HE4 and Risk Factors of Endometrial Cancer in Women with Abnormal Uterine Bleeding; Application of Accelerated Failure Time Models

Abstract

Background: Endometrial cancer (EC) is the leading cause of death from gynecologic cancers. Objectives: This study was executed to estimate the role of human epididymal protein 4 (HE4) levels in the prognosis and follow-up of EC. Methods: This registry-based, single-center retrospective cohort study was conducted on women with abnormal uterine bleeding (AUB) between March 15, 2022, and September 15, 2023, at a university hospital in Ilam, southwest Iran. The study applied accelerated failure time (AFT) models to a dataset of 38 women with AUB. Model performance was evaluated using Akaike’s information criterion (AIC) and visual assessment of Cox-Snell residuals. The HE4 concentrations > 140 g/L at admission were considered predictive of ovarian tumors. Results: In the adjusted model, the results of the Weibull model showed that HE4 (adjusted time ratio; 1.89 (95% CI: 1.30 - 2.19; P < 0.001) was the accelerated factor for progression to EC in women with AUB. Conclusions: Serum HE4 dosage seems to be a useful preoperative test for predicting EC outcomes in women with AUB.