title: Physiopathological factors affecting the diagnostic value of serum HE4-test for gynecologic malignancies.
abstract: Serum epididymis protein 4 (HE4) represents a useful biomarker for the management of ovarian cancer and endometrial cancer patients. However, HE4 levels are affected by many physiopathological conditions or disorders that should be taken into consideration for an efficient application of this biomarker. Areas covered: The review provides an up-to-date reference on the multiple physiopathological factors that cause fluctuation of HE4 serum levels, and evaluates their impact on HE4-test in clinical settings. Potential mechanisms underlying the regulation of HE4 expression are also discussed. The review is based on data from literature search of PubMed and the author's opinions. Expert commentary: Studies have shown that physiopathological factors such as age, infection/inflammation, renal function, menopause and hormonal levels impose significant impacts on HE4 serum levels. HE4 amount shed into the circulation is related to HE4 expression and secretion by tumor as well as normal tissues, which is affected by cancer heterogeneity, vascular permeability, renal clearance and HE4 degradation. Investigation on interfering factors builds a basis for the construction of a quantitative logarithm for individualized application of HE4-test in clinical settings.
authors: a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
authors: Wanglei
authors: W
authors: Qu
authors: b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA.
authors: Jinping
authors: J
authors: Li
authors: a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
authors: Ping
authors: P
authors: Duan
authors: c Department of Medical Genetics, School of Basic Medical Sciences , Capital Medical University , Beijing , China.
authors: Zuoqing
authors: Z
authors: Tang
authors: b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA.|d Department of Histology and Embryology , Shantou University Medical College , Shantou , Guangdong , China.
authors: Fengbiao
authors: F
authors: Guo
authors: d Department of Histology and Embryology , Shantou University Medical College , Shantou , Guangdong , China.
authors: Haibin
authors: H
authors: Chen
authors: a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
authors: Xueqiong
authors: X
authors: Zhu
authors: a Department of Obstetrics and Gynecology , The Second Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.|b Department of Biomedical Science , Mercer University School of Medicine , Savannah , GA , USA.
authors: Shi-Wen
authors: SW
authors: Jiang
mesh_terms: D014408:Biomarkers, Tumor; D016889:Endometrial Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008593:Menopause / Q000097:blood; D008597:Menstrual Cycle / Q000097:blood; D009928:Organ Specificity / Q000235:genetics; D010051:Ovarian Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000235:genetics; D011506:Proteins / Q000235:genetics / Q000378:metabolism*; D012307:Risk Factors; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D014408:Biomarkers, Tumor; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
keywords: HE4; biomarker; diagnosis; gynecologic cancers; prognosis