Comparison of the Serum Level of Cancer Antigen 125 and Human Epididymis Protein 4 in Ovarian Cancer Patients and Healthy Groups in Isfahan City

Document Type : Original Article


1 Department of Biochemistry, Shiraz Sciences and Research Branch, Islamic Azad University, Shiraz, Isfahan, Iran

2 Department of Biochemistry, Falavarjan Branch, Islamic Azad University, Isfahan, Iran

3 Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Ovarian cancer is the most common fatal malignancy of the gynecology tract. The purpose of this study was to compare serum levels of tumor markers cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in both healthy groups and patients with ovarian cancer. Materials and Methods: this case–control study was performed on Seyed Al-Shohada Hospital in Isfahan. Research on the treatment of 44 patients with ovarian cancer and 44 healthy controls was performed. CA125 and HE4 were measured in serum by sandwich ELISA method. Results: Average CA125 in ovarian cancer patients (83.30 ± 43.99 μ/ml) was significantly higher than in healthy controls (12.39 ± 5.50 μ/ml) (P < 0.001). Average HE4 in ovarian cancer patients (295.41 ± 133.33 PM) was significantly higher than in healthy controls (114.64 ± 17.31 PM) (P < 0.001). Conclusions: HE4 test is complementary of CA125 test in women with epithelial ovarian cancer. It is also used to study the disease process.


Kobayashi E, Ueda Y, Matsuzaki S, Yokoyama T, Kimura T, Yoshino K, et al. Biomarkers for screening, diagnosis, and monitoring of ovarian cancer. Cancer Epidemiol Biomarkers Prev 2012;21:].  Back to cited text no. 1
Yin BW, Lloyd KO. Molecular cloning of the CA125 ovarian cancer antigen: Identification as a new mucin, MUC16. J Biol Chem 2001;276:].  Back to cited text no. 2
Yin BW, Dnistrian A, Lloyd KO. Ovarian cancer antigen CA125 is encoded by the MUC16 mucin gene. Int J Cancer 2002;98:737-40.  Back to cited text no. 3
Santillan A, Garg R, Zahurak ML, Gardner GJ, Giuntoli RL, Armstrong DK, et al. Risk of epithelial ovarian cancer recurrence in patients with rising serum CA-125 levels within the normal range. J Clin Oncol 2005;23:9338-43.  Back to cited text no. 4
Kabawat SE, Bast RC Jr., Bhan AK, Welch WR, Knapp RC, Colvin RB. Tissue distribution of a coelomic-epithelium-related antigen recognized by the monoclonal antibody OC125. Int J Gynecol Pathol 1983;2:275-85.  Back to cited text no. 5
Li J, Dowdy S, Tipton T, Podratz K, Lu WG, Xie X, et al. HE4 as a biomarker for ovarian and endometrial cancer management. Expert Rev Mol Diagn 2009;9:555-66.  Back to cited text no. 6
Rosen DG, Wang L, Atkinson JN, Yu Y, Lu KH, Diamandis EP, et al. Potential markers that complement expression of CA125 in epithelial ovarian cancer. Gynecol Oncol 2005;99:267-77.  Back to cited text no. 7
Moore RG, Brown AK, Miller MC, Skates S, Allard WJ, Verch T, et al. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol 2008;108:402-8.  Back to cited text no. 8
Mutz-Dehbalaie I, Egle D, Fessler S, Hubalek M, Fiegl H, Marth C, et al. HE4 is an independent prognostic marker in endometrial cancer patients. Gynecol Oncol 2012;126:186-91.  Back to cited text no. 9
Ruggeri G, Bandiera E, Zanotti L, Belloli S, Ravaggi A, Romani C, et al. HE4 and epithelial ovarian cancer: Comparison and clinical evaluation of two immunoassays and a combination algorithm. Clin Chim Acta 2011;412:1447-53.  Back to cited text no. 10
Kirchhoff C, Habben I, Ivell R, and Krull N. A major human epididymis-specific cDNA encodes a protein with sequence homology to extracellular proteinase inhibitors. Biol Reprod. 1991; 45:350-7.  Back to cited text no. 11
John R, Martha H, Jeffrey A, Ledbetter M, Schummer M, Charles D, et al. The HE4 (WFDC2) protein is a biomarker for ovarian carcinoma. Cancer Res 2003;63:3695-700.  Back to cited text no. 12
Iwabuchi H, Sakamoto M, Sakunaga H, Ma YY, Carcangiu ML, Pinkel D, et al. Genetic analysis of benign, low-grade, and high-grade ovarian tumors. Cancer Res 1995;55:6172-80.  Back to cited text no. 13
Schummer M, Ng WV, Bumgarner RE, Nelson PS, Schummer B, Bednarski DW, et al. Comparative hybridization of an array of 21,500 ovarian cDNAs for the discovery of genes overexpressed in ovarian carcinomas. Gene 1999;238:375-85.  Back to cited text no. 14
Andersen MR, Goff BA, Lowe KA, Scholler N, Bergan L, Drescher CW, et al. Use of a symptom index, CA125, and HE4 to predict ovarian cancer. Gynecol Oncol 2010;116:378-83.  Back to cited text no. 15
Yousefi Z, Homaei F. Risk factors and prognostic factors in ovarian cancer. Iran J Med Counc Islam Repub 2004;24:279-88.  Back to cited text no. 16
Arab M, Maktabi M, Jam H, Kemeaei P, Dolo S. Addition of serum CA125 measurements to increase the accuracy of ultrasound in the diagnosis of malignancy before surgery in patients with ovarian mass. Hamedan Univ Med Sci Health Serv 2011;18:42.  Back to cited text no. 17
Chan KK, Chen CA, Nam JH, Ochiai K, Wilailak S, Choon AT, et al. The use of HE4 in the prediction of ovarian cancer in Asian women with a pelvic mass. Gynecol Oncol 2013;128:239-44.  Back to cited text no. 18
Moore R, Miller M, Eklund E, Karen H, Bast B, Messerlian G. Serum level of the ovarian cancer bio marker HE4 are decreased in pregnancy and in increase with age. Oncology 2012; 206:349.  Back to cited text no. 19
Trudel D, Têtu B, Grégoire J, Plante M, Renaud MC, Bachvarov D, et al. Human epididymis protein 4 (HE4) and ovarian cancer prognosis. Gynecol Oncol 2012;127:511-5.  Back to cited text no. 20