The role of CA125 and HE4 serum markers in predicting the locoregional stage of endometrial cancer

Aim: The aim of this paper was to evaluate the usefulness of preoperative values of CA125 and HE4 serum markers in assessing the locoregional severity of endometrial cancer. Materials and methods: We analyzed clinical material from patients with endometrial cancer who were initially treated surgically in the Center of Oncology (Krakow Branch) between 2012 and 2014. As part of preoperative preparation pelvic magnetic resonance imaging with an assessment of myometrial invasion was performed and CA125 and HE4 marker levels were determined. After this, patients were selected for surgery-hysterectomy with both salpingooophorectomy. Lymphadenectomy was performed on patients from high-risk group. We analyzed the relationship between the assessment of marker levels, on the one hand, and myometrial invasion, the presence if Lymphovascular Space Invasion (LVSI) and the severity and the risk of recurrence, on the other. The statistical evaluation of the results was based on the Mann-Withney test and the Kruskal-Wallis test. Results: We analyzed medical history of 128 patients with endometrial cancer. It was shown in the study group that CA125 levels were significantly higher in patients with affected lymph nodes as well as in patients with stages III and IV, the presence of LVSI and cervical infiltration, muscular infiltration exceeding ½ of the myometrial wall thickness, assessed preoperatively in both the MRI and clinical examination but this relationship was not observed in the final histopathological evaluation. Marker levels were also not affected by the histological type of the tumour. HE4 levels were significantly higher in patients with muscular infiltration exceeding ½ of the wall thickness assessed in MRI as well as in clinical and histopathological, in patients with stage III and IV, the presence of LVSI and cervical infiltration. There were no relationship between higher HE4 values and affected lymph nodes. Conclusion: Our results confirm the utility of the CA125 and HE4 markers in EC. The sensitivity and specificity of each of them separately is not enough to make clinical decisions. However, when combined with other factors they can be an important criterion for determining the classification of patients who belong in the high-risk group.