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Wang T, Bin Y, Zhao L, Li Q. Positive Rate of Malignant Cells in Endometrial Cytology Samples of Ovarian Cancer, Fallopian Tube Cancer, and Primary Peritoneal Cancer Patients: A Systematic Review and Meta-Analysis. J Cytol 2023; 40:51-57. [PMID: 37388400 PMCID: PMC10305903 DOI: 10.4103/joc.joc_49_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 03/30/2023] [Indexed: 07/01/2023] Open
Abstract
To estimate the feasibility of diagnosing ovarian cancer, fallopian tube cancer, and primary peritoneal cancer through endometrial cytology, we performed a systematic review and meta-analysis to calculate the pooled positive rate of malignant cells in endometrial cytology samples. We queried PubMed, EMBASE, Medline, and Cochrane Central Register of Controlled Trails from inception to November 12, 2020 for studies estimating positive rates of malignant cells in endometrial cytology samples from patients with ovarian cancer, fallopian tube cancer, and primary peritoneal cancer. The positive rates of the included studies were calculated as pooled positive rate through meta-analyses of proportion. Subgroup analysis based on different sampling methods was conducted. Seven retrospective studies involving 975 patients were included. Pooled positive rate of malignant cells in endometrial cytology specimens of ovarian cancer, fallopian tube cancer, and primary peritoneal cancer patients was 23% (95% CI: 16% - 34%). Statistical heterogeneity between the included studies was considerable (I2 = 89%, P < 0.01). The pooled positive rates of the group of brushes and the group of aspiration smears were 13% (95% CI: 10% - 17%, I2 = 0, P = 0.45) and 33% (95% CI: 25% - 42%, I2 = 80%, P < 0.01), respectively. Although endometrial cytology is not an ideal diagnostic tool for ovarian cancer, fallopian tube cancer, and primary peritoneal cancer, it is a convenient, painless, and easy-to-implement adjunct to other tools. Sampling method is one of the factors that affect the detection rate.
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Affiliation(s)
- Tiantian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
| | - Yadi Bin
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
| | - Lanbo Zhao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
| | - Qiling Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xi’an Jiaotong University, China
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2
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Plasmonic Gold Chip for Multiplexed Detection of Ovarian Cancer Biomarker in Urine. Chem Res Chin Univ 2022. [DOI: 10.1007/s40242-022-2117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sun ML, Yang ZY, Wu QJ, Li YZ, Li XY, Liu FH, Wei YF, Wen ZY, Lin B, Gong TT. The Role of Human Epididymis Protein 4 in the Diagnosis and Prognosis of Diseases: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies. Front Med (Lausanne) 2022; 9:842002. [PMID: 35402435 PMCID: PMC8987291 DOI: 10.3389/fmed.2022.842002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background The application of human epididymis protein 4 (HE4) in diverse health diseases, especially in cancers, has been extensively studied in recent decades. To summarize the existing evidence of the aforementioned topic, we conducted an umbrella review to systematically evaluate the reliability and strength of evidence regarding the role of HE4 in the diagnostic and prognostic estimate of diverse diseases. Methods Electronic searches in PubMed, Web of Science, and Embase databases were conducted from inception to September 16, 2021, for meta-analyses, which focus on the role of HE4 in the diagnosis and prognosis of diseases. This study protocol has been registered at PROSPERO (CRD42021284737). We collected the meta-analysis effect size of sensitivity, specificity, positive predictive value, and negative predictive value from diagnostic studies and gathered the hazard ratio (HR) of disease-free survival, overall survival, and progression-free survival from prognostic studies. For each systematic review and meta-analysis, we used a measurable tool for evaluating systematic reviews and meta-analysis (AMSTAR) to evaluate the methodological quality. Additionally, we assessed the quality of evidence on estimating the ability of HE4 in the diagnosis and prognosis of diverse diseases by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guideline. Results Overall, 20 meta-analyses including a total of 331 primary studies of different diseases were examined, mainly including ovarian cancer (OC) (n = 9), endometrial cancer (EC) (n = 6), and lung cancer (LC) (n = 4). The methodological qualities of all studies were rated as moderate (45%) or high (55%) by the AMSTAR. According to the GRADE, the certainties of 18 diagnostic pieces of evidence (9 for sensitivity and 9 for specificity) were rated as moderate (34%), low (33%), and very low (33%). Moreover, outcomes from prognosis studies showed evidence (1 for disease-free survival) with high certainty in regard to cancers (such as EC, OC, and LC) with the remaining three being moderate. Conclusion This umbrella review suggested that HE4 was a favored biomarker in the prognosis of cancers, which was supported by high certainty of evidence. Additionally, HE4 could provide a suitable method for the diagnosis of EC, OC, and LC with moderate certainty evidence. Further large prospective cohort studies are needed to better elucidate the diagnostic and prognostic role of HE4 in diseases.
