Diagnostic and Prognostic Potential of HE4 in Ovarian Cancer
Ream Langhe, Sharon O'Toole, Lucy Norris, Max Petzold, Ashling Harrison, Rachel Varley, Feras Abusaadeh, Noreen Gleeson, John O'Leary. Trinity College, Dublin, Ireland; St James's Hospital, Dublin, Ireland; Dublin City University, Dublin, Ireland; Sahlgrenska Academy, University of Gothenburg, Germany
Background: Ovarian cancer is the fifth most common cancer in women and the most frequent cause of gynaecologic malignancy-related mortality in women. Clinical outcome and survival may be improved if the disease is identified in the early stages. Recently a novel biomarker Human epididymis protein 4 (HE4) has been demonstrated to be a sensitive and specific serum biomarker for ovarian cancer that is elevated less frequently by benign conditions that occur in premenopausal women. The aim of the study was to evaluate the utility of HE4 as a diagnostic and prognostic marker of ovarian cancer in premenopausal and postmenopausal women.
Design: Diagnostic arm: Serum was collected from 386 women of various histological subtypes prior to surgery for invasive, borderline and benign ovarian disease. Prognostic arm: Serum was collected from 30 women 4 to 10 days after surgery for ovarian cancer and benign ovarian disease. Another set of serum samples were collected from 9 women undergoing chemotherapy for ovarian cancer. These samples were taken prior to commencement of chemotherapy, half way through the course of treatment and post chemotherapy. All chemo samples recruited in the study were of the same histology (serous papillary adenocarcinoma stage 3 and grade 3). HE4 EIA protocol and CanAg CA125 EIA protocols were carried out according to manufacturer's instructions (FUJIREBIO Diagnostics). Risk of Ovarian Malignancy Algorithm (ROMA), which combines the result of HE4 and CA125, was calculated for premenopausal and postmenopausal women. Non-parametric tests (Kruskal-Wallis Test and Mann-Whitney test) were used for statistical analysis.
Results: The combination of HE4 and CA125 in the ROMA index increased the sensitivity and specificity of detecting ovarian cancer than either marker alone. HE4 alone is more specific than CA125. Significant decreases in HE4 were observed in the majority of patients in the post operative setting and throughout chemotherapy. However, in a minority of cases HE4 values did not decrease and these women went on to develop progressive/chemoresistant disease.
Conclusions: The study shows that HE4 increases the specificity of ovarian cancer detection and in combination with CA125 the overall sensitivity and specificity of detecting ovarian cancer is improved. HE4 also holds promise as a prognostic marker in the postoperative setting and for monitoring response to chemotherapy.
Category: Gynecologic & Obstetrics
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 187, Wednesday Morning