage, myometrial invasion and lymph node metastases, which means it could be used to guide decisions regarding the extent of surgery and need for adjuvant therapy. Serum HE4 has also shown promise for predicting responses to progestin therapy in early-stage EC. The use of algorithms and indices incorporating serum HE4 and other biomarkers, including clinical and imaging variables, is an area of increasing interest. Serum HE4 levels rise with age and renal dysfunction, which may affect the interpretation of results. This review covers the evidence supporting the use of HE4 as an EC biomarker for diagnosis, prognosis, recurrence monitoring, and prediction of therapy response. The evidence for combining serum HE4 with other biomarkers, including clinical and imaging variables, its value as a biomarker in other biofluids and potential challenges of its clinical use are also discussed.
Collapse
|
2
|
Zhang K, Zhang Y, Fang X, Fang M, Shi B, Dong J, Qian L. Nomograms of Combining Apparent Diffusion Coefficient Value and Radiomics for Preoperative Risk Evaluation in Endometrial Carcinoma. Front Oncol 2021; 11:705456. [PMID: 34386425 PMCID: PMC8353445 DOI: 10.3389/fonc.2021.705456] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives To evaluate the value of nomogram models combining apparent diffusion coefficient (ADC) value and radiomic features on magnetic resonance imaging (MRI) in predicting the type, grade, deep myometrial invasion (DMI), lymphovascular space invasion (LVSI), and lymph node metastasis (LNM) of endometrial carcinoma (EC) preoperatively. Methods This study included 210 EC patients. ADC value was calculated, and radiomic features were measured on T2-weighted images. The univariate and multivariate logistic regressions and cross-validations were performed to reduce valueless features, then radiomics signatures were developed. Nomogram models using ADC combined with radiomic features were developed in the training cohort. The receiver operating characteristic (ROC) curve was performed to estimate the diagnostic efficiency of nomogram models by the area under the curve (AUC) in the training and validation cohorts. Results The ADC value was significantly different between each subgroup. Radiomic features were ultimately limited to four features for type, six features for grade, six features for DMI, four features for LVSI, and eight features for LNM for the nomogram models. The AUC of the nomogram model combining ADC value and radiomic features in the training and validation cohorts was 0.851 and 0.867 for type, 0.959 and 0.880 for grade, 0.839 and 0.766 for DMI, 0.816 and 0.746 for LVSI, and 0.910 and 0.897 for LNM. Conclusions The nomogram models of ADC value combined with radiomic features were associated with the type, grade, DMI, LVSI, and LNM of EC, and provide an effective, non-invasive method to evaluate preoperative risk stratification for EC.
Collapse
Affiliation(s)
- Kaiyue Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yu Zhang
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xin Fang
- Department of Radiology, First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, China
| | - Mengshi Fang
- Department of Radiology, First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, China
| | - Bin Shi
- Department of Radiology, First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jiangning Dong
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.,Department of Radiology, First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Cancer Hospital, Hefei, China
| | - Liting Qian
- Department of Radiation Oncology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China.,Department of Radiation Oncology, First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| |
Collapse
|
3
|
Insin P, Yimyam Y, Prueksaritanond N. Association of preoperative serum HE4 levels on the survival of patients with endometrial cancer. Arch Gynecol Obstet 2021. [PMID: 34109467 DOI: 10.1007/s00404-021-06118-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the association between preoperative serum human epididymis protein 4 (HE4) levels and survival outcomes in endometrial cancer (EC) patients. METHODS A retrospective cohort study was conducted of EC patients who were scheduled for surgery between September 2013 and May 2014 at Rajavithi Hospital. Association between preoperative serum HE4 levels and clinicopathological characteristics were evaluated. Cox proportional-hazards model was used to compare overall survival (OS) and recurrence-free survival (RFS) between EC patients who had high serum HE4 levels and those who did not. RESULTS A total of 86 EC patients were enrolled. Serum HE4 levels was significantly associated with older age (p < 0.001), postmenopausal women (p = 0.001), large tumor size (p < 0.001), presence of lymphovascular invasion (p = 0.022), deep myometrial invasion (p = 0.001), lymph node metastasis (0.017), high-risk group (p < 0.001), and death status (p = 0.002). With a median follow-up of 53 months, the 3-years OS and PFS of EC patients who had high serum HE4 levels were significantly poorer than those who did not (71% vs 95.8%, and 67.7% vs 91.7%, respectively). A high serum HE4 level was a significant prognostic factor for OS and RFS from the univariate analysis. However, it was not a significant prognostic factor in the multivariate analysis. CONCLUSION Preoperative high serum HE4 levels were significantly associated with the worse clinicopathological characteristic of EC patients and decreased OS and RFS. Although there was no strong independent prognostic factor for survival, serum HE4 levels could be used in an algorithm for stratifying high-risk EC patients with more proper management.