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Affiliation(s)
- Ming-Li Sun
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhi-Yong Yang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qi-Jun Wu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yi-Zi Li
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xin-Yu Li
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fang-Hua Liu
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yi-Fan Wei
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhao-Yan Wen
- Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bei Lin
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Bei Lin,
| | - Ting-Ting Gong
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Ting-Ting Gong,
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Yu J, Guo Y, Gu Y, Li F, Song H, Nian R, Fan X, Liu W. Targeting and neutralizing human epididymis protein 4 by novel nanobodies to suppress ovarian cancer cells and attenuate cisplatin resistance. Int J Biol Macromol 2022; 199:298-306. [PMID: 35016970 DOI: 10.1016/j.ijbiomac.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 11/05/2022]
Abstract
Human epididymis protein 4 (HE4) is a glycoprotein secreted by epithelial ovarian cancer (EOC) cells and is a novel and specific biomarker for diagnosing and prognosing EOC. Previous studies have shown that overexpression of HE4 is correlated with EOC tumorigenesis and chemoresistance. However, less has been reported regarding the direct effect of the secreted HE4 protein as an autocrine factor in EOC cells. Here, we investigated the molecular mechanism of the secretory form of HE4 on the growth of EOC cells by applying nanobodies with a targeted interaction of free HE4. Three anti-HE4 nanobodies were selected from an immune library by phage display. HE4 secreted by serum-free cultured OVCAR3 cells increased and was effectively neutralized by anti-HE4 nanobodies, which inhibited cell viability. Treatment with the anti-HE4 nanobody 1G8 decreased Bcl-2 expression and increased BAX, cleaved PARP, and p53 levels, resulting in apoptosis of OVCAR3 cells. Moreover, 1G8 significantly improved the cisplatin response of OVCAR3 cells. Our data suggest that secretory HE4 played a novel pro-survival autocrine role and was a target of the anti-HE4 nanobody to improve the therapeutic effects of cisplatin-based chemotherapy.
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Affiliation(s)
- Jianli Yu
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China; University of Chinese Academy of Sciences, No. 19(A) Yuquan Road, Beijing 100049, China
| | - Yang Guo
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Yi Gu
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China; University of Chinese Academy of Sciences, No. 19(A) Yuquan Road, Beijing 100049, China
| | - Fei Li
- Shenzhen Innova Nanobodi Co., Ltd., No. 1301 Guanguang Road, Shenzhen 518110, China
| | - Haipeng Song
- Shenzhen Innova Nanobodi Co., Ltd., No. 1301 Guanguang Road, Shenzhen 518110, China
| | - Rui Nian
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China
| | - Xiying Fan
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China.
| | - Wenshuai Liu
- CAS Key Laboratory of Biobased Materials, Qingdao Institute of Bioenergy and Bioprocess Technology, Chinese Academy of Sciences, No. 189 Songling Road, Qingdao 266101, China.
