Preoperative CA-125 Value as a Predictive Factor for Postoperative Outcome in First Relapse of Platinum-sensitive Serous Ovarian Cancer

HE4 as a serum biomarker for the diagnosis of pelvic masses: a prospective, multicenter study in 965 patients

Background

To evaluate the diagnostic value of adding human epididymis protein 4 (HE4), cancer antigen 125 (CA125) and risk of malignancy algorithm (ROMA) to ultrasound for detecting ovarian cancer in patients with a pelvic mass.

Methods

This was a prospective, observational, multicenter study. Patients aged > 18 years who were scheduled to undergo surgery for a suspicious pelvic mass had CA125 and HE4 levels measured prior to surgery, in addition to a routine transvaginal ultrasound scan. The diagnostic performance of CA125, HE4 and ROMA for distinguishing between benign and malignant adnexal masses was assessed using receiver operating characteristic (ROC) analysis and the corresponding area under the curve (AUC).

Results

Of 965 evaluable patients, 804 were diagnosed with benign tumors and 161 were diagnosed with ovarian cancer. In late-stage ovarian cancer, CA125, HE4 and ROMA all had an excellent diagnostic performance (AUC > 0.92), whereas in stage I and II, diagnostic performance of all three biomarkers was less adequate (AUC < 0.77). In the differential diagnosis of ovarian cancer and endometriosis, ROMA and HE4 performed better than CA125 with 99 and 98.1% versus 75.0% sensitivity, respectively, at 75.4% specificity.

Conclusions

ROMA and HE4 could be valuable biomarkers to help with the diagnosis of ovarian cancer in premenopausal patients in order to differentiate from endometriosis, whereas CA125 may be more adequate for postmenopausal patients.

• Serum biomarkers can help to distinguish benign from malignant pelvic masses

• We evaluated the diagnostic value of adding HE4, CA125 and ROMA to ultrasound for detecting ovarian cancer

• In stage III and IV ovarian cancer all three biomarkers showed excellent performance

• ROMA and HE4 performed better than CA125 in the differential diagnosis of ovarian cancer and endometriosis

The use of biomarkers to stratify surgical care in women with ovarian cancer: Scientific Impact Paper No. 69 March 2022: Scientific Impact Paper No. 69 May 2022

Biomarkers may offer unforeseen insights into clinical diagnosis, as well as the likely course and outcome of a condition. In this paper, the focus is on the use of biological molecules found in body fluids or tissues for diagnosis and prediction of outcome in ovarian cancer patients. In cancer care, biomarkers are being used to develop personalised treatment plans for patients based on the unique characteristics of their tumour. This tailoring of care can be used to pursue specific targets identified by biomarkers, or treat the patient according to specific tumour characteristics. Surgery is one of the core treatments for ovarian cancer, whether it is offered in primary surgery or following chemotherapy in delayed surgery. Biomarkers already exist to guide the treatment of tumours with chemotherapy, but very little research has determined the value of biomarkers in tailoring surgical care for ovarian cancer. Such research is required to identify new biomarkers and assess their effectiveness in a clinical setting as well as to help identify specific tumour types to guide surgery. Biomarkers could help to determine the success of removing the disease surgically, or help to identify tumour deposits that persist after chemotherapy. All of these aspects would improve current practice. This Scientific Impact Paper highlights research that may pave the way towards bespoke surgery according to the biological characteristics of a tumour and aid gynaecological oncologists to provide surgical treatment according to individual need, rather than a blanket approach for all.

Prognostic Significance of CA125 Dynamic Change for Progression Free Survival in Patients with Epithelial Ovarian Carcinoma

Background

This study aimed to investigate the value of CA125 dynamic change in PFS prediction for patients with epithelial ovarian carcinoma (EOC).

Material/Methods

Data analysis was performed using SPSS 24.0 statistical software with progression-free survival (PFS) as an outcome measure. Kaplan-Meier method was used to analyze the relationship between PFS and preoperative and postoperative NLR, PLR and CA125 levels, CA125 half-life, CA125-negative time, age, FIGO stage, histopathology, differentiation, vessel carcinoma embolus, and ascites. The survival curves were compared by the log-rank test. Based on the results of single-factor analysis, the Cox model was used for multifactor analysis to analyze independent risk factors affecting the PFS of epithelial ovarian carcinoma.

Results

A total of 117 patients with EOC were selected from January 2012 to January 2019 to carry out a retrospective study. Univariate analyses showed that PFS of the patients with EOC was associated with differentiation, vessel carcinoma embolus, FIGO stage, CA125 half-life, CA12-negative time, and preoperative NLR (P<0.05). Multivariate analysis by the Cox model showed that vessel carcinoma embolus, CA125 half-life, differentiation, and preoperative NLR are the independent risk factors for PFS in patients with EOC.

Conclusions

The serum CA125 dynamic as reflected by CA125 half-life is the most important independent prognostic factor in patients with EOC. The simplicity of CA125 monitoring and its correlation with EOC patient survival can identify patients with poor prognosis through monitoring CA125 half-life, which can provide a reference value for use in clinical practice.