Collapse
|
4
|
Degez M, Caillon H, Chauviré-Drouard A, Leroy M, Lair D, Winer N, Thubert T, Dochez V. Endometrial cancer: A systematic review of HE4, REM and REM-B. Clin Chim Acta 2020; 515:27-36. [PMID: 33388311 DOI: 10.1016/j.cca.2020.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Endometrial cancer, one of the most frequent pelvic gynecologic cancer worldwide, currently has no biomarker used to assess it in daily practice. Nonetheless, human epididymis 4 (HE4) appears to offer the best prospects, alone or combined with CA125. This study sought to systematically review the work on HE4 from the first publications in 2008 until now. MATERIAL AND METHODS Two independent reviewers searched the PubMed database with the terms "HE4″, "endometrial cancer", "endometrial carcinoma", and HE4 or human epididymis protein 4. Only original clinical research articles and meta-analyses, published in English, were included, with literature reviews and case reports excluded. RESULTS Studies were organized into 3 categories: diagnosis, prognosis, and recurrence/survival. Overall we identified 117 articles dealing with HE4 and endometrial cancer and selected 52 relevant texts: 46 articles, 6 meta-analyses. The sensitivity of HE4 for the diagnosis of endometrial cancer varied from 44.2% to 91% and its specificity from 65.5 to 100%, versus 24.1 to 71.5% and from 65.6 to 100% for CA125. Two meta-analyses of their combination produced areas under the curve (AUC): 0.83 and 0.86. Two available algorithms - the REM (risk of endometrial malignancy) and REM-B (risk of endometrial malignancy associated with BMI) scores - require more study. HE4 is also strongly associated with prognostic factors such as myometrial invasion, tumor grade, FIGO stage, and lymph node involvement. It also predicts recurrence and can serve as a monitoring tool, as reported by a 2018 meta-analysis with a hazard ratio of 2.15 (P < 0.001). CONCLUSION HE4, alone or associated with CA125, appears to be an important tool in the management of endometrial cancer, initially for diagnosis, but for assessing prognosis and survival. Other prospective and multicenter studies are necessary to confirm these hopes and be able to recommend the use of HE4 in regular practice.
Collapse
Affiliation(s)
- Manon Degez
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France
| | | | | | - Maxime Leroy
- Plateforme de Biométries et Biostatistiques, CHU de Nantes, Nantes, France
| | - David Lair
- Département Promotion, Direction de la Recherche, CHU de Nantes, Nantes, France
| | - Norbert Winer
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France; Centre d'Investigation Clinique (CIC), CHU de Nantes, Nantes, France
| | - Thibault Thubert
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France; Centre d'Investigation Clinique (CIC), CHU de Nantes, Nantes, France
| | - Vincent Dochez
- Service de Gynécologie-Obstétrique, CHU de Nantes, Nantes, France; Centre d'Investigation Clinique (CIC), CHU de Nantes, Nantes, France.