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Heitz F, Lakis S, Harter P, Heikaus S, Sehouli J, Talwar J, Menon R, Ataseven B, Bertrand M, Schneider S, Mariotti E, Bommert M, Müller JN, Prader S, Leenders F, Hengsbach A, Gloeckner C, Braicu EI, Heukamp LC, du Bois A, Heuckmann JM. Cell-free tumor DNA, CA125 and HE4 for the objective assessment of tumor burden in patients with advanced high-grade serous ovarian cancer. PLoS One 2022; 17:e0262770. [PMID: 35130283 PMCID: PMC8820624 DOI: 10.1371/journal.pone.0262770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The present prospective study aimed at determining the impact of cell-free tumor DNA (ct-DNA), CA125 and HE4 from blood and ascites for quantification of tumor burden in patients with advanced high-grade serous epithelial ovarian cancer (EOC). METHODS Genomic DNA was extracted from tumor FFPE and ct-DNA from plasma before surgery and on subsequent post-surgical days. Extracted DNA was subjected to hybrid-capture based next generation sequencing. Blood and ascites were sampled before surgery and on subsequent post-surgical days. 20 patients (10 undergoing complete resection (TR0), 10 undergoing incomplete resection (TR>0)) were included. RESULTS The minor allele frequency (MAF) of TP53 mutations in ct-DNA of all patients with TR0 decreased significantly, compared to only one patient with TR>0. It was not possible to distinguish between patients with TR0 and patients with TR>0, using CA125 and HE4 from blood and ascites. CONCLUSIONS Based upon the present findings, ct-DNA assessment in patients with high-grade serous EOC might help to better determine disease burden compared to standard tumor markers. Further studies should prospectively evaluate whether this enhancement of accuracy can help to optimize management of patients with EOC.
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Affiliation(s)
- Florian Heitz
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Corporate member of Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sotirios Lakis
- NEO New Oncology GmbH, Cologne, Germany
- ULTIVUE, Segrate Milan, Italy
| | - Philipp Harter
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | - Sebastian Heikaus
- Evangelische Kliniken Essen-Mitte, Center for Pathology, Essen, Germany
| | - Jalid Sehouli
- Department for Gynecology with the Center for Oncologic Surgery Charité Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Corporate member of Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Germany
| | | | | | - Beyhan Ataseven
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
| | - Miriam Bertrand
- NEO New Oncology GmbH, Cologne, Germany
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Stephanie Schneider
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | | | - Mareike Bommert
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | | | - Sonia Prader
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
- Department of Obstetrics and Gynecology, General Hospital (SABES-ASDAA), Brixen–Bres-sanone, Italy
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Inns-bruck, Austria
| | | | - Alexandra Hengsbach
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
| | | | | | | | - Andreas du Bois
- Evangelische Kliniken Essen-Mitte Klinik für Gynäkologie und gynäkologische Onkologie, Essen, Germany
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Salminen L, Gidwani K, Grènman S, Carpén O, Hietanen S, Pettersson K, Huhtinen K, Hynninen J. HE4 in the evaluation of tumor load and prognostic stratification of high grade serous ovarian carcinoma. Acta Oncol 2020; 59:1461-1468. [PMID: 33030975 DOI: 10.1080/0284186x.2020.1827157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Human epididymis protein 4 (HE4) is a validated, complementary biomarker to cancer antigen 125 (CA125) for high grade serous ovarian carcinoma (HGSC). Currently, there are insufficient data on the utility of longitudinal HE4 measurement during HGSC treatment and follow up. We set to provide a comprehensive analysis on the kinetics and prognostic performance of HE4 with serial measurements during HGSC treatment and follow up. METHODS This prospective study included 143 patients with advanced HGSC (ClinicalTrials.gov identifier: NCT01276574). Serum CA125 and HE4 were measured at baseline, before each cycle of chemotherapy and during follow up until first progression. Baseline biomarker values were compared to the tumor load assessed during surgery and to residual disease. Biomarker nadir values and concentrations at progression were correlated to survival. RESULTS The baseline HE4 concentration distinguished patients with a high tumor load from patients with a low tumor load assessed during surgery (p<.0001). The baseline CA125 level was not associated with tumor load to a similar extent (p=.067). At progression, the HE4 level was an independent predictor of worse survival in the multivariate analysis (p=.002). All patients that were alive 3 years post-progression had a serum HE4 concentration below 199.20 pmol/l at the 1st recurrence. CONCLUSION HE4 is a feasible biomarker in the treatment monitoring and prognostic stratification of patients with HGSC. Specifically, the serum level of HE4 at first relapse was associated with the survival of patients and it may be a useful complementary tool in the selection of second line treatments. This is to the best of our knowledge the first time this finding has been reported.
