Serum CA125 And HE4 Predict Response To Platinum-based Chemotherapy Among Epithelial Ovarian Cancer Patients

Objective The study aims at investigating the predictive value of CA125 and HE4 in term of platinum –resistant recurrence in advanced-stage epithelial ovarian carcinoma (EOC)patients Methods From November 2016 to January 2019,69 patients with epithelial ovarian cancer(EOC),who received PDS with residual tumor=0 and first line platinum-based chemotherapy(CT)after surgery,treated at Shengjing Hospital of China Medical University were selected.Of the 69 patients included,20 patients who have relapsed within 6 months were classified as platinum-resistant group,the other 49 patients were classified as the control group.These patients achieved clinical remission after initial treatment,collecting clinical data of them which include age,FIGO stage,pathological type,residual lesions,CA125 and HE4-related variables.Associations of these variables with platinum resistance were evaluated.Results HE4 after third chemotherapy postoperatively(HE4 3rd CT),HE4 nadir and the number of people with HE4 over 70 pmol/L postoperatively in the first three chemotherapies have been found statistically significant difference between two groups(P<0.05),while there was no statistical difference of CA125 level in the same circumstance(P>0.05).According to Logistic regression analysis,these HE4 associated factors were related to platinum-resistance(P<0.05).According to ROC curve,HE4 3rd CT >66.58pmoL/L reached the sensitivity of 80%,the specificity of63.3%(PPV=47.1%,NPV=88.6%,),and HE4 still over 70pmol/L in the first three chemotherapies reached the sensitivity of 60%,the specificity 77.6%(PPV= 52.1%,NPV= 88.8%).Further analyzing CA125 and HE4 data,we grouped patients by age.A statistically difference have been found in the level of HE4 preoperatively and the decrease ratio of HE4 after N1(= 1,2,3)CT in the group of patients ?50 years old(P<0.05),which correlated with the platinum-resistance(P <0.05),while the other group didn't reach the same conclusion.According to ROC curve,HE4 preoperatively >385.1pmoL/L reached best predictive value with the sensitivity of 100% and the specificity of 66.7%%(PPV=55.1%,NPV=100%,).And the decrease ratio of HE4 after N1(=1,2,3)CT also has demonstrated good diagnostic value.When the decrease ratio of HE4<9% after 3rd CT,the best predictive value can be achieved and the possibility of platinum resistance is reduced,with the sensitivity was 95.2% and the specificity was80%(PPV=66%,NPV=97.6%,).Conclusions HE4 is superior to CA125 in the detection of platinum –resistant recurrent in EOC patients.When patients with HE4 <70pmol/L at least one time in the first three chemotherapies or HE4 3rd CT <66.58pmoL/L,the possibility of platinum-resistant is reduced.The superior predictive value of HE4 outstands especially for the EOC patients who less than 50 years old appearing HE4 preoperatively >385.1pmoL/L or the decrease ratio of HE4 <9% after 3rd CT,and these people require more rigorous follow-up.