Diagnostic role of urine human epididymis protein 4 in ovarian cancer

Graphical abstract

Highlights

• Urine human epididymis protein 4 (HE4) and protein-to-creatinine ratio (HE4/CRE) are higher in ovarian cancer

• Urine HE4 and HE4/CRE ratio can be used in the differential diagnosis of ovarian cancer

• Urine HE4/CRE is a predictive marker of chemotherapy resistance and disease recurrence

• Urine HE4 can be detected in urine by immunoassays or mass spectrometry

• Standardization of the urine HE4 determination is needed before its clinical application

Abstract

Ovarian cancer is the 8th most common malignancy in women and the deadliest gynecological cancer. Due to the non-specific symptoms and the lack of effective diagnostic methods, late diagnosis remains the main barrier for improving the poor prognosis. Human epididymis protein 4 (HE4) is a protein overexpressed in ovarian cancer, but not in healthy individuals or benign conditions. The aim of this review article is to evaluate the laboratory aspect and potential clinical application of urine HE4. The methodology is presented, together with discussion on preanalytical, analytical and postanalytical phase of HE4 detection using urine. Moreover, we present the diagnostic role of urine HE4 in differential diagnosis, chemotherapy response, detection of recurrence and detection of low-malignant potential tumors. It has been found that urine HE4 presents as a promising, non-invasive tumor marker for detection and monitoring of ovarian cancer. However, standardization of the HE4 detection process is needed prior to implementation in clinical diagnostics.