title: The role of HE4 in endometrial cancer recurrence: how to choose the optimal follow-up program.
abstract: The aim of this study was to evaluate for the first time in the literature the role of HE4, at primary diagnosis, compared to CA125 as an indicator of endometrial cancer (EC) recurrence. Our study is a retrospective analysis of 252 EC patients treated, between January 2009 and July 2013, at the Division of Gynaecologic Oncology of Campus Bio-Medico University of Rome. Thirty-seven patients experienced recurrence. Median follow-up was 38 months. HE4 and CA125 levels were analyzed at primary diagnosis, during follow-up and either after histological or radiological confirmation of recurrent disease or at last registered visit, when patients returned to our Department with no evidence of recurrent disease. A statistically significant difference was observed between HE4 values at primary diagnosis and at recurrence, respectively, comparing recurrent and non-recurrent patients (p < 0.05), while CA125 values resulted not statistically significant (p = 0.08) at each time point. Considering the poor specificity of HE4 at threshold of 70 pmol/L at primary diagnosis, in our cohort of patients, we found out that HE4 cut-off of 201.3 pmol/L is able to correctly classify patients at high or low risk of EC recurrence, with a sensitivity of 80 % and a specificity of 91 % (PPV = 90.3 % and NPV = 90.8 %). In particular, HE4 performance improves in cases of endometrioid histotype. HE4 levels at primary diagnosis correlate with an increased risk of EC recurrence, particularly in cases of endometrioid histotype, and they may help to recognize patients who may need a more intensive follow-up.
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Angioli
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy. s.capriglione@unicampus.it.
authors.forename: Stella
authors.initials: S
authors.lastname: Capriglione
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Scaletta
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Aloisi
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Miranda
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Cicco Nardone
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Terranova
authors.affiliation: Department of Obstetrics, University of Rome "Campus Bio-Medico", Via Alvaro del Portillo, 200, 00128, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Plotti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000096:biosynthesis* / Q000235:genetics; D018394:CA-125 Antigen / Q000096:biosynthesis / Q000235:genetics*; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008565:Membrane Proteins / Q000096:biosynthesis / Q000235:genetics*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000473:pathology; D011379:Prognosis; D011506:Proteins / Q000235:genetics*; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
keywords: Endometrial cancer; HE4; Prognostic factor; Recurrence