abstract
OBJECTIVE:
About
5-15% of all malignant ovarian tumors are metastases from other
malignancies such as gastrointestinal tumors, breast cancer or melanoma.
Also other gynecological tumors can metastasize to the ovaries. It is
crucial to differentiate between primary epithelial ovarian cancer (EOC)
and ovarian metastases because different treatment is required. The
clinical value of Human Epididymal secretory protein 4 (HE4) as a serum
biomarker in primary ovarian cancer has been established.
The use of HE4
in the differentiation between primary ovarian cancer and ovarian
metastases from other malignancies has never been investigated.
METHODS:
HE4,
CA125 and CEA were measured in 192 patients with EOC (n=147) or ovarian
metastases (n=40). Univariate and multivariate logistic regression
analyses were done. Sensitivity, specificity and area under the curve
(AUC) were calculated for all markers and ratios hereof using receiver
operating characteristics methodology.
RESULTS:
Median
serum HE4 concentration was significantly higher in patients with EOC
compared to patients with ovarian metastases (431 pmol/L vs 68 pmol/L,
p<0.001). HE4 and CEA were independent factors in differentiating
between EOC and ovarian metastases (both p<0.001) while CA125 was not
(p=0.33). The HE4
2.5/CEA ratio demonstrated the highest
discriminative value (ROC-AUC 0.94) compared to HE4, CEA, CA125 or
CA125/CEA ratio (0.88, 0.78, 0.80 and 0.89 respectively) and showed a
specificity of 82.5% at set sensitivity of 90% in discriminating EOC
from ovarian metastases.
CONCLUSION:
HE4 can be used in combination with CEA to make the distinction between EOC and ovarian metastases from gastrointestinal origin.
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