الفهرس 
Ovarian CancerOnly 14 pages are availabe for public view
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Abstract
Ovarian cancer has the highest mortality rate out of all types of gynecologic cancer and considered the fifth leading cause of cancer deaths among women. The main challenge for laboratory biomarkers of ovarian cancer diagnosis is to allow the accurate detection of malignancy as early as possible with a good screening test which must adequately address validity, reliability, yield, cost, acceptance and follow-up services to improve clinical outcome and survival of patients.
Aim of work:
1- To compare between the Human epididymis protein-4(HE4), Mesothelin, Vascular endothelial growth factor (VEGF) and CA125 in diagnosis of benign and malignant ovarian cancer in patients with adnexal masses.
2- To evaluate the utility of using Human epididymis protein -4(HE4), Mesothelin, Vascular endothelial growth factor (VEGF) and CA125 in prediction of benign and malignant ovarian cancer in patients with adnexal masses.
3- To evaluate the utility of using a novel serum tumor markers as Human epididymis protein- 4 (HE4), Mesothelin and Vascular endothelial growth factor (VEGF) either alone or in combination with CA125 in diagnosis of ovarian cancer in patients with adnexal masses.
A total of 174 Gynecologic Hospitalized Patients presented with adnexal mass and planned for surgical management were included in this study. Serum levels of HE4, Mesothelin and VEGF were determined in addition to CA125, CA19.9, CEA and AFP. The present study revealed the presence of a highly significant statistical difference as regard to the median values of age, menstrual status and duration of marriage between women who had benign and those with malignant ovarian tumors as well as presence of ascites was significantly associated with 7-fold higher risk of malignancy between both groups. The using of Spearman correlation coefficient test showed a significant positive correlation between all studied markers as well as between (HE4, Mesothelin and VEGF) as regard to the stage of the tumor while Mesothelin had a significant positive correlation with both the stage and grade of the tumor. Also data revealed that, the median values of measured serum biomarkers HE4, Mesothelin, VEGF and CA-125 were all significantly higher in women with malignant ovarian tumors when compared to those with benign ovarian lesions. Results also indicated that the Mesothelin had a lower sensitivity than CA125 but higher specificity than CA125 in detecting malignancy in all included women. However in the present work the using of receiver operator characteristics (ROC) curves were constructed for measured serum biomarkers as predictors of malignancy in included women. All measured markers showed significant predictability as denoted by the significantly large area under the curves (AUCs); with serum Mesothelin and serum VEGF being the most significant predictors followed by serum CA125 and HE4.This study showed the rate of false negative and false positive cases, respectively regarding all measured biomarkers, serum CA125 had the least false negative rate followed by Mesothelin, VEGF and HE4. On the other hand VEGF had the least false positive rate followed by HE4 and Mesothelin. Also accuracy of different combinations between biomarkers, sonographic features and menopausal status as predictors of malignant or benign nature of the ovarian masses in included women showed significant sensitivity and specificity of each combination which could help in diagnosis and prediction of the ovarian cancer.
The results of this study revealed that serum HE4, Mesothelin and VEGF can successfully differentiate benign from malignant ovarian masses, since the levels of serum HE4, Mesothelin and VEGF were significantly elevated in malignant versus benign ovarian lesions. Also the studied tumor markers (Mesothelin, VEGF and HE4) showed a high sensitivity and specificity in predicting ovarian malignancy in all included women, CA125 can do this mission but HE4, Mesothelin and VEGF had a higher specificity than CA125. These findings demonstrated the usefulness of HE4, Mesothelin and VEGF in supporting CA125 as a monitoring marker and the possibility of adding HE4 Mesothelin and VEGF alongside CA125 in monitoring of ovarian cancer status and could be a promising new tumor marker which should be under investigation for clinical use.
It is concluded that the use of these markers (HE4, Mesothelin and VEGF) either alone or in combination with CA-125, sonographic features and menopausal status could be a useful tool in prediction and early diagnosis of ovarian cancer.