| Objective: This study is conducted by detecting the expression levels of urinary HE4, serum CA125 and serum HE4 from patients who are diagnosed with ovarian cancer and ovarian benign tumors, and from healthy women. The research aims to study the expressions and discuss the diagnostic significance of urine HE4 in patients with ovarian cancer.Methods: In this research, 28 patients with ovarian cancer, 30 patients with benign ovarian tumors and 30 healthy women are chosen as the samples of the subjects. The research is designed by collecting fasting venous blood 5ml of the samples, to test their expression levels of serum CA125 and serum HE4 in The Clinical Laboratory of our hospital before treatment. Meanwhile, by collecting5 ml morning urine of the subjects, the expression levels of urinary HE4 by using ELISA method before treatment are tested. Moreover,the professional statistical software SPSS 21.00 is adopted to analyze the collected experimental data.Results: 1. The comparisons of urinary HE4, serum HE4 and serum CA125 in the three groups of subjects before treatment are as follows. The expression levels of urinary HE4(pmol/L) in patients with ovarian cancer, patients with benign ovarian tumor and the healthy group are respectively: 10.60(8.30~14.50), 3.24(2.90~5.00), 3.30(2.16~5.78); The expressions of serum HE4(pmol/ L) are respectively: 148.40(77.20~308.98)、41.60(34.43~47.82)、38.70(28.28~48.70); moreover, the expressions of serum CA125(U / ml)are respectively: 5110.60(33.75~382.80)、13.60(9.38~37.63)、13.14(7.68~22.33).According to the research, the levels of urinary HE4, serum HE4 and serum CA125 of patients with ovarian cancer are significantly higher than those of patients with ovarian benign ovarian tumors and the group of healthy women(P < 0.05). However, the levels of urinary HE4, serum HE4 and serum CA125 are not significantly different between the group of patients with benign ovarian tumor and the group of healthy women(P > 0.05). 2. The comparisons of the expression levels of urinary HE4, serum HE4 and serum CA125 in patients with ovarian cancer who have different clinical features before treatment are as follows. 2.1 The expression levels of urinary HE4(pmol/L) in patients that are at early stage ovarian cancer(FIGO stage I/II) and late stage ovarian cancer(FIGO stage Ⅲ /Ⅳ)are9.80(8.16 ~ 11.20) and 13.86(11.29 ~ 16.42)respectively. Meanwhile, the expression levels of serum HE4(pmol/L) are96.70(75.50~197.20) and 243.60(161.60~342.40)respectively. Furthermore, the expression levels of serum CA125(U/ml)are44.30(28.57~235.30) and 134.90(310.00~1568.45)respectively. Thus, it seems that the levels of urinary HE4, serum HE4 and serum CA125 of patients with late stage ovarian cancer(stage Ⅲ/Ⅳ) are not significantly higher than that of patients with early stage ovarian cancer(stage I/II)(P > 0.05). 2.2 The expression levels of urinary HE4(pmol / L),serum HE4(pmol / L) and serum CA125(U / ml) in patients with histological grade G1 ovarian cancer are respectively: 10.32(7.76~14.63), 117.35(59.03~384.60) and 110.60(25.35~351.60); meanwhile, the statistics of patients with histological grade G2 ovarian cancer are respectively: 10.34(8.92~15.26), 171.20(80.60~334.70) and 159.20(31.95~5129.50); furthermore, patients with histological grade G3 ovarian cancer are respectively: 11.20(8.71~14.66), 144.80(102.90~233.10) and 93.96(38.45~3690.20).According to the results, it shows that the levels of urinary HE4, serum HE4 and serum CA125 are notsignificantly different among the patients with histological grade G1 ovarian cancer, histological grade G2 ovarian cancer and patients with histological grade G3 ovarian cancer(P > 0.05). 2.3 The expression levels of urinary HE4(pmol/L), serum HE4(pmol/L) and serum CA125(U / ml) in patients with ovarian cancer before menopause are respectively 9.82(8.50 ~ 16.92), 76.90(96.70 ~ 362.50) and 110.60(36.15 ~ 367.20); meanwhile, patients with ovarian cancer after menopause are respectively 10.83(7.34~12.74), 152.00(98.90~259.75) and 110.60(28.60~1421.50). Thus, it seems that the levels of urinary HE4, serum HE4 and serum CA125 are not significantly different between ovarian cancer patients who are before the menopause or after the menopause(P > 0.05). 3. The diagnostic value of urine HE4, serum HE4, serum CA125 and ROMA in the diagnosis of early stage ovarian cancer(FIGO stage I/II)(the gold standard is pathological diagnosis)is as follow: The values of sensitivity are 89.47%、73.68%、63.15% and 84.2% respectively. Moreover, the values of specificity are respectively 95%、96.7% 、86.7% and 95%. The positive predictive values are 85%、87.5%、60% and 84.2% respectively. Meanwhile, the negative predictive values are respectively 96.6%、92.6% 、88.1% and 95%. Furthermore, the diagnostic accordance rates are 93.6%、91.0% and 81.0% respectively. In terms of the diagnosis of early stage ovarian cancer(FIGO stage I/II), the specificity and positive predictive value of serum HE4 are not significantly higher than that of urinary HE4 and the negative predictive. Meanwhile, the diagnostic coincidence rate of urinary HE4 is not significantly higher than that of serum HE4. However, the value of sensitivity of urinary HE4 is significantly higher than that of serum HE4. 4. The AUC of urine HE4, serum HE4,and serum CA125 and ROMA index in the diagnosis of ovarian cancer are respectively 0.988, 0.969, 0.898 and 0.977.According to the results, it shows that the value of urine HE4 in the diagnosis of ovarian cancer is the highest, which also indicates higher value in terms of diagnoses. 5. As for the correlation analysis of urine HE4 and serum HE4, the results are asfollows:r=0.9295,P<0.0001. Thus, urinary HE4 is positively associated with serum HE4.Conclusion: 1. The level of urinary HE4 from patients with ovarian cancer is significantly higher than that of patients with ovarian benign ovarian tumors and the group of healthy women(P < 0.05). 2. The value of urinary HE4 in diagnosis of ovarian cancer may be better than that of serum CA125,serum HE4 and ROMA index, and the value for the early diagnosis of ovarian cancer may be more prominent. 3. Urinary HE4 is positively associated with serum HE4(r=0.0.9295, P < 0.0001), and may be relevant factors in patients with ovarian cancer and age, menopause, clinical stage, histological grade and renal function. Therefore, urinary HE4 as a non-invasive, convenient and economic detection method is expected to be a reference index for ovarian cancer screening and early diagnosis. |
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