Poster Presentation 35th Lorne Cancer Conference 2023

Can HE4 replace CA 125 as a diagnostic biomarker in ovarian cancer? (#136)

Harshita Dubey 1 , Amar Ranjan 1 , PRANAY TANWAR 1
  1. All India Institute of Medical Sciences, New Delhi, New Delhi, DELHI, India


Ovarian cancer is currently diagnosed using CAl25, which has a number of fallacies. Recently HE4 (human epididymis protein) is an emerging biomarker. It has higher potency to differentiate benign tumors from a malignant one.   


We studied 123 cases of ovarian cancer confirmed by histopathological examination. Whole blood samples were collected at the time of diagnosis prior to therapy (chemotherapy or surgery). We tested them for serum level of CA 125 & HE4. Cut-off values for HE4 and CA125 were <57.6 pmol/L and <39.6 U/mL respectively. Cut off values were calculated by ROC curve analysis. 


 Total 123 cases were evaluated for serum levels of HE4 & CA125 prior to therapy. Results are being displayed in table 1. 

Out of 123 cases, 38 showed CA 125 values negative, whereas the same was 14 for HE4, indicating better diagnostic performance by HE4. As studied by Drapkin et al 2005, the serum level of HE4 will not be raised in 50% cases of clear-cell variants and almost all cases of mucinous tumors. It is positive in 93% of cases of serous tumors and almost all cases of endometrioid tumors. It will not be raised in benign ovarian cysts. 

Among premenopausal cases (42/123), 10 showed CA 125 negative whereas HE4 was negative in 7/42 cases. Out of 10 CA 125 negative cases, 5 were HE4 positive. Out of HE4 negative cases, 2/7 showed CA 125 positive results. Mucinous and clear cell variants show HE4 negative results.

Among postmenopausal cases (81/123), 25 showed CA 125 negative whereas HE4 was negative in 7/42 cases. 18/ 25 CA 125 negative cases showed positive HE4 results. None of the HE4 negative case showed a higher CA 125 value.


Study shows HE is more accurate in diagnosing OC & differentiating it from benign tumors. The study is continued to achieve a decisive conclusion.