Recent studies have demonstrated that epithelial ovarian cancer (EOC) are factual several different diseases. A two-tier system divides EOC into type I and type II EOC. HE4 has been used as a complementary biomarker for diagnosing EOC. This study aimed to evaluate the different clinicopathologic characteristics and HE4 expression levels in types I and II EOCs. This retrospective study included 127 EOC patients. Data related to patient demographics, cancer stages, grades, histology, operation procedures, residual disease, adjuvant chemotherapy, recurrence, and survival were collected. A total of 134 ovarian carcinoma tissue specimens and 40 matching borderline ovarian tumor specimens were chosen from the pathology department archives. Immunohistochemistry was used to assess HE4 expression in EOC and borderline ovarian tumor tissue specimens. Of the 127 patients, there were 42 type I EOC patients (7 low grade serous carcinomas, 8 mucinous carcinomas, 12 low grade endometrioid carcinomas and 15 clear cell carcinomas) and 85 type II EOC patients (83 high grade serous carcinomas and 2 high grade endometrioid carcinomas). The median followed--up time was 18.3 months. There were significant differences between the two types of EOC in terms of the menopausal state, FIGO stage and pathological differentiation, but there were no differences in the residual tumor and chemotherapy treatment. In type I EOC, the median follow--up time was 31 months and the median progression--free survival was 72 months (95% CI: 40.34-103.66). There were 15 (35.7%) relapsed or progressive patients. In type II EOC, the median follow-up time was 17 months (0-60 m), and the median progression--free survival was 27 months (95% CI: 17.83-36.17). There were 47 (55.3%) relapsed or progressive patients. There was a significant difference between the two types of EOCs in terms of progression--free survival (P<0.001). Among the 44 type I specimens, 25 demonstrated positive expression of HE4 (56.8%). In contrast, 78 (86.7%) type II EOC demonstrated positive expression levels. There was a significant difference between type I and type II EOCs in terms of HE4 expression. Additionally, there was a significant difference between high grade serous carcinoma and borderline serous tumor, but no difference was observed between low grade serous carcinoma and borderline serous tumor or other types of EOC and corresponding borderline tumors. The different clinicopathologic characteristics between type I and type II EOC indicate that the two--tier EOC system reasonable and reliable. HE4 would be a powerful biomarker to distinguish type II EOC from borderline tumors but it is less useful in type I EOC. Type I EOC is generated from the corresponding borderline tumor.

卵巢癌是发病率位居第2的女性生殖系统恶性肿瘤,其病死率却高居首位.美国近10年来的流行病学统计数据显示,卵巢癌的发病人数及死亡人数均大致呈上升趋势,2009年的新发病例达到21500例,为近年之最[1].随着新的诊疗手段及早期诊断的推行,卵巢癌的病死率略有下降,然而与乳腺癌及宫颈癌相比,下降幅度非常有限,这可能与卵巢癌的病理机制纷繁多样,疾病进展迅速、肿瘤发展机制及病因不清有关.人们不断地对卵巢癌发生、发展机制进行研究.2002年,Singer等[2]提出了卵巢浆液性癌的两级分级系统,即将卵巢浆液性癌分为高级别卵巢浆液性癌、低级别卵巢浆液性癌两类.