The role of HE4 in predicting surgical outcome in recurrent ovarian cancer (ROC).

Abstract

e15556 Background: The value of secondary tumordebulking in ROC remains unclear. Retrospective analyses indicate that patient’s survival is positively affected only when complete macroscopic tumor resection is achieved, so that efforts are internationally focussed on prediction of operability and postoperative tumor residuals. HE4 constitutes a novel biomarker in ovarian cancer, showing so far promising results in the early diagnosis. Primary aim was to evaluate the predictive role of HE4 on surgical outcome and platinum response in 2nd line systemic treatment. Secondary aims were prognostic role of HE4 for overall- (OAS) and progression free survival (PFS). Methods: Plasma was obtained before secondary cytoreductive surgery from 76 patients with ROC. HE4 was detected using ELISA technique Results: In 64.5% of the patients a complete macroscopical tumor debulking could be obtained. A total of 85.5% patients were primary platinum sensitive. Mean HE4 plasma concentration was 195,05 pg/ml (range 36.8-900pg/mLl). HE4 correlated significantly with the presence of peritoneal carcinomatosis (p<0.001) and residual tumor mass after surgery (p= 0.001, HR 12, 61, 95% CI 2.77-57.39). At a HE4 cut off value of 70pg/ml surgical outcome in terms of postoperative residuals could be predicted with a sensitivity of 44.9% and a specificity of 88.9% (95%CI 0.618-0.865). Even though HE4 expression in plasma significantly correlated with OAS (p=0.019, HR=2.77, 95%CI 1.18-6.50) in univariate analysis, it could not retain prognostic significance in multivariate setting. Independent factors for OAS were presence of ascites, residual tumor mass, and initial platinum response. The latter two were also independent prognostic factors for PFS. Conclusions: HE4 appears to be a novel predictive marker for postoperative tumor residuals at secondary tumor debulking in ROC. Larger population studies are warranted to validate these first results.