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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2014

01-03-2014 | Gynecologic Oncology

HE4 Expression in Plasma Correlates with Surgical Outcome and Overall Survival in Patients with First Ovarian Cancer Relapse

Authors: Elena Ioana Braicu, MD, Radoslav Chekerov, MD, Rolf Richter, PhD, Carmen Pop, Dipl. Med., Mani Nassir, Dipl. Med., Hanna Loefgren, Florin Stamatian, MD, PhD, Mustafa Zelal Muallem, MD, Christina Hall, PhD, Christina Fotopoulou, MD, PhD, Jalid Sehouli, MD, PhD, Klaus Pietzner, MD

Published in: Annals of Surgical Oncology | Issue 3/2014

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Abstract

Background

Epithelial ovarian cancer (EOC) remains the main cause of mortality due to gynecological malignancies. Optimal tumor debulking and platinum response are the most important prognostic factors for overall survival (OS) in primary EOC. In the setting of recurrence, the role of cytoreduction is not clear. A critical point is to predict preoperatively the subgroup of patients with optimal surgical outcome. The aim of the study was to analyze the predictive role of HE4 for surgical outcome and platinum response in EOC patients experiencing a first relapse. Secondary aims were the prognostic role of HE4 for OS and progression-free survival (PFS).

Methods

Plasma was obtained before secondary cytoreduction from 73 EOC patients. A total of 66.7 % underwent a total macroscopic tumor clearance; 86.3 % of the patients had disease that responded to platinum therapy. HE4 was detected by enzyme-linked immunosorbent assay. For statistical analysis, the chi-square test, Fisher’s exact test, Kendall’s tau b, and Mann-Whitney U test were used. OS, PFS rates, and respective 95 % confidence intervals (CI) were estimated according to the Kaplan–Meier method.

Results

At a HE4 cutoff value of 250 pMk, a sensitivity of 52 % and a specificity of 93.8 % (p = 0.001, 95 % CI 0.601–0.861) were reached in predicting total macroscopic tumor clearance. Plasma HE4 concentrations together with platinum response were the only independent prognostic factors for OS (p < 0.001, hazard ratio [HR] 18.77, 95 % CI 4.68–75.25; and p = 0.044, HR 3.33, 95 % CI 1.03–10.7, respectively). Together with ascites, HE4 was the only independent predictive factor for surgical outcome (p = 0.029, odds ratio [OR] 7.2, 95 % CI 1.22–42.19 and p = 0.036, OR 10.18, 95 % CI 1.16–88.69, respectively).

Conclusions

HE4 is an independent predictive marker for surgical outcome and OS in patients with recurrent EOC. Larger population studies are needed to validate these results.
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Metadata
Title
HE4 Expression in Plasma Correlates with Surgical Outcome and Overall Survival in Patients with First Ovarian Cancer Relapse
Authors
Elena Ioana Braicu, MD
Radoslav Chekerov, MD
Rolf Richter, PhD
Carmen Pop, Dipl. Med.
Mani Nassir, Dipl. Med.
Hanna Loefgren
Florin Stamatian, MD, PhD
Mustafa Zelal Muallem, MD
Christina Hall, PhD
Christina Fotopoulou, MD, PhD
Jalid Sehouli, MD, PhD
Klaus Pietzner, MD
Publication date
01-03-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3347-1

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