Serum human epididymis protein 4 vs carbohydrate antigen 125 for ovarian cancer diagnosis: a systematic review

Journal of Clinical Pathology - Tập 66 Số 4 - Trang 273-281 - 2013
Simona Ferraro1, Federica Braga1, Monica Lanzoni2,3, Patrizia Boracchi2,3, Elia Biganzoli2,3, Mauro Panteghini1
1Laboratorio Analisi Chimico-Cliniche, Azienda Ospedaliera 'Luigi Sacco', and Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Università degli Studi, Milano, Italy
2Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
3Sezione di Statistica Medica e Biometria, Università degli Studi, Milano, Italy

Tóm tắt

BackgroundHuman epididymis protein 4 (HE4) measurements in serum have been proposed for improving the specificity of laboratory identification of ovarian cancer (OC).ObjectiveTo critically revise the available literature on the comparison between the diagnostic accuracy of HE4 and carbohydrate antigen 125 (CA-125) to confirm the additional clinical value of HE4.MethodsA literature search was undertaken on electronic databases and references from retrieved articles; articles were analysed according to predefined criteria. Meta-analyses for HE4 and CA-125 biomarkers with OR, diagnostic sensitivity, specificity, positive (LR+) and negative (LR–) likelihood ratios as effect sizes were performed.Results16 articles were originally included in meta-analyses, but two for HE4 and one for CA-125 were eliminated as outliers. Furthermore, for HE4 a publication bias was detected. ORs for both HE4 (37.2, 95% CI 19.0 to 72.7, adjusted for publication bias) and CA-125 (15.4, 95% CI 10.4 to 22.8) were significant, although in a heterogeneous set of studies (p<0.0001). By combining sensitivity and specificity, the overall LR+ and LR– were 13.0 (95% CI 8.2 to 20.7) and 0.23 (95% CI 0.19 to 0.28) for HE4 and 4.2 (95% CI 3.1 to 5.6) and 0.27 (95% CI 0.23 to 0.31) for CA-125, respectively.ConclusionsHE4 measurement seems to be superior to CA-125 in terms of diagnostic performance for identification of OC in women with suspected gynaecological disease. Due to the high prevalence of OC in post-menopausal women and the need for data focused on early tumour stages, more studies tailored on these specific subsets are needed.

Từ khóa


Tài liệu tham khảo

Ferlay J Shin HR Bray F . GLOBOCAN 2008, cancer incidence and mortality worldwide: International Agency for Research on Cancer. Lyon, France, 2010. http://globocan.iarc.fr (accessed May 2012).

10.1016/j.ygyno.2006.08.022

National Institute for Health and Clinical Excellence (NICE): Guidance. Ovarian cancer: the recognition and initial management of ovarian cancer. National Collaborating Centre for Cancer (UK). Cardiff, UK: National Collaborating Centre for Cancer, 2011.

10.1373/clinchem.2008.105601

10.1200/JCO.2003.01.068

Köbel, 2008, Ovarian carcinoma subtypes are different diseases: implications for biomarker studies, PLoS Med, 5, 1749, 10.1371/journal.pmed.0050232

10.1245/ASO.2003.05.015

10.1016/j.ygyno.2008.04.041

Hellström, 2003, The HE4 (WFDC2) protein is a biomarker for ovarian carcinoma, Cancer Res, 63, 3695

10.1016/j.ygyno.2005.06.040

Shuang, 2012, Diagnostic value of HE4 for ovarian cancer: a meta-analysis, Clin Chem Lab Med, 50, 1439

10.1059/0003-4819-155-8-201110180-00009

10.1016/j.jclinepi.2010.07.015

10.1371/journal.pmed.1000100

10.1186/1471-2288-6-31

10.1136/bmj.329.7458.168

10.1093/jnci/djn326

10.1002/ijc.26129

10.1158/1055-9965.EPI-11-0635

10.1373/clinchem.2010.157073

10.1007/s13277-011-0204-3

10.1016/j.ajog.2011.05.017

10.1097/IGC.0b013e31821a3726

10.1016/j.cca.2011.04.028

10.1016/j.ygyno.2011.02.022

10.1038/sj.bjc.6606092

10.1515/CCLM.2011.075

10.1371/journal.pone.0029533

Modarres-Gilani, 2011, Simultaneous measurement of two serum markers (CA-125 and HE-4) while diagnosing malignant ovarian epithelial tumors, Pak J Med Sci, 27, 858

Abdel-Azeez, 2010, HE4 and mesothelin: novel biomarkers of ovarian carcinoma in patients with pelvic masses, Asian Pac J Cancer Prev, 11, 111

10.1007/s13277-009-0015-y

10.1016/j.ygyno.2010.02.005

10.1038/sj.bjc.6605011

10.1200/JCO.2007.11.9594

10.1097/01.AOG.0000263913.92942.40

National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology. Ovarian cancer. Version 2.2009. Washington, PA: NCCN, 2009.

Zweig, 1982, Why we need better test evaluation, Clin Chem, 28, 1272, 10.1093/clinchem/28.6.1272

10.1002/sim.3631

10.1002/sim.2889

10.1093/jnci/djj019

10.1136/jclinpath-2011-200198

Thông tin
Thông tin xuất bản

Journal of Clinical Pathology

Tập 66 Số 4

273-281

Thông tin tác giả