The Diagnostic Value Of Determination Of Serum HE4 Associated With CA125, CA19-9 In Patients With Ovarian Cancer

Ovarian cancer is one of the three main malignant gynecological malignancies. Its histological type is complicated and serous ovarian cancer is the most common. The death rate of ovarian malignant tumor remains at the top and the incidence of this disease have been rising year by year. Because there is no effective method to diagnose the disease at its early stage, about 70～80% of ovarian cancers have been in advanced stage when they are diagnosed. The 5-year survival rate for Ovarian cancer is only 20～30%. Now serum antigen cancer 125 (CA125) has been widely used in the world as epithelial ovarian cancer tumor markers. The value of CA125 has been confirmed. However, The CA125 diagnosis rate in the early stage is low. In the other benign diseases of female such as endometriosis, pelvic inflammatory disease or other malignant genital tumor of female and other malignant disease in other organs, the level of CA125 is, to some extent, higher. So one of the contemporary researches is focused on discovering tumor markers combined with CA125 in order to enhance sensitivity, specificity and early diagnosis rate for ovarian cancer. Human epididymis secretary protein4(HE4, called WFDC2) may be a new biomarker for ovarian cancer. The expression of HE4 gene is enhanced in ovarian cancer, whereas its expression in normal tissues, including benign tumor, is low. This suggests that HE4 may have certain value for diagnosis of ovarian cancer, but at present, the research on HE4 is rare and its clinical significance needs further study. We want to evaluate the value of serum HE4 joint CA125, CA19-9 detection in ovarian cancer diagnosis and postoperative evaluation.The patients with pelvic mass from the second and the first Affiliated Hospital of Zhengzhou University were chosen from January 2008 to April,2009. According to the postoperative pathology, patients were divided into ovarian cancer group(35 cases) and pelvic benign mass group(73 cases).40 healthy women in the hospital medical center were taken as control group.ELISA techique was used to detect the HE4 level of all women's blood specimens. The level of CA125 and CA19-9 were obtained by the conventional lab test in our hospital.All data are processed by software SPSS13.0. The data were all expressed as mean±standard deviation (x±s). Counting material was analyzed by variance analysis and t test. Comparison between groups was analyzed by using LSD and difference in masculine rate was analyzed by x test. In addition, the diagnosis value for HE4 is analyzed using the receiver-operating characteristic (ROC) curve.α= 0.05.1. Comparing the positive rate of HE4 with CA125 in ovarian cancer group, we get the result that the differences between them were not statistically significant. (χ2 =0.299, P=0.584); Comparing the positive rate of serum HE4 with CA125 and CA19-9 in pelvic benign masses group, we get the result the difference between them was statistically significant (χ2=25.903, P<0.001;χ2=15.485, P< 0.001)2. Sensitivity of combination of HE4, CA125 and CA19-9 is higher than single marker measure, the differences are statistically significant (P< 0.05).3. The levels of serum HE4 in patients with serous carcinoma and endometrial carcinoma were significantly higher than that in patients with mucous carcinoma, transparent cell carcinoma and germ cell tumors patients.4. Comparing the levels of serum HE4 in III-IVstage of malignant ovarian tumor with that inⅠ～Ⅱstage, we get the result that The difference was not statistically significant (T=0.668; P=0.432).5. Comparing the levels of serum HE4, CA125, CA19-9 after the operation with them before the operation, we get the result that the differences were statistically significant (T=3.15, P=0.002; T=3.363, P=0.001; T=9.087, P=0.001).6. When HE4 cut-off point of 112.2pmol/L and 150pmol/L, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy was no statistically significant difference (P> 0.05).1. The joint inspection of these markers may improve the diagnosis of ovarian cancer.2. HE4 may be applied as a new marker of ovarian tumor used for clinical ovarian cancer diagnosis, which is expected to become the reference index in the judge of clinical curative effect for ovarian serous carcinoma and endometrial carcinoma.3. HE4 is better than CA125 in distinguishing malignant ovarian disease from benign ovarian disease, so it is expected to become the important reference index for early diagnosis of ovarian cancer.4. The expression level of HE4 may correlate with the histological type, but has no obvious correlation with the clinical stages.5. When the set point of HE4 is 112.6 pmol/L in this study, it may be superior to 150 pmol/L for improving the diagnostic sensitivity, accuracy and reducing the rate of missed diagnosis.