| |
Collapse
|
5
|
Espiau Romera A, Coronado Martín PJ, Chóliz Ezquerro M, Cuesta Guardiola T, Adiego Calvo I, Baquedano Mainar L. Value of preoperative HE4 as predictor of advanced disease in endometrioid endometrial cancer. Int J Gynaecol Obstet 2020; 153:64-70. [PMID: 33156532 DOI: 10.1002/ijgo.13473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/06/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the predictive value of serum human epididymis protein 4 (HE4) marker in the preoperative prediction of the risk of advanced disease in the endometrioid subtype of endometrial cancer, and its association with poor prognostic factors. In addition, a cut-off value of HE4 was defined to classify patients according to these results. METHODS Prospective and multicenter cohort analytical pilot study of patients operated for endometrial cancer at the Miguel Servet University Hospital of Zaragoza (Spain) and the Complejo Universitario of León (Spain) from January 2017 to May 2019. Preoperative serum levels of HE4 were analyzed by clinical and pathologic characteristics. RESULTS In all, 126 patients were included. A statistically significant association was found between the preoperative HE4 value and node involvement (P = 0.008), late-stage disease (P = 0.003), high histologic grade (P = 0.007), deep myometrial invasion (P = 0.001), lymphovascular space invasion (P = 0.001), and other pathologic factors. In addition, an HE4 cut-off value (156.4 pmol/L) has been determined to predict, preoperatively, which patients will present with early stage disease. CONCLUSIONS The preoperative marker HE4 is a useful tool in the preoperative study of patients with endometrial cancer as it relates to late-stage disease as well as other prognostic factors in the endometrioid subtype of endometrial cancer.
Collapse
Affiliation(s)
- Andrea Espiau Romera
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Marta Chóliz Ezquerro
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Ignacio Adiego Calvo
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | - Laura Baquedano Mainar
- Department of Obstetrics and Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| |
Collapse
|
6
|
O'Toole SA, Huang Y, Norris L, Power Foley M, Shireen R, McDonald S, Kamran W, Ibrahim N, Ward M, Thompson C, Murphy C, D'Arcy T, Farah N, Heron E, O'Leary JJ, Abu Saadeh F, Gleeson N. HE4 and CA125 as preoperative risk stratifiers for lymph node metastasis in endometrioid carcinoma of the endometrium: A retrospective study in a cohort with histological proof of lymph node status. Gynecol Oncol 2020; 160:514-519. [PMID: 33213897 DOI: 10.1016/j.ygyno.2020.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether HE4 and CA125 could identify endometrioid adenocarcinoma patients who might most benefit from full staging surgery with lymphadenectomy. METHODS Sequential patients with a preoperative banked serum and histology of endometrioid adenocarcinoma of endometrium who had undergone surgical staging with lymph node dissection over a 5-year period between 2011 and 2016 were included from a tertiary Gynaecological Cancer Centre, Dublin, Ireland. Preoperative serum HE4 and CA125 were measured using ELISA, with the cut-offs HE4 81 pmol/L and CA125 35 U/ml. Predictive values were estimated using AUC, sensitivity, specificity and odds ratios. RESULTS 9.5% of the cohort had lymph node metastases. A HE4 cut-off of 81 pmol/L yielded a sensitivity of 78.6% and specificity of 53.4% for predicting lymph node metastases. Sensitivity of CA125 at 35 U/ml was 57% and specificity 91.4%. The AUC was 0.66 (0.52-0.80) for HE4 and 0.74 (0.58-0.91) for CA125. Sensitivity was 92.8% and specificity 51.1% when an elevation of either HE4 or CA125 was included, AUC was 0.72 (0.61-0.83), this combination yielded the highest NPV of 98.6%. Sensitivity was 42.9% and specificity 93.8% if both markers were elevated simultaneously, AUC was 0.68 (0.51-0.86). Preoperative clinical predictors of high-grade preoperative histology and radiology had sensitivities of 21.4% and 41.7%, respectively. Patients with a HE4 above 81 pmol/L had an odds ratio of 4.2 (1.12-15.74), p < 0.05, of lymph node metastases and CA125 had an odds ratio of 14.2 (4.16-48.31), p < 0.001. CONCLUSIONS Serum HE4 and CA125 improved on existing methods for risk stratification of endometrioid carcinomas and warrant further investigation.