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Affiliation(s)
- Liina Salminen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kamlesh Gidwani
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Seija Grènman
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Olli Carpén
- Institute of Biomedicine and Western Finland Cancer Centre (FICAN), University of Turku, Turku, Finland
- Medicum, Research Program in Systems Oncology and HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sakari Hietanen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Kim Pettersson
- Department of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Kaisa Huhtinen
- Institute of Biomedicine and Western Finland Cancer Centre (FICAN), University of Turku, Turku, Finland
| | - Johanna Hynninen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
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7
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Lv M, Wang F, Wang X, Zhang C. Diagnostic value of human epididymis protein 4 in malignant pleural effusion in lung cancer. Cancer Biomark 2020; 26:523-528. [PMID: 31658049 DOI: 10.3233/cbm-190840] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to assess the diagnostic value of human epididymis protein 4 (HE4) in the pleural effusion of lung cancer patients. METHODS HE4 protein in the pleural effusion of 60 lung cancer patients was measured by electrochemiluminescence, in parallel with those from 56 patients with benign lung disease, and the association with malignant pleural effusion was evaluated. RESULTS The level of HE4 in samples from lung cancer patients was significantly higher than the level for those with benign lung lesions (P= 0.001) and patients with lung adenocarcinoma showed significantly higher levels of HE4 than those with squamous cell carcinoma and small cell carcinoma (P= 0.002 and P= 0.034, respectively). Using an optimal threshold of 652.2 pmol/L, the HE4 level distinguished malignant lung cancer from benign lesions with a sensitivity of 78.3% and a specificity of 75.0%. Moreover, the HE4 level differentiated adenocarcinoma from benign lesions with a sensitivity of 75.9% and a specificity of 85.7% when a threshold of 744.05 pmol/L was used. However, there was no significant difference in the 2 year survival rates of lung cancer patients with high and low HE4 concentrations in pleural fluid (P= 0.882). In addition, there was no significant difference in HE4 levels between tuberculous and inflammatory pleural effusions (P= 0.309). CONCLUSION HE4 in the pleural fluid of lung cancer patients can be valuable in the diagnosis of malignant pleural effusion; however, it does not correlate with the prognosis of patients.
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Affiliation(s)
- Min Lv
- Department of Molecular Biology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Molecular Biology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fen Wang
- Department of Oncology, Nanjing Jiangning Hospital, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.,Department of Molecular Biology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyan Wang
- Department of Clinic Laboratory, Nanjing Jiangning Hospital The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Cuilan Zhang
- Department of Clinical Laboratory, Nanjing Jiangning Hospital The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Vincent L, Jankowski C, Ouldamer L, Ballester M, Bendifallah S, Bolze PA, Akladios C, Costaz H, Lavoué V, Canlorbe G, Collinet P, Touboul C, Huchon C, Bricou A, Dridi S, Padéano MM, Bengrine L, Arnould L, Coutant C. Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: A multicenter cohort analysis from the FRANCOGYN study group. Eur J Surg Oncol 2020; 46:1689-1696. [PMID: 32417154 DOI: 10.1016/j.ejso.2020.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to identify prognostic factors of overall survival in patients with FIGO stage IIIc or IVa ovarian cancer (OC) treated by neo-adjuvant chemotherapy (NAC) followed by interval debulking surgery. MATERIALS AND METHODS Data from 483 patients with ovarian cancer were retrospectively collected, from January 1, 2000 to December 31, 2016, from the FRANCOGYN database, regrouping data from 11 centers specialized in ovarian cancer treatment. Median overall survival was determined using the Kaplan-Meier method. Univariate and multivariate analysis were performed to define prognostic factors of overall survival. RESULTS The median overall survival was 52 after a median follow up of 30 months. After univariate analysis, factors significantly associated with decreased overall survival were; no pelvic and/or para-aortic lymphadenectomy (p = 0.002), residual disease (CC1/CC2/CC3) after surgery (p < 0.001), positive cytology after NAC (p < 0.001), omental disease after NAC (p = 0.002), no pathologic complete response (pCR) (p = 0.002). In multivariate analysis, factors significantly associated with decreased overall survival were; residual disease after surgery (HR = 1.93; CI95% (1.16-3.21), p = 0.01) and positive cytology after NAC (HR = 1.59; CI95% (1.01-2.55), p = 0.05). Patients with no residual disease after surgery had a median overall survival of 64 months versus 35 months for patients with residual disease. Patients with negative cytology after NAC had a median overall survival of 71 months versus 43 months for patients with positive cytology after NAC. CONCLUSION In this first and largest French based retrospective study, complete cytoreductive surgery in ovarian cancer remains the main prognostic factor of overall survival.
