The Utility of CA125 and HE4 in Patients Suffering From Endometrial Cancer

Uterine endometrial cancer (EC) is the most common female reproductive system malignancy. There are various comments on pelvic and para-aortic lymphadenectomy during the surgical staging of EC. Several oncologists believe that total lymphadenectomy, in some cases, may lead to operative morbidity without any considerable advantage over more surveillance, especially in patients with comorbidities. The purpose of the current study was to examine the correlation between serum tumor marker levels and stage, grade, histological type, myometrial invasion, and lymph node involvement in EC.

A total of 131 patients with EC participated in the present cross-sectional study. Preoperative serum CA125 and HE4 levels were evaluated 1 week before surgery. Then, the stage, grade, and lymph node involvement were recorded according to the pathological findings. After Data analysis through SPSS software, P value<0.05 was considered to be significant.

One hundred thirty-one patients with EC (70, 31, 15, and 15 patients in sequence with stages IA, IB, II, and III) were analyzed. The serum CA125 and HE4 levels were significantly higher in more advanced stages (over IA), (P = 0.016 and P = 0.004, respectively). Levels of both tumor markers were significantly higher in patients with lymph node involvement, and cervical and myometrial invasions. In logistic regression analysis, a significant correlation was found between HE4 level (odds ratio [OR] = 1.005, P = 0.035) and grade of disease (OR = 2.137, P = 0.005).

HE4 and CA125 are useful for predicting high-risk patients. Sensitivity of 64% and specificity of 60% were indicated at cut-off value of 70 pmol/L for HE4 in stage IA in comparison with stages over IA. Although the ideal cut-off which is defined as higher than 80% was not obtained, such a cut-off (60%) can also be considered for preoperative evaluation of surgical staging of EC.