Expression Of Serum HE4 And CA125 In Gynecological Benign And Malignant Lesions

BackgroundThe most widely used serum biomarker in gynecology is CA125. However, neither sensitivity nor specificity of CA125 is ideal. CA125 could be elevated with different level and proportion in both malignant tumor such as ovarian cancer or in benign occasion such as endometriosis. Therefore, to find another serum biomarker, to be a supplement of CA125 in order to better differential diagnosis of gynecologic conditions, is under great concern. Recently, there appeared a new biomarker called human epididymis protein 4(HE4), is under heat discussion.Objective1. To find out the differences of serum CA125 level as well as HE4 level in common gynecologic tumors.2. To explore what factors influence the serum level of CA125 and HE4.3. Whether CA125 and HE4 can differential diagnosis of ovarian cyst, uterine disease and benign/malignant conditions of gynecology as a whole.4. Evaluate the effect of CA125 and HE4 combined test.MethodsFrom Jan.2015 to May 2015, select in-patients who are in the GYN ward of Peking Union Medical College Hospital, with common benign or malignant tumors and will take surgery. The total number is 202. Draw their venous blood one day before surgery and separate serum from the whole blood. Test the serum HE4 level via HE4 ELISA kit. Then collect their clinical information such as baseline information, CA125 level tested by the Hospital Lab before surgery, and pathology results. Through Statistical analysis to get final results.Result1. In endometriosis, menopause (p=0.04)and parity(p=0.015) affect serum CA125 level. Apart from this condition, age, menopause, gravidity, parity are neither factors that affect CA125 and HE4(p>0.05).2. Different type of endometriosis(OE, AM,pEM,DIE,combined) does not affect CA125 or HE4(p>0.05). But we can observe the trend that abdominal EM patients’CA125 and HE4 level is lower than other types.3. In endometriosis, GnRha treatment can make CA125 level down but won’t for HE4.4. In myoma, we can observe the trend that myoma degeneration group has higher CAl 25 and HE4 level, but without significance.5. In ovarian tumor, benign/malignant affect CA125 level with significance while the pathologic type affect HE4 significantly.6. Get rid of the effects of chemotherapy and pathologic type, HE4 can differentiate benign\borderline\malignant ovarian tumors.7. HE4 react to chemotherapy greater than CA125.8. HE4 level is higher in teratoma than other ovarian benign tomor.9. There are no significant difference between benign endometrial diseases and endometrial cancer with CA125 and HE4.10. Both CA125 and HE4 are not capable to differientiate OC and OE.11. To differentiate gynecologic diseases, malignant vs. benign, AUC:CA125 0.575±0.058, HE40.628+0.050 CA125+HE4 0.662±0.053, combined test is better than either.Conclusion1. Main factors that affect serum CA125 level in ovarian tumor is benign or malignant. In endometriosis, serum CA125 level is also affected by menopause, parity and GnRha treatment.2. Main factors that affect serum HE4 level is benign or malignant, pathology classification of ovarian tumors and chemotherapy.3. Serum HE4 level is high in ovarian tumor, all types of endometriosis and teratoma. These three group cannot be differentiate. HE4 level is low in other benign tumors.4. Neither CA125 nor HE4 can differentiate ovarian cancer and ovarian endometriosis. Neither can they differentiate uterine benign and malignant diseases. Both can differentiate ovarian cancer from benign ovarian tumor(apart from OE and teratoma).5. Single CA125 level cannot differentiate benign/malignant gynecologic condition but single HE4 level can. Nevertheless, CA125+HE4 combination test is better than single test.