The value of serum CA125 for the development of virtual follow-up strategies for patients with epithelial ovarian cancer: a retrospective study

Role of human epididymis protein 4 (HE4) in detecting recurrence in CA125 negative ovarian cancer patients

OBJECTIVE

There are no current guidelines regarding evaluation of patients with normal CA125 at initial diagnosis during routine surveillance after completion of treatment. Thus, the purpose of this study was to evaluate the role of human epididymis protein 4 (HE4) in the detection of recurrence in patients with ovarian cancer and a negative CA125 at diagnosis.

METHODS

All patients with ovarian cancer with a negative CA125 referred to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome were included in the study. Inclusion criteria were: age between 18 and 70 years old, diagnosis of epithelial ovarian cancer, optimal primary surgery (residual tumor <1 cm), and normal CA125 at initial diagnosis. Patients with other malignancies or chronic diseases were excluded from the study. Statistical analysis was based on the calculation of percentages, means, medians, and ranges of the values.

RESULTS

A total of eight patients were included in the study. The median age was 53 years (range 40-75). All patients had a normal CA125 at initial diagnosis while seven (87.5%) patients had abnormal HE4 levels at diagnosis. The International Federation of Gynecology and Obstetrics (FIGO) stages at enrollment varied from IC to IIIC (IB (1), IC (3), IIC (1), IIIC (3)). The most common histologic subtype was serous (62.5%). Seven patients recurred and had abnormal HE4 and normal CA125 values. The median HE4 at recurrence was 107 pmol/L. The median disease-free interval was 55 months (range 5-108) and all the patients underwent optimal cytoreductive surgery.

CONCLUSIONS

HE4 levels may serve as a marker for recurrence in patients with a normal CA125 at initial diagnosis. Future studies are needed to evaluate the role of HE4 levels in earlier detection of recurrent ovarian cancer.

Clinical relevance of expression of B7-H1 and B7-H4 in ovarian cancer

The aim of the present study was to investigate the expression of B7-H1 and B7-H4 in ovarian neoplasm tissues and to examine their clinical relevance. A total of 112 ovarian biopsies were collected from patients with epithelial ovarian cancer (EOC) and 10 were taken from ovarian benign neoplasms. The samples were processed in paraffin tissue chips, and subjected to immunohistochemical staining and analysis. Associations of B7-H1 and B7-H4 expression with patients' clinical parameters, such as histological typing, cell grading, International Federation of Gynecology and Obstetrics staging, tumor size, and metastatic status, were examined by statistical analysis. Survival curves were constructed using the Kaplan-Meier method and the log-rank test. Independent prognostic factors were evaluated using the Cox regression model. The results showed an extremely low or negative expression of B7-H1 and B7-H4 in the 10 benign ovarian neoplasm tissues (control): By contrast, a positive expression of B7-H1 and B7-H4 was observed in 55.4% (62/112) and 37.5% (42/112) of the EOC tissues, respectively. The differences between the two groups were significant. In addition, the co-expression of B7-H1 and B7-H4 was found in 31.3% (35/112) of the EOC cases. Furthermore, the progression-free survival and overall survival were significantly lower in EOC patients with a high expression of B7-H1 and B7-H4 (χ²=45.60 and 37.99, respectively). These results demonstrated that the expression of B7-H1 and B7-H4 in EOC tissues was significantly associated with poor prognosis and high relapse rate of EOC. The findings suggest that B7-H1 and B7-H4 is a negative prognostic marker for EOC and a potential immunotherapeutic target for patients with EOC.

Biomarkers in uterine leiomyoma

Biomarkers are biologic compounds that are easily accessible and reflect normal physiology or pathology. They are useful in a variety of clinical situations that involve detection of subclinical disease, risk stratification, preoperative planning, and monitoring treatment. A useful intervention needs to exist for a biomarker to be an effective tool. Many compounds have been investigated as potential biomarkers for the diagnosis and surveillance of uterine leiomyomas. Most of these compounds demonstrate subtle differences among patients when leiomyomas are compared with controls. The compounds investigated lack the diagnostic accuracy necessary to add any benefit to the current available modalities used to diagnose and monitor uterine leiomyomas.