Abstract
Introduction: Epithelial Ovarian Cancer, tubal- and peritoneal cancer (EOC) is still the major cause of death in gynecological cancer. The outcome of primary surgery is an important prognostic factor. The primary aim of this study was to study the utility of HE4 and CA125 in monitoring the response of chemotherapy during treatment and in predicting prognosis and recurrence during follow-up. We have also evaluated the role of HE4 as a predictor of the result of surgical intervention. Methods: Seventy-eight patients scheduled for chemotherapy were monitored with serum HE4 and CA125 during treatment and follow-up. In 39 patients samples for tumor markers were also obtained prior to surgical intervention. Results: Both HE4 and CA125 decreased in response to treatment. PFS and OS were strongly dependent on HE4 levels prior to start of chemotherapy with significantly prolonged PFS and OS when HE4 levels were under upper reference limit of 82pmol/L (P=0.018 resp. P<0.001). The levels of HE4 correlated with primary surgical outcome with significantly lower postoperative HE4 in the radically operated group (P<0.001). An increase in HE4 and/or CA125, signals a recurrence 3-6months before diagnosis. Median levels for both HE4 and AC125 before start, during and at the end of treatment were significantly higher for platinum resistant patients (P<0.005). Conclusion: Both tumor markers are valuable in monitoring the response of chemotherapy as well as in predicting recurrence during follow-up. Postoperative HE4 holds promise as an objective marker to evaluate the result of surgery and is highly predictive for future prognosis.
Highlights
Epithelial Ovarian Cancer, tubal- and peritoneal cancer (EOC) is still the major cause of death in gynecological cancer
In 39 patients samples for tumor markers were obtained prior to surgical intervention. Both Human Epididymal protein 4 (HE4) and Cancer Associated Antigen 125 (CA125) decreased in response to treatment
Progression free survival (PFS) and overall survival (OS) were strongly dependent on HE4 levels prior to start of chemotherapy with significantly prolonged PFS and OS when HE4 levels were under upper reference limit of 82 pmol/L
Summary
Epithelial Ovarian Cancer, tubal- and peritoneal cancer (EOC) is still the major cause of death in gynecological cancer despite improved chemotherapy and more recently introduction of new biological therapies. The outcome of primary surgery conducted with the intention to achieve complete cytoreduction is one of the main prognostic factors [1]. Neoadjuvant chemotherapy followed by delayed surgery has been proposed to result in the same clinical outcome as primary surgery in combination with post-operative chemotherapy when complete initial debulking is not deemed to be possible [3, 4]. With the goal to achieve complete tumor debunking, should be considered after 3–4 cycles of NACT. In this context, a decrease of CA125 during NACT is an important factor
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