Materials and Methods: The study was conducted on 99 patients with a mean age of 53±64. The patients were all cases with a definitive diagnosis of endometrial cancer. With regard to the histology and the surface measurement, the HE4 and CA 125 were both confirmed within 1 to 2 week(s) prior to hysterectomy by implementing the standard-procedure treatment of extra facial total hysterectomy and bilateral salpingo-oophorectomy with selective pelvic and para-aortic node dissection. Then, risk-assessment for possible recurrence (Mayo criteria) was carried out as well. Patients with the variables of HE4 and CA 125 in the upper third (66th) percentiles were grouped as high-risk. Finally, the data were analyzed using SPPS 23, and P <0.05 was considered statistically significant.

Results: The mean (SE) of OS among patients with the serum CA 125 of ≤22 kU/L and higher 22 kU/L was 47.97 (±2.58) and 41.78 (3.75) months (P = 0.466). In addition, the mean (SE) of OS in patients with the serum HE4 level of ≤ 98 ρmol/L and >98 ρmol/L was 50.14 (2.06) and 38.54 (3.74), respectively. The log-rank test revealed a substantial difference between low- and high-risk groups by HE4 (χ2=4.98, P = 0.025). Accordingly, there is no significant difference between recurrence-free survival (RFS) with CA 125 (P = 0.264) and HE4 (P = 0.114), respectively.

Conclusions: In general, the serum HE4 level is a significant independent prognostic factor for OS in endometrial cancer and is useful in survival studies.