ROLE OF SOME SERUM BIOMARKERS IN DISCRIMINATION OF BENIGN FROM MALIGNANT ADNEXAL MASS PATIENTS

Abstract

Ovarian cancer is one of the most common reproductive cancers and has the highest mortality rate amongst gynecologic cancers. Because most ovarian cancer diagnosis occurs in the late stages of the disease, five-year survival rates fall below 20%. To improve survival rates and to lower mortality rates for ovarian cancer, improved detection at early stages of the disease is needed. Current screening approaches include tumor markers, ultrasound, or a combination. Efforts are underway to discover new biomarkers of ovarian cancer in order to surmount the obstacles in early-stage diagnosis. Among serum protein markers HE4, Mesothelin and VEGF can augment CA125 detection providing higher sensitivity and specificity due to the presence of these proteins in early-stage of ovarian cancer. The aim of this study was to evaluate the validity of using HE4, Mesothelin and VEGF either alone or in combination with CA125 in discrimination of benign from malignant adnexal mass patients in the effort of early detection of ovarian cancer. At different ages, a total of 174 Gynecologic Hospitalized Patients presented with adnexal mass and planned for surgical management were included in this study. They were classified into two groups (women with benign lesions and women with malignant tumors). Blood samples were taken just before surgery; sera were subjected to determination of serum HE4, Mesothelin and VEGF which determined using ELISA kit developed by Fujirebio Diagnostic, Inc., while CA125, CA19.9, CEA and AFP were determined by the electrochemiluminesence immunoassay technique on Elecsys 2010 immunoassay analyzer-Hitachi Ltd- Japan. The present data revealed a significant statistical difference between studied groups as regard to HE4, Mesothelin, VEGF and CA125. Also the present results demonstrated a significant positive correlation between studied markers (HE4, Mesothelin and VEGF) as regard to the stage of the tumor while Mesothelin had a significant positive correlation with both stage and grade of the tumor. While the using receiver operating characteristic curves (ROC) for Mesothelin, VEGF and HE4 revealed the prediction of malignancy in all included women donated by the area under the curves (AUC). It could be concluded that the using of HE4, Mesothelin and VEGF either alone or in combination with CA-125 could be a useful tool in prediction and early diagnosis of ovarian cancer at different stages and grades.