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Affiliation(s)
- L Vincent
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France.
| | - C Jankowski
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - L Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, 2 Tonnelé boulevard, 37000, Tours, France; INSERM U1069 Université François-Rabelais, 10 Tonnelé boulevard, 37000, Tours, France
| | - M Ballester
- Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Avron Street, 75020, Paris, France
| | - S Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 Chine street, 75020, Paris, France
| | - P A Bolze
- Gynecological Surgery Service, CHU Lyon-Sud, 165 Grand Revoyet Road, 69495, Pierre-Bénite, France
| | - C Akladios
- Department of Surgical Gynecology, University Hospital of Strasbourg, Molière Avenue, 67200, Strasbourg, France
| | - H Costaz
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - V Lavoué
- Department of Gynecological Surgery, Rennes University Hospital, 16 Bulgarie boulevard, 35200, Rennes, France
| | - G Canlorbe
- Department of Gynecologic and Breast Surgery and Oncology, AP-HP, Pitié-Salpêtrière University Hospital, 47-83 Hopital boulevard, 75013, Paris, France; INSERM,UMR S 938, Sorbonne University, 75005, Paris, France
| | - P Collinet
- Department of Gynecological Surgery, Jeanne de Flandre University Hospital, Eugéne Avinée Avenue, 59000, Lille, France
| | - C Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, 40 Verdun Avenue, 94010, Créteil, France
| | - C Huchon
- Department of Gynecology, Centre Hospitalier de Poissy, 10 Champ Gaillard Street, 78300, Poissy, France
| | - A Bricou
- Department of Gynaecology, Bobigny University, AP-HP, Hôpital Jean-Verdier, 14 Juillet Avenue, 93140, Bondy, France
| | - S Dridi
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France
| | - M M Padéano
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - L Bengrine
- Department of Medical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, 1 Professeur Marion Street, 21000, France
| | - L Arnould
- Department of Anatomopathology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France
| | - C Coutant
- Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, 1 Professeur Marion Street, 21000, Dijon, France; University of Burgundy, 7 Jeanne d'Arc boulevard, 21000, Dijon, France
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9
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Furrer D, Grégoire J, Turcotte S, Plante M, Bachvarov D, Trudel D, Têtu B, Douville P, Bairati I. Performance of preoperative plasma tumor markers HE4 and CA125 in predicting ovarian cancer mortality in women with epithelial ovarian cancer. PLoS One 2019; 14:e0218621. [PMID: 31220149 PMCID: PMC6586345 DOI: 10.1371/journal.pone.0218621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/05/2019] [Indexed: 02/01/2023] Open
Abstract
Clinical utility of new biomarkers often requires the identification of their optimal threshold. This external validation study was conducted to assess the performance of the preoperative plasma tumor markers HE4 and CA125 optimal cut-offs to predict cancer mortality in women with epithelial ovarian cancer (EOC). Participating women had upfront debulking surgery in the University Hospital of Quebec City (Canada) between 1998 and 2013. A total of 136 women participated in the training cohort (cohort 1) and 177 in the validation cohort (cohort 2). Preoperative plasma HE4 and CA125 levels were measured by Elecsys. Optimal thresholds were identified in the cohort 1 using time-dependent receiver operating characteristic (ROC) curves. Multivariate Cox models were used to validate the biomarkers using their optimal cut-offs in the cohort 2. The likelihood ratio (LR) test was done to test whether the biomarkers added prognostic information beyond that provided by standard prognostic factors. The Areas Under the Curves (AUC) for HE4 and CA125 were respectively 64.2 (95% CI: 54.7-73.6) and 63.1 (95%CI: 53.6-72.6). The optimal thresholds were 277 pmol/L for HE4 and 282 U/ml for CA125. Preoperative plasma HE4 (≥277 pmol/L) was significantly associated with EOC mortality (adjusted hazard ratio (aHR): 1.90; 