The Utility of Serum HE4 in Predicting Myometrial Invasion in Patients with Endometrial Cancer

Background: Human epididymis protein 4 (HE4) is a novel tumor marker that has shown a strong potential in diagnosing and predicting the prognosis of endometrial cancer. In this study, we aimed to assess the association of tumor size and stage, ovarian involvement, lymph node metastasis, lymphovascular space invasion and deep myometrial invasion with preoperative serum levels of HE4 in endometrial cancer patients. Method: This cross-sectional study included patients with endometrial cancer awaiting surgery in Ghaem Hospital, Mashhad, Iran, from May 2016 to May 2017. We measured the HE4 levels preoperatively and gathered other required information postoperatively; collected data were analyzed using SPSS version 16. Results: We enrolled 104 endometrial cancer patients. Mean serum HE4 was 149.6±186.2pmol/l. Level of serum HE4 had significant positive correlations with tumor size and stage, lymph node metastasis, ovary involvement, lymphovascular space invasion and profound myometrial invasion (P<0.001). There was no association between age and myometrial invasion. Moreover, using ROC curve, we calculated a serum HE4 cut-off of 104 pmol/l to be 91% sensitive and 89.6% specific for the detection of deep myometrial invasion. Conclusion: HE4 is a novel biomarker capable of preoperatively predicting the depth of myometrial invasion with high specificity and sensitivity. This marker can be utilized in guiding the surgical plan of patients with endometrial cancer.