Serum human epididymis protein 4 (HE4) and Risk for Ovarian Malignancy Algorithm (ROMA) as new diagnostic and prognostic tools for epithelial ovarian cancer management
Menée sur 419 patientes (140 témoins, 131 kystes bénins de l'ovaire, 34 endométrioses, 114 cancers épithéliaux de l'ovaire), cette étude évalue la valeur diagnostique et pronostique du niveau sérique de la protéine HE4 et du modèle de calcul de risque ROMA (Risk for Ovarian Malignancy Algorithm) dans le cancer épithélial de l'ovaire
Introduction The aim of this work was to analyze the diagnostic and prognostic value of serum human epididymis protein 4 (HE4) and Risk for Ovarian Malignancy Algorithm (ROMA) in epithelial ovarian cancer (EOC). Material and Methods Preoperative serum samples of 419 women (140 healthy controls, 131 ovarian benign cysts, 34 endometriosis, 114 EOC) were tested for CA125 and HE4 using fully automated methods (Abbott ARCHITECT) and validated cut-off values. Results For the discrimination of benign masses from EOC, in pre-menopausal women the sensitivity and specificity were 92.3% and 59.4% for CA125, 84.6% and 94.2% for HE4, and 84.6% and 81.2% for ROMA while in post-menopausal women the sensitivity and specificity were 94.3% and 82.3% for CA125, 78.2% and 99.0% for HE4, 93.1% and 84.4% for ROMA. In patients with EOC, elevated CA125, HE4 and ROMA levels were associated with advanced FIGO stage, sub-optimally debulking, ascites, positive cytology, lymph node involvement and advanced age (all p≤0.05). Elevated HE4 and ROMA (both p≤0.01), but not CA125 (p=0.0579), were associated with undifferentiated tumours. In multivariable analysis, elevated HE4 and ROMA (all p≤0.05) were independent prognostic factors for shorter overall survival, disease free survival and progression free survival. Discussion This study underlines the high specificity of HE4 in discriminating endometriosis and ovarian benign cysts from EOC and the high sensitivity of CA125 in detecting EOC. We demonstrated HE4 and ROMA as