High preoperative blood levels of HE4 predicts poor prognosis in patients with ovarian cancer

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2012

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Kalapotharakos Grigorios , Asciutto Christine , Henic Emir , Casslén Bertil , Borgfeldt , Borgfeldt Christer

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The aim of this study was to assess the clinical value of preoperative blood levels of HE4 as a predictor of overall survival in patients with ovarian cancer and to validate previous data of HE4 and the ROMA algorithm including HE4 and CA125 in discriminating benign and malignant ovarian tumors. Experimental design The preoperative plasma levels of HE4 and CA125 were analyzed with ELISA in 312 patients with adnexal lesions. Tumors were classified as benign (n= 206), borderline (i.e. low malignant potential tumors) (n= 25), and well (n= 14), moderately (n= 15), and poorly (n= 51) differentiated malignant. Results In univariate Cox regression analyses high levels (dichotomized at the median) of HE4, CA125, increased age (continuous variable), advanced-stage of disease 2–4, histological grade 3 and non-optimal tumor debulking at primary surgery were all significantly associated with shorter overall survival. A multivariate Cox regression model including pre-operative available covariates HE4 and CA125 both dichotomized at median in addition to age as continuous variable showed that high levels of HE4 was an independent prognostic marker for worse prognosis HR 2.02 (95% CI 1.1-3.8). In postmenopausal women the ROMA algorithm gave the highest AUC of 0.94 (95% CI, 0.90-0.97) which was higher than the separate markers HE4 AUC 0.91 (95% CI 0.86-0.95) and CA125 AUC 0.91(95% CI 0.87-0.96). Conclusions High concentration of plasma HE4 is an independent preoperative marker of poor prognosis in patients with ovarian cancer. The algorithm ROMA discriminates in postmenopausal women between malignant and benign tumors with an AUC of 0.94.

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biomed

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01 janvier 2012

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Kalapotharakoset al. Journal of Ovarian Research2012,5:20 http://www.ovarianresearch.com/content/5/1/20

R E S E A R C HOpen Access High preoperative blood levels of HE4 predicts poor prognosis in patients with ovarian cancer 1 11 11,2* Grigorios Kalapotharakos , Christine Asciutto , Emir Henic , Bertil Casslénand Christer Borgfeldt

Abstract:The aim of this study was to assess the clinical value of preoperative blood levels of HE4 as a predictor of overall survival in patients with ovarian cancer and to validate previous data of HE4 and the ROMA algorithm including HE4 and CA125 in discriminating benign and malignant ovarian tumors. Experimental design:The preoperative plasma levels of HE4 and CA125 were analyzed with ELISA in 312 patients with adnexal lesions. Tumors were classified as benign (n= 206), borderline (i.e. low malignant potential tumors) (n= 25), and well (n= 14), moderately (n= 15), and poorly (n= 51) differentiated malignant. Results:In univariate Cox regression analyses high levels (dichotomized at the median) of HE4, CA125, increased age (continuous variable), advancedstage of disease 2–4, histological grade 3 and nonoptimal tumor debulking at primary surgery were all significantly associated with shorter overall survival. A multivariate Cox regression model including preoperative available covariates HE4 and CA125 both dichotomized at median in addition to age as continuous variable showed that high levels of HE4 was an independent prognostic marker for worse prognosis HR 2.02 (95% CI 1.13.8). In postmenopausal women the ROMA algorithm gave the highest AUC of 0.94 (95% CI, 0.900.97) which was higher than the separate markers HE4 AUC 0.91 (95% CI 0.860.95) and CA125 AUC 0.91(95% CI 0.870.96). Conclusions:High concentration of plasma HE4 is an independent preoperative marker of poor prognosis in patients with ovarian cancer. The algorithm ROMA discriminates in postmenopausal women between malignant and benign tumors with an AUC of 0.94. Keywords:HE4, ROMA, Ovarian neoplasm, Survival analyses, Prognosis

Introduction The majority of patients with ovarian cancer are not diag nosed until the disease is in advanced stages due to mild and diffuse symptoms. These patients face poor prognosis since the five year overall survival is only 40–45%. In con trast, earlystage ovarian cancer i.e.(before the tumor has spread in the peritoneal cavity) has excellent curability. Numerous efforts have been done to identify a biomarker which will allow screening of population cohort at risk, but so far without substantial success. Even the most used tumor marker CA125, is not reliable due to low sen sitivity in patients with earlystage ovarian cancer [1]. Also CA125 has low specificity since it is often increased in patients with benign endometriosis. Gynecologic ultrasound

* Correspondence: christer.borgfeldt@med.lu.se 1 Department of Obstetrics & Gynecology, Skanes University Hospital, Lund, Sweden 2 Department of Obstetrics and Gynecology Region Skåne University Hospital, Lund University, SE22185 Lund, Sweden

has high sensitivity and acceptable specificity but is too labor intense to be employed for screening. Thus a new tumor biomarker or a combination of biomarkers with high sensitivity and reasonable specificity for early stage ovarian cancer is urgently needed. Such biomarker can hopefully be employed for screen ing of asymptomatic women in age group at risk in order to promote early detection and thus increase curability. Human Epididymis Protein 4 (HE4) is a novel tumor marker approved by the United States FDA for moni toring recurrence or progressive disease in patients with epithelial ovarian cancer. HE4 is a secreted low molecu lar weight glycoprotein that is predominantly expressed in epithelial cells of the epididymis and the normal female reproductive tract. Although its physiological functions have not been fully identified, over expression of the HE4 protein has been found to occur in serous and endometrioid ovarian carcinomas [2].

© 2012 Kalapotharakos et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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