| Objective:ovarian cancer is one of the three most common malignant tumors of female reproductive tract.About 50%of patients with advanced ovarian epithelial cancer achieved complete remission after surgery and chemotherapy,but 70%relapsed within 2 years.Only 25~30%of cCR patients had no residual lesions after secondary surgery,that is,pCR.Therefore,further treatment rather than follow-up observation,seems to be necessary before recurrence of the disease.However,there is no effective indicator to choose patients who need maintenance treatment after the completion of standard treatment.Sometimes CA125 became negative after6-8 courses of chemotherapy in clinic,but HE4 continued to be positive.Thus,it is necessary to explore the prognosis of patients with continuous positive HE4,so as to discuss the clinic significance of HE4 in maintenance therapy.Methods:1.Subjects:240 patients with epithelial ovarian cancer admitted to our hospital from August 2015 to August 2016 were included in the study.Among them,154 patients who lacked preoperative serum specimens,did not receive standard treatment,had other cancers at the same time,and did not have complete follow-up data were excluded.This study FIGOⅠ-Ⅱperiod patients accepted comprehensive staging surgery plus necessary 3 to 8 routine platinum-based chemotherapy,FIGOⅢ-Ⅳperiod patients received primary debulking surgery or neoadjuvant chemotherapy(≤3)plus interval debulking surgery and postoperative platinum-based chemotherapy(total≤8).The remaining 86 patients met the inclusion criteria.2.Blood collection and measurement:all the patients were sampled intravenously before treatment,and the detection was completed by the clinical laboratory department of the fourth hospital of HeBei Medical University,using the electrochemiluminescence immunoanalyzer and supporting reagents of Roche.3.Statistical data and analysis:all data were input to excel and database.SPSS 22.0 statistical software was used for analysis.The measurement data were expressed as mean and standard deviation(x±S),and analysis of variance or the rank sum test was used for comparison among groups.The counting data were tested by X~2 squared test.Patients’PFS and OS were evaluated by Kaplan-Meier survival curve method.Kappa test was used to test the consistency of the two indicators.ROC curve method was used to evaluate the diagnosis effect.P<0.05 was statistically significant.Results:1.In patients with epithelial ovarian cancer,the later the clinical stage,the higher the CA125 and HE4 level.2.The expression of HE4 in ovarian serous adenocarcinoma,hyaline carcinoma and endometrioid carcinoma was higher than normal level,while the expression in ovarian mucinous carcinoma was lower than normal level.The HE4 level of poorly differentiated adenocarcinoma was significantly higher than other grades.3.Patients were divided into two groups according to the level of HE4.The mean PFS of the higher group and the lower group were 34.52 months,31.02 months,and the OS mean were 35.04 months,33.20 months,respectively.The difference is statistically significant.4.ROC curve was drawn according to the values of CA125 and HE4 and whether tumor cell depletion was performed in patients with ovarian cancer.The area under the ROC curve for CA125 prediction of surgical outcome was0.570>0.5,P=0.404>0.05,and 95%confidence interval was(0.404,0.736).However,the area under the ROC curve of HE4 to predict surgical outcome was 0.817>0.5,P=0.000<0.05,and 95%confidence interval was(0.676,0.957).ROC curves of the two groups were compared,Z test statistics=2.391,P=0.017<0.05.5.Patients whose HE4 did not become negative after standard treatment contained 4 cases,1 case ofⅢA period,while the other 3 cases ofⅢC period,all recurring rapidly in 14 months after chemotherapy.PFS was shorter comparing withⅢperiod,OS was not shorter..Conclusion:1.In patients with epithelial ovarian cancer,the later the clinical stage,the higher the HE4 level.2.The expression of HE4 was higher than normal level in ovarian serous adenocarcinoma,ovarian hyaline carcinoma and endometrial carcinoma,and lower than normal level in mucinous carcinoma.3.Before treatment,HE4 was associated with PFS,but not with OS.4.HE4 is associated with tumor surgical outcomes in patients with advanced EOC,and its predictive value for non-ideal tumor cell depletion is better than that of CA125.5.In this study,PFS of patients whose HE4 did not become negative after standard treatment was shorter than that became negative,and there was no difference in OS.It is suggested that when CA125 becomes negative but HE4does not,it may be necessary to take measures such as increasing chemotherapy courses or changing the chemotherapy regimen. |
PDF Full Text Request