Utility of HE4 to identify patients with endometrioid endometrial cancer who may require lymphadenectomy.
OBJECTIVE
The aim of the study was to establish whether preoperative serum levels of HE4 and CA125 could be a good predictor for lymphadenectomy in the early stage of endometrioid adenocarcinoma of the uterus.


METHODS
Preoperative serum HE4 and CA125 were measured in 78 postmenopausal patients treated surgically. The ROC curves were generated to determine the optimal cutoff values of HE4 and CA125 levels with optimum sensitivity and specificity for the prediction of lymphadenectomy.


RESULTS
Based on ROC curve, we found that the HE4 value of 78pmol/l is the best cutoff to identify candidates who may require lymphadenectomy with the sensitivity of 86.6% and the specificity of 67.2% (NPV=88.4% and PPV=51.2%). The area under the curve (AUC) equals 0.814 (95% CI=0.721-0.886). The cutoff level of CA125 that shows the prognostic indices is 26U/ml, with the sensitivity of 66.6% and the specificity of 61.2% (NPV=69.4% and PPV=44.3%). For CA125 the AUC amounts to 0.671 (95% CI=0.568-0.764). We also found a statistically significant difference, comparing HE4 and CA125 AUC (0.814 vs. 0.671, respectively, p<0.001). The combination of HE4 and CA125 established in our study as the cutoff point has the sensitivity of 81.2% and the specificity of 65.9% with NPV=83.4% and PPV=47.9%.


CONCLUSIONS
Our findings indicate that in the early stage of endometrioid endometrial cancer, HE4 can serve as a preoperative tool that can help to identify postmenopausal women who may require lymphadenectomy.
Department of Obstetrics, Gynecology and Maternity Care, Medical University of Bialystok, Bialystok, Poland.
Bozena
B
Dobrzycka
Department of Gynecologic Oncology, Bialystok Oncology Center, Bialystok, Poland.
Beata
B
Mackowiak-Matejczyk
Department of Food Science and Technology, Medical University of Bialystok, Bialystok, Poland.
Katarzyna Maria
KM
Terlikowska
Department of Gynecology and Obstetrics, Provincial Hospital in Bialystok, Bialystok, Poland.
Maciej
M
Kinalski
Department of Obstetrics, Gynecology and Maternity Care, Medical University of Bialystok, Bialystok, Poland. Electronic address: sterlikowski@gmail.com.
Slawomir Jerzy
SJ
Terlikowski
D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood; D018269:Carcinoma, Endometrioid / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011506:Proteins / Q000378:metabolism*; D012372:ROC Curve; D000081102:WAP Four-Disulfide Core Domain Protein 2
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
CA125; Endometrial cancer; HE4; Lymphadenectomy