Serum HE4 as a prognostic marker in endometrial cancer: a population based study

Brennan, Donal J., Hackethal, Andreas, Metcalf, Alex M., Coward, Jermaine, Ferguson, Kaltin, Oehler, Martin K., Quinn, Michael A., Janda, Monika, Leung, Yee, Freemantle, Michael, Webb, Penelope M., Spurdle, Amanda B., Obermair, Andreas, ANECS Group, Spurdle, A. B., Webb, P. M. and Young, J. (2014) Serum HE4 as a prognostic marker in endometrial cancer: a population based study. Gynecologic Oncology, 132 1: 159-165. doi:10.1016/j.ygyno.2013.10.036

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Author Brennan, Donal J.
Hackethal, Andreas
Metcalf, Alex M.
Coward, Jermaine
Ferguson, Kaltin
Oehler, Martin K.
Quinn, Michael A.
Janda, Monika
Leung, Yee
Freemantle, Michael
Webb, Penelope M.
Spurdle, Amanda B.
Obermair, Andreas
Spurdle, A. B.
Webb, P. M.
Young, J.
Title Serum HE4 as a prognostic marker in endometrial cancer: a population based study
Journal name Gynecologic Oncology   Check publisher's open access policy
ISSN 0090-8258
Publication date 2014-01-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.ygyno.2013.10.036
Open Access Status Not Open Access
Volume 132
Issue 1
Start page 159
End page 165
Total pages 7
Place of publication Amsterdam, Netherlands
Publisher Elsevier
Language eng
Formatted abstract
HE4 has emerged as a promising biomarker in gynaecological oncology. The purpose of this study was to evaluate serum HE4 as a biomarker for high-risk phenotypes in a population-based endometrial cancer cohort.

Peri-operative serum HE4 and CA125 were measured in 373 patients identified from the prospective Australian National Endometrial Cancer Study (ANECS). HE4 and CA125 were quantified on the ARCHITECT instrument in a clinically accredited laboratory. Receiver operator curves (ROC), Spearman rank correlation coefficient, and chi-squared and Mann–Whitney tests were used for statistical analysis. Survival analysis was performed using Kaplan–Meier and Cox multivariate regression analyses.

Median CA125 and HE4 levels were higher in stage III and IV tumours (p < 0.001) and in tumours with outer-half myometrial invasion (p < 0.001). ROC analysis demonstrated that HE4 (area under the curve (AUC) = 0.76) was a better predictor of outer-half myometrial invasion than CA125 (AUC = 0.65), particularly in patients with low-grade endometrioid tumours (AUC 0.77 vs 0.64 for CA125). Cox multivariate analysis demonstrated that elevated HE4 was an independent predictor of recurrence-free survival (HR = 2.40, 95% CI 1.19–4.83, p = 0.014) after adjusting for stage and grade of disease, particularly in the endometrioid subtype (HR = 2.86, 95% CI 1.25–6.51, p = 0.012).

These findings demonstrate the utility of serum HE4 as a prognostic biomarker in endometrial cancer in a large, population-based study. In particular they highlight the utility of HE4 for pre-operative risk stratification to identify high-risk patients within low-grade endometrioid endometrial cancer patients who might benefit from lymphadenectomy.
Keyword Biomarker
Endometrial cancer
Prognostic marker
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID 339435
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Mater Research Institute-UQ (MRI-UQ)
Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 31 times in Thomson Reuters Web of Science Article | Citations
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