95% CI:1.09-3.29). The prognostic effect of HE4 was strongest in the subgroup of women with serous ovarian cancer (aHR: 2.42; 95% CI: 1.25-4.68). Using a multivariate model including all standard prognostic factors, this association was maintained (aHR: 2.21; 95% CI: 1.15-4.23). In addition, preoperative plasma HE4 added prediction for death over the standard prognostic markers in women with serous tumors (p-value for LR-test: 0.01). Preoperative CA125 was not associated with cancer mortality, both in women with EOC and in those with serous tumors. Preoperative HE4 is a promising prognostic biomarker in EOC, especially in serous tumor.
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Affiliation(s)
- Daniela Furrer
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
| | - Jean Grégoire
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
- Gynecologic Oncology Division, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, L’Hôtel-Dieu-de-Québec, Québec, Québec, Canada
| | - Stéphane Turcotte
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
| | - Marie Plante
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
- Gynecologic Oncology Division, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval, L’Hôtel-Dieu-de-Québec, Québec, Québec, Canada
| | - Dimcho Bachvarov
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
| | - Dominique Trudel
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Department of Pathology, Hôpital Saint-Luc, Centre Hospitalier Universitaire de Montréal, rue Saint-Denis, Montréal, Québec, Canada
| | - Bernard Têtu
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
| | - Pierre Douville
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
| | - Isabelle Bairati
- Université Laval Cancer Research Center 11, Côte du Palais, Quebec City, QC, Canada
- Research Center of the CHU de Québec-Université Laval (Oncology division), Côte du palais, Quebec City, QC, Canada
- Faculty of Medicine, Université Laval, Avenue de la Médecine, Quebec City, QC, Canada
- * E-mail:
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Ferraro S, Robbiano C, Tosca N, Panzeri A, Paganoni AM, Panteghini M. Serum human epididymis protein 4 vs. carbohydrate antigen 125 in ovarian cancer follow-up. Clin Biochem 2018; 60:84-90. [DOI: 10.1016/j.clinbiochem.2018.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/08/2018] [Accepted: 08/15/2018] [Indexed: 01/04/2023]
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James NE, Chichester C, Ribeiro JR. Beyond the Biomarker: Understanding the Diverse Roles of Human Epididymis Protein 4 in the Pathogenesis of Epithelial Ovarian Cancer. Front Oncol 2018; 8:124. [PMID: 29740539 PMCID: PMC5928211 DOI: 10.3389/fonc.2018.00124] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/05/2018] [Indexed: 12/12/2022] Open
Abstract
Human epididymis protein 4 (HE4) is an important clinical biomarker used for the detection of epithelial ovarian cancer (EOC). While much is known about the predictive power of HE4 clinically, less has been reported regarding its molecular role in the progression of EOC. A deeper understanding of HE4’s mechanistic functions may help contribute to the development of novel targeted therapies. Thus far, it has been difficult to recommend HE4 as a therapeutic target owing to the fact that its role in the progression of EOC has not been extensively evaluated. This review summarizes what is collectively known about HE4 signaling and how it functions to promote tumorigenesis, chemoresistance, and metastasis in EOC, with the goal of providing valuable insights that will have the potential to aide in the development of new HE4-targeted therapies.
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Affiliation(s)
- Nicole E James
- Division of Gynecologic Oncology, Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, United States.,Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, United States
| | - Clinton Chichester
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, United States
| | - Jennifer R Ribeiro
- Division of Gynecologic Oncology, Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, United States
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