Predictive Value Of Serum CA125 And HE4 Reduction Rate During Chemotherapy For Recurrent Epithelial Ovarian Cancer

Objective: To investigate the effect of changes in serum CA125 and HE4 on the prognosis of patients with recurrent epithelial ovarian cancer(EOC)during chemotherapy,and to determine the serum CA125 and HE4 thresholds that distinguish patients with a recurrence interval of more than 12 months from those with a recurrence interval of 12 months.Methods: Retrospective analysis was performed on the recurrent EOC patients diagnosed in the department of gynecology of the first hospital of lanzhou university and undergoing surgery and adjuvant chemotherapy from January 1,2009 to August 31,2019.For the 124 patients enrolled,unifactorial regression analysis was used to determine the important prognostic factors,and kaempmeier method was used to evaluate the OS and RFS of the patients.Results:1.The reduction rate of serum CA125 after the fourth cycle of chemotherapy was more than 95.1%,which was correlated with the recurrence time(P < 0.05),with a sensitivity of 54.5% and a specificity of 87.5%.2.The reduction rate of serum HE4 after the third cycle of chemotherapy was more than 72.9%,which was correlated with the recurrence time(P < 0.05),with a sensitivity of 63.6% and a specificity of 78.7%.3.The effect of serum HE4 reduction rate in predicting EOC recurrence interval may be better than that of CA125(area under ROC curve 0.759 Vs 0.705),but there is no statistical significance(P > 0.05).4.The efficacy of serum CA125 combined with HE4 reduction rate in predicting EOC recurrence interval was better than that of serum CA125 alone or HE4 alone(P < 0.05).5.Patients whose serum CA125 reduction rate exceeds 95.1% after the fourth chemotherapy cycle have significantly better OS and RFS than patients whose reduction rate is lower than 95.1%(P <0.001).Similarly,the serum HE4 reduction rate exceeds 72.9 after the third chemotherapy cycle % Patients with OS and RFS were significantly better than those with a reduction rate of less than 72.9%(P <0.001).Conclusions:1.The reduction rate of serum CA125 after the fourth chemotherapy cycle and the reduction rate of serum HE4 after the third chemotherapy cycle can be used to predict the recurrence of EOC and assess the prognosis of patients.The combination of the two is used to predict EOC within 12 months When relapses,the rate of misdiagnosis and missed diagnosis can be significantly reduced.2.According to the ROC curve,the best cut-off value of the serum CA125 reduction rate after 4 cycles of chemotherapy was 95.1%,and the best cut-off value of the serum HE4 reduction rate after 3 cycles of chemotherapy was 72.9%.When the reduction rate of serum CA125 or HE4 is lower than this critical value,it indicates that the possibility of EOC recurrence increases within 12 months,and more frequent follow-up and more active review should be performed.3.No matter whether the reduction rate of serum HE4 after the third chemotherapy cycle is used alone or the reduction rate of serum CA125 after the fourth chemotherapy cycle or a combination of both,the positive predictive value can not reach 100%.The accuracy of the prediction of relapse cannot reach 100%,and it is necessary to improve the accuracy of the prediction by combining with gynecological examination and imaging examination.