Preoperative serum HE4 and CA125 were measured in 78 postmenopausal patients treated surgically. The ROC curves were generated to determine the optimal cutoff values of HE4 and CA125 levels with optimum sensitivity and specificity for the prediction of lymphadenectomy.
Based on ROC curve, we found that the HE4 value of 78 pmol/l is the best cutoff to identify candidates who may require lymphadenectomy with the sensitivity of 86.6% and the specificity of 67.2% (NPV = 88.4% and PPV = 51.2%). The area under the curve (AUC) equals 0.814 (95% CI = 0.721–0.886). The cutoff level of CA125 that shows the prognostic indices is 26 U/ml, with the sensitivity of 66.6% and the specificity of 61.2% (NPV = 69.4% and PPV = 44.3%). For CA125 the AUC amounts to 0.671 (95% CI = 0.568–0.764). We also found a statistically significant difference, comparing HE4 and CA125 AUC (0.814 vs. 0.671, respectively, p < 0.001). The combination of HE4 and CA125 established in our study as the cutoff point has the sensitivity of 81.2% and the specificity of 65.9% with NPV = 83.4% and PPV = 47.9%.
Our findings indicate that in the early stage of endometrioid endometrial cancer, HE4 can serve as a preoperative tool that can help to identify postmenopausal women who may require lymphadenectomy.