Abstract
BackgroundThis study assessed the prognostic value of HE4 marker measurements at various stages of first-line chemotherapy for ovarian cancer.MethodsThe study consisted of 90 ovarian cancer patients, including 48 women undergoing primary surgical treatment and 42 patients qualified for neoadjuvant chemotherapy. Each patient underwent HE4 and CA 125 level measurements at the time of diagnosis and subsequently as follows: after surgical treatment, after the third course of adjuvant chemotherapy, before interval cytoreductive surgery and after chemotherapy. The HE4 value was assessed based on the PSF, OS, DFS, surgical outcome, two-year survival and platinum sensitivity.ResultsPreoperative HE4 levels were a predictor of platinum sensitivity (AUC– 0.644; p = 0.035) and DFS (AUC = 0.637; p = 0.0492). A univariate logistic regression analysis showed that serum HE4 significantly correlated with PFS (baseline results over median HR = 2.96, p = 0.0009; baseline over 75 percentile HR = 2.44, p = 0.0062; normalization after treatment HR = 0.46, p = 0.0125; 50% reduction before IDS HR = 0.64, p = 0.0017). In the multivariate analysis, normalization after treatment and 50% reduction before IDS significantly influenced the PFS (HR = 0.29, p = 0.00008; HR = 0.23, p = 0.0024). The HE4 levels also correlated with the OS as follows: values below the median (HR = 1.88, p = 0.0087), normalization after chemotherapy (HR = 0.08, p = 0.0003), and 50% reduction before IDS (HR = 0.39, p = 0.0496).ConclusionsThe significant effect of the normalization of the HE4 marker after therapy and 50% reduction of HE4 levels before interval cytoreductive surgery on PFS and OS confirmed that HE4 might be an independent prognostic factor of treatment response. HE4 measurements performed during first-line treatment of ovarian cancer may have prognostic significance.
Highlights
Despite the use of most modern treatments, ovarian cancer is characterized with the worst survival parameters among all gynecological malignancies
Preoperative HE4 levels were a predictor of platinum sensitivity (AUC– 0.644; p = 0.035) and disease-free survival (DFS) (AUC = 0.637; p = 0.0492)
The HE4 levels correlated with the overall patient survival (OS) as follows: values below the median (HR = 1.88, p = 0.0087), normalization after chemotherapy (HR = 0.08, p = 0.0003), and 50% reduction before IDS (HR = 0.39, p = 0.0496)
Summary
Despite the use of most modern treatments, ovarian cancer is characterized with the worst survival parameters among all gynecological malignancies. As a standard of adjuvant treatment in Poland according to the recommendations of the Polish Society of Gynecologic Oncology, platinum derivatives in combination with paclitaxel are used as a first-line treatment [1]. This treatment is concordant with the protocols of ovarian cancer treatment in other European countries [2]. A greater proportion of women achieving long periods of complete remission increased by 38% in breast cancer and by only 17% in ovarian cancer [4] It seems that a significant number of these failures results from resistance to primary treatment which, in the case of ovarian cancer, is related to platinum resistance. This study assessed the prognostic value of HE4 marker measurements at various stages of first-line chemotherapy for ovarian cancer
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