Prospective evaluation of 92 protein biomarkers for early detection of endometrial cancer

Abstract

The human epididymis protein 4 (HE4) remains the best available endometrial cancer (EC) biomarker; however, its discrimination between cases and cancer-free individuals is limited and might be improved when combined with other protein markers. We evaluated the discrimination capacity of 92 proteins as potential early detection biomarkers for EC in nested case-control studies in the European Prospective Investigation into Cancer and Nutrition (EPIC) (63 cases, 123 controls) and Janus (75 cases, 146 controls) cohorts, evaluating blood samples taken ≤2 years prior to diagnosis. Proteins were measured with the Olink Target 96 Oncology II panel assays. Areas under the receiver operating characteristic curves (AUCs) were calculated using logistic regression. The discrimination between cases and controls of top-performing proteins was modest (EPIC: HE4, CA125, CAIX, and S100A4; Janus: HE4, CA125, FURIN, CXCL13, and IL6; AUC range: 0.65 [S100A4], 0.76 [HE4, EPIC] within 0 to <12 months of blood collection) and decreased as the time between blood draw and cancer diagnosis increased (12-24 months AUC range: 0.49 [S100A4], 0.69 [CA125, Janus]). The combination of these other markers with HE4 did not improve discrimination. HE4 and other candidate proteins had limited discrimination between EC cases and controls and hence do not appear to be useful for early detection of this disease in women at average population risk.

Keywords: biomarkers; early detection; endometrial cancer.

FIGURE 1

Distributions of proteins in the EPIC and Janus cohorts, stratified by lag‐time category. The proteins above displayed an AUC value of ≥0.65 for cases in the 0 to <12 months lag‐time interval and controls, and were selected for further analysis. AUC, area under the curve; EPIC, European Prospective Investigation into Cancer and Nutrition.

FIGURE 2

Cohort‐specific ROC curves depicting the discriminative performance (AUC [95% CI]) of proteins with AUCs ≥0.65 for cases in the 0 to <12 months lag‐time interval and controls. ROC curves for these top performing proteins in the 12–24 lag‐time interval are also displayed. For both the EPIC and Janus cohorts, AUCs are adjusted for age at blood draw, and additionally menopausal status for the EPIC cohort only. AUC, area under the curve; EPIC, European Prospective Investigation into Cancer and Nutrition; ROC, receiver operating characteristics.