Serum HE4 Detects Ovarian Cancer Recurrence Earlier Than CA 125: Indian Study

Abstract

Introduction: Recurrence is a frequent phenomenon of the natural history of epithelial Ovarian Cancer (OC). Early detection of recurrence is important. Clinical examination combined with Carbohydrate Antigen 125 (CA125) and imaging are used for the follow-up of these patients. Human Epididymis Protein 4 (HE4) is a recent marker which is found to have elevated in OC. Aim: To study the role of HE4 in detection of OC recurrence. Materials and Methods: This prospective study was conducted at Department of Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh, India. Patients were enrolled from January 2014 to January 2016 after informed written consent. Total 65 patients of carcinoma ovary were prospectively followed up after completion of their primary treatment. 19 patients had clinical evidence of recurrence as detected by radiological imaging and subsequently proved by pathological examination. Timing and levels of rise in tumour marker were studied and correlated with timing of clinical evidence of disease. Results: HE4 and CA125 detected recurrence in 19 (100%) and 14 (73.7%) patients respectively. Among these 5 (26.3%) recurrence were detected by HE4 alone. In 10 (52.6%) patients, simultaneous rise in both of these markers were noticed and in 4 (21.1%) patients HE4 started rising before CA125 with a lead time of 3.25 months. CA125 was found to be in normal range in all mucinous carcinoma and two out of 16 serous carcinoma. Conclusion: HE4 is a potential useful serum marker to detect OC recurrence timely and better as compared to traditional utilised CA125. Future studies based on recurrence detection by HE4 may provide evidence on its role on survival.

Keywords

• carbohydrate antigen 125
• carcinoma ovary
• early detection
• human epididymis protein 4