Collapse
Affiliation(s)
- Sharon A O'Toole
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland..
| | - Yanmei Huang
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; School of Forensic Medicine, Xinxiang Medical University, Xinxiang, Henan, China
| | - Lucy Norris
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Megan Power Foley
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Rizmee Shireen
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Seamus McDonald
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland
| | - Waseem Kamran
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Nadia Ibrahim
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Mark Ward
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Claire Thompson
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Cliona Murphy
- Department of Obstetrics & Gynaecology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Tom D'Arcy
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland.; Department of Obstetrics & Gynaecology, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Nadine Farah
- Department of Obstetrics & Gynaecology, Coombe Women & Infants University Hospital, Dublin 8, Ireland.; Department of Gynaecology, Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Elizabeth Heron
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - John J O'Leary
- Department of Histopathology, Trinity College Dublin and Trinity St James's Cancer Institute, St. James's Hospital, Dublin 8, Ireland.; Emer Casey Molecular Pathology Research Laboratory, Coombe Women & Infants University Hospital, Dublin 8, Ireland
| | - Feras Abu Saadeh
- Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| | - Noreen Gleeson
- Department of Obstetrics & Gynaecology, Trinity College Dublin and Trinity St James's Cancer Institute, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland.; Division of Gynaecological Oncology and Trinity St James's Cancer Institute, St James's Hospital, Dublin 8, Ireland
| |
Collapse
|
7
|
Panyavaranant P, Manchana T. Preoperative markers for the prediction of high-risk features in endometrial cancer. World J Clin Oncol 2020; 11:378-388. [PMID: 32874951 PMCID: PMC7450819 DOI: 10.5306/wjco.v11.i6.378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preoperative evaluations aiming to assess high-risk features in clinical stage 1 endometrial cancer patients are crucial to refer these patients to gynecologic oncologists. Cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) have been reported in endometrial cancer patients with poor prognostic factors.
AIM To evaluate the association between preoperative levels of CA125 and HE4 and high-risk features and establish optimal cut-off values in clinical stage 1 endometrial cancer.
METHODS A retrospective study was conducted in clinical stage 1 endometrial cancer patients who underwent primary surgery between January 2013 and December 2018. A total of 128 patients had preoperative serum CA125 and HE4 measurements. High-risk features included grade 3 tumors, large tumor sizes (more than 2 cm), deep myometrial invasion (more than 50%), lymphovascular space invasion (LVSI), cervical involvement, extrauterine involvement and node metastasis. Receiver operating characteristic (ROC) curves were generated to analyze the optimal cut-off values.
RESULTS The mean age of the patients was 57.4 years, and 69.5% of them were postmenopausal. Most patients presented with stage I disease (67.2%) and had the endometrioid subtype (97.7%). The median CA125 and HE4 levels in all patients were 22.1 U/mL and 104.7 pmol/L, respectively. CA125 and HE4 levels were significantly elevated in those with large tumor sizes, deep myometrial invasion, LVSI, extrauterine metastasis, and advanced stage, but node metastasis was associated with elevated CA125 only. According to the ROC curve, both serum markers had statistical significance for the prediction of high-risk features only in postmenopausal patients, with an optimal cut-off value of 20 U/mL for CA125 [area under the concentration-time curve (AUC) = 0.72, P = 0.002] and 113 pmol/L for HE4 (AUC = 0.70, P = 0.006). The combination of both serum markers had 80% sensitivity and 64.4% positive predictive value. Significantly worse 5-year disease-free survival was observed in patients with high levels of CA125 and HE4 (78.4% and 100%, respectively; P = 0.01).
CONCLUSION Preoperative CA125 levels greater than 20 U/mL or HE4 levels greater than 113 pmol/L are associated with an increased risk of having high-risk features and present as prognostic factors in clinical stage 1 postmenopausal endometrial cancer patients. This information is helpful for general gynecologists to refer high-risk patients to gynecologic oncologists to perform complete surgical staging.
Collapse
Affiliation(s)
- Pinyada Panyavaranant
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| | - Tarinee Manchana
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
| |
Collapse
|
8
|
Espiau Romera A, Cuesta Guardiola T, Benito Vielba M, De Bonrostro Torralba C, Coronado Martín PJ, Baquedano Mainar L. HE4 tumor marker as a predictive factor for lymphatic metastasis in endometrial cancer. Int J Gynaecol Obstet 2020; 149:265-268. [PMID: 32147821 DOI: 10.1002/ijgo.13140] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/04/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022]
Abstract
Endometrial cancer is the most common genital cancer in high-resource countries. Treatment is essentially surgical, but the role of lymphadenectomy in the treatment of low-stage and low-grade tumors has not been defined. Although no tumor factors have been validated for use as preoperative prognostic markers of endometrial cancer at yet, human epididymis protein 4 (HE4) has received much interest as a potential diagnostic and prognostic tumor marker. Since 2008, several studies have explored its utility in the management of endometrial cancer: HE4 may be a useful preoperative prognostic marker because it is associated with lymphatic metastasis and other unfavorable factors in endometrial cancer. In addition, some studies have explored a HE4 cutoff value to classify patients according to lymph node involvement. HE4 might be beneficial as a serum marker that helps clinicians in the decision-making algorithm for treatment of endometrial cancer, enabling them to perform individualized operations and decrease the adverse effects of unnecessary surgery.
