HE4 Test for Patients with Ovarian Cancer

Ovarian cancer is one of the common malignant tumors that threaten women's health. 70% of the patients have been diagnosed with advanced stage. Even after tumor cell reduction and chemotherapy, the five-year survival rate of advanced stage patients is only 20% to 30%. Currently, the diagnosis of ovarian cancer mainly depends on clinical symptoms, pelvic examination, transvaginal ultrasound, CT/MRI, and serum tumor markers.

Commonly used serum markers include CA125,HCG,CEA,TPA, etc., especially carcinoma antigen 125, which is the most widely used and plays an important role in clinical diagnosis, chemotherapy monitoring, and follow-up. However, due to the low specificity, it has little significance in the early screening of ovarian cancer.

Therefore, for ovarian cancer, there is a clinical lack of effective means of early diagnosis. The discovery of human epididymal protein 4 (HE4) helped to solve this problem to a great extent.

1. Application of human epididymal protein 4 (HE4) test:

(1) Combined with CA125, this test was used to calculate the risk prediction index (PI) of malignant ovarian cancer to evaluate the risk of epithelial ovarian cancer in premenopausal and postmenopausal women with pelvic tumors (predicted probability ROMA value).

(2) Monitor the disease status of patients diagnosed with ovarian cancer:

Multiple studies have demonstrated that changes in serum HE4 concentration in ovarian cancer patients are positively correlated with changes in disease progression. Therefore, the progression of ovarian cancer can be evaluated by continuous tests of serum HE4 concentration levels.

(3) Explanation of application limitations:

Human epididymal protein 4 (HE4) levels may be normal in some patients with diagnosed ovarian cancer, which may be found in mucin-type ovarian cancer or germ cell-type ovarian cancer, which rarely express HE4.

The concentration level of the HE4 tumour marker cannot be used as absolute evidence to determine the existence of malignant tumors.

The risk assessment rules for malignant ovarian cancer do not apply to patients undergoing chemotherapy or younger than 18 years of age.

2. Interpretation of human epididymal protein 4 (HE4)

HE4 levels are associated with age, and the older you get, the higher its level is. Healthy women have HE4 levels below 140, and about 98% of women have HE4 levels below 140. HE4 is expressed at a high level in ovarian cancer cases, and more than 80% of the patients with a significant increase have suffered ovarian cancer.

HE4 levels are associated with disease progression. If there is a significant increase in HE4, the disease is progressing.

HE4 level can also reflect the effect of chemotherapy. An increase in HE4 indicates disease progression and a decrease in HE4 indicates the disease is in remission and the treatment is responding.

HE4 can also reflect the outcome of surgery. HE4 decreases in the vast majority of patients after surgery, some by more than 90 percent. If the HE4 level is found to be decreased and then increased in the postoperative follow-up, it indicates that the tumor may relapse. Therefore, HE4 is also a test index of early tumor recurrence.

Under normal physiological conditions, HE4 human epididymis protein 4 is expressed at a very low level in the human body, but it is highly expressed in ovarian cancer tissues and serum of patients, which can be used for the early diagnosis, differentiation, treatment monitoring and prognosis evaluation of ovarian cancer. Elevated HE4 occurs in 88% of ovarian cancer patients.

Compared with CA125, HE4 is more sensitive and specific, especially in the asymptomatic stage at the early stage of the disease. The sensitivity for early diagnosis of HE4 was 82.7%, but only 45.9% for CA125. Compared with the 20% specificity of CA125, the specificity of HE4 is up to 99%. This means that clinicians have more confidence in the results of the HE4 test. When a clinician diagnoses ovarian cancer based solely on the CA125 test, 8 out of 10 women may be misdiagnosed. HE4 and CA125 are complementary markers. Combined application of the two can increase the sensitivity to 92% and reduce the false negative results by 30%, greatly increasing the accuracy of ovarian cancer diagnosis. Clinicians can also grade the risk of epithelial ovarian cancer in women with pelvic masses by using HE4 in conjunction with CA125 to calculate ROMA (malignant risk calculation).

In addition, the quantitative test of human epididymal protein 4 (HE4) in ovarian cancer patients can also help to monitor the disease status, reflect the therapeutic effect and detect cancer recurrence in the early stage, which has important reference value. In most ovarian cancers, both HE4 and CA125 are elevated, but in some ovarian cancers, only a single tumor marker is elevated. Therefore, the combination of the two can avoid the negative results of a single application resulting in the missed diagnosis of disease recurrence. Learn more about tumor markers list including ca199 marker.