Collapse
Affiliation(s)
| | | | - Marta Benito Vielba
- Department of Gynecology, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | | |
Collapse
|
9
|
James NE, Chichester C, Ribeiro JR. Beyond the Biomarker: Understanding the Diverse Roles of Human Epididymis Protein 4 in the Pathogenesis of Epithelial Ovarian Cancer. Front Oncol 2018; 8:124. [PMID: 29740539 PMCID: PMC5928211 DOI: 10.3389/fonc.2018.00124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022] Open
Abstract
Human epididymis protein 4 (HE4) is an important clinical biomarker used for the detection of epithelial ovarian cancer (EOC). While much is known about the predictive power of HE4 clinically, less has been reported regarding its molecular role in the progression of EOC. A deeper understanding of HE4’s mechanistic functions may help contribute to the development of novel targeted therapies. Thus far, it has been difficult to recommend HE4 as a therapeutic target owing to the fact that its role in the progression of EOC has not been extensively evaluated. This review summarizes what is collectively known about HE4 signaling and how it functions to promote tumorigenesis, chemoresistance, and metastasis in EOC, with the goal of providing valuable insights that will have the potential to aide in the development of new HE4-targeted therapies.
Collapse
Affiliation(s)
- Nicole E James
- Division of Gynecologic Oncology, Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, United States.,Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, United States
| | - Clinton Chichester
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, United States
| | - Jennifer R Ribeiro
- Division of Gynecologic Oncology, Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, United States
| |
Collapse
|
10
|
Ribeiro JR, Gaudet HM, Khan M, Schorl C, James NE, Oliver MT, DiSilvestro PA, Moore RG, Yano N. Human Epididymis Protein 4 Promotes Events Associated with Metastatic Ovarian Cancer via Regulation of the Extracelluar Matrix. Front Oncol 2018; 7:332. [PMID: 29404274 PMCID: PMC5786890 DOI: 10.3389/fonc.2017.00332] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/26/2017] [Indexed: 01/06/2023] Open
Abstract
Human epididymis protein 4 (HE4) has received much attention recently due to its diagnostic and prognostic abilities for epithelial ovarian cancer. Since its inclusion in the Risk of Ovarian Malignancy Algorithm (ROMA), studies have focused on its functional effects in ovarian cancer. Here, we aimed to investigate the role of HE4 in invasion, haptotaxis, and adhesion of ovarian cancer cells. Furthermore, we sought to gain an understanding of relevant transcriptional profiles and protein kinase signaling pathways mediated by this multifunctional protein. Exposure of OVCAR8 ovarian cancer cells to recombinant HE4 (rHE4) promoted invasion, haptotaxis toward a fibronectin substrate, and adhesion onto fibronectin. Overexpression of HE4 or treatment with rHE4 led to upregulation of several transcripts coding for extracellular matrix proteins, including SERPINB2, GREM1, LAMC2, and LAMB3. Gene ontology indicated an enrichment of terms related to extracellular matrix, cell migration, adhesion, growth, and kinase phosphorylation. LAMC2 and LAMB3 protein levels were constitutively elevated in cells overexpressing HE4 and were upregulated in a time-dependent manner in cells exposed to rHE4 in the media. Deposition of laminin-332, the heterotrimer comprising LAMC2 and LAMB3 proteins, was increased in OVCAR8 cells treated with rHE4 or conditioned media from HE4-overexpressing cells. Enzymatic activity of matriptase, a serine protease that cleaves laminin-332 and contributes to its pro-migratory functional activity, was enhanced by rHE4 treatment in vitro. Proteomic analysis revealed activation of focal adhesion kinase signaling in OVCAR8 cells treated with conditioned media from HE4-overexpressing cells. Focal adhesions were increased in cells treated with rHE4 in the presence of fibronectin. These results indicate a direct role for HE4 in mediating malignant properties of ovarian cancer cells and validate the need for HE4-targeted therapies that will suppress activation of oncogenic transcriptional activation and signaling cascades.
Collapse
Affiliation(s)
- Jennifer R. Ribeiro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
| | - Hilary M. Gaudet
- Department of Chemistry, Wheaton College, Norton, MA, United States
| | - Mehreen Khan
- Department of Chemistry, Wheaton College, Norton, MA, United States
| | - Christoph Schorl
- Center for Genomics and Proteomics, Genomics Core Facility, Brown University, Providence, RI, United States
| | - Nicole E. James
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, United States
| | - Matthew T. Oliver
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
| | - Paul A. DiSilvestro
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
| | - Richard G. Moore
- Department of Obstetrics and Gynecology, Wilmot Cancer Institute, Division of Gynecologic Oncology, University of Rochester Medical Center, Rochester, NY, United States
| | - Naohiro Yano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Program in Women’s Oncology, Women and Infants Hospital, Providence, RI, United States
- Roger Williams Medical Center, Department of Surgery, Boston University Medical School, Providence, RI, United States
| |
Collapse
|
11
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
12
|
Knific T, Osredkar J, Smrkolj Š, Tonin I, Vouk K, Blejec A, Frković Grazio S, Rižner TL. Novel algorithm including CA-125, HE4 and body mass index in the diagnosis of endometrial cancer. Gynecol Oncol 2017; 147:126-132. [PMID: 28735628 DOI: 10.1016/j.ygyno.2017.07.130] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic and prognostic potential of preoperative serum CA-125 and HE4 levels in patients with endometrial cancer. METHODS Prospective case-control study of 133 women who underwent surgical treatment at the University Medical Centre Ljubljana (64 patients with endometrial cancer, 69 control patients with prolapsed uterus or myoma). Serum CA-125 and HE4 levels were determined using electrochemiluminescent assays. RESULTS Serum CA-125 and HE4 levels were significantly higher in patients with endometrial cancer, compared to the controls (p=2.67×10-4, 1.36×10-7, respectively). A diagnostic model that combines serum CA-125 and HE4 levels and body mass index separated patients with endometrial cancer from controls, with AUC of 0.804, sensitivity of 66.7%, and specificity of 84.6%. Serum HE4 levels showed good prognostic potential and stratified the patients according to presence/absence of deep myometrial invasion (p=0.001) or lymphovascular invasion (p=0.003), with AUCs of 0.78 and 0.81, respectively. In low-risk patients with grade 1 and 2 endometrioid cancer for whom lymphadenectomy can be avoided, HE4 allowed stratification according to deep myometrial invasion (p=3.39×10-4), with AUC of 0.84. Although median HE4 levels were higher in patients with lymphovascular invasion, this difference did not reach significance (p=0.06). CONCLUSIONS A model based on preoperative serum CA-125 and HE4 levels and body mass index has good diagnostic accuracy for separation of patients with endometrial cancer and control patients. In patients with endometrial cancer, serum HE4 levels allow prediction of deep myometrial and lymphovascular invasion.
Collapse
Affiliation(s)
- Tamara Knific
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Joško Osredkar
- Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Špela Smrkolj
- Division of Obstetrics and Gynaecology, University Medical Centre, 1000 Ljubljana, Slovenia
| | - Irena Tonin
- Division of Obstetrics and Gynaecology, University Medical Centre, 1000 Ljubljana, Slovenia
| | - Katja Vouk
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andrej Blejec
- National Institute of Biology, 1000 Ljubljana, Slovenia
| | - Snježana Frković Grazio
- Department of Pathology, Division of Obstetrics and Gynaecology, University Medical Centre, 1000 Ljubljana, Slovenia
| | - Tea Lanišnik Rižner
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
| |
Collapse
|
13
|
Dewan R, Dewan A, Hare S, Bhardwaj M, Mehrotra K. Diagnostic Performance of Serum Human Epididymis Protein 4 in Endometrial Carcinoma: A Pilot Study. J Clin Diagn Res 2017; 11:XC01-XC05. [PMID: 28893024 DOI: 10.7860/jcdr/2017/28926.10285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/19/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Endometrial Cancer (EC) is a common female malignant disorder. To date, there are no specific tumour markers for EC that may be routinely used in clinical practice for diagnosis. AIM To evaluate the diagnostic performance of the serum Human Epididymis protein 4 (HE4) as biomarker for EC and to determine its association with clinicopathological variables. MATERIALS AND METHODS The study population included 60 postmenopausal women with a diagnosis of EC and 60 healthy postmenopausal female subjects (control group). Concentrations of serum HE4 and CA-125 in EC patients and control group were determined using Enzyme-Linked Immunosorbent Assays (ELISA). The value of serum HE4 and CA-125 for the diagnosis and prediction of stage, histology, myometrial invasion and lymph nodal metastasis was analysed. RESULTS The mean serum HE4 and CA-125 levels were significantly higher in patients with EC than those with control group (p<0.05). Comparison for HE4 and CA-125 between different stages showed a statistically significant difference. Stage I EC patients with <50% myometrial invasion had a significantly lower mean serum HE4 value than patients with >50% myometrial invasion (p=0.007). Corresponding values of CA-125 showed a similar trend (p=0.023). There were significantly higher levels of HE4 and CA-125 in cases with lymph node involvement. The levels of serum HE4 and CA-125 were higher in the non-endometroid histology, but the difference was not statistically significant. The Receiver Operating Characteristics (ROC) curve analysis for EC and control group showed that HE4 had greater Area Under Curve (AUC) when compared with CA-125. Using ROC curve, a serum HE4 concentration of 69.8 pmol/l (AUC 0.974) and/or serum CA-125 level of 34.50 U/mL (AUC 0.714) was used to predict malignancy. Sensitivity of combined biomarkers showed no additional improvement in comparison to HE4 or CA-125 alone. CONCLUSION Our results show that HE4 is a sensitive diagnostic serum marker for detection of EC patients, exhibiting a better diagnostic performance compared to CA-125. Good performance of HE4 in diagnosis of early stages EC indicates its usefulness as a prognostic marker and also to monitor therapy and detect early recurrence.
Collapse
Affiliation(s)
- Rupali Dewan
- Professor, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Abhinav Dewan
- Attending Consultant, Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Swati Hare
- Postgraduate Student, Department of Obstetrics and Gynaecology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Mausumi Bhardwaj
- Senior Scientist, Department of Research, National Institute of Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Krati Mehrotra
- Medical Officer, Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| |
Collapse
|
14
|
Abstract
Serum epididymis protein 4 (HE4) level is a useful biomarker for the management of ovarian and endometrial cancer patients. Urine HE4-test, with its easier access than serum test, has emerged as a new method with promising application for the diagnosis of ovarian cancer. Areas covered: This review summarizes data regarding the detection and alteration of HE4 in urine samples collected from ovarian cancer patients and controls. The performance and limitation of the assay and potential direction of future study are also discussed. Expert commentary: Several studies have demonstrated an appreciable efficiency of urine HE4-test in the discrimination of ovarian cancer patients from general population. However, the data is based on small cohorts, and the performance of urine HE4-test need to be validated in larger groups. An algorithm incorporating other important factors may allow a quantitative assessment of cancer possibility. Future studies on the HE4 renal secretion and HE4 degradation dynamics in urine are also required for the establishment of standard protocols for the application of urine HE4-test in clinical settings.
Collapse
Affiliation(s)
- Wanglei Qu
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , China
| | - Quansheng Gao
- b Laboratory of the Animal Center , Academy of Military Medical Sciences , Beijing , China
| | - Haibin Chen
- c Department of Histology and Embryology , Shantou University Medical College , Shantou , China
| | - Zuoqing Tang
- d Department of Medical Genetics , School of Basic Medical Sciences, Capital Medical University , Beijing , China
| | - Xueqiong Zhu
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , China
| | - Shi-Wen Jiang
- a Department of Obstetrics and Gynecology , The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University , Wenzhou , China
- e Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA
| |
Collapse
|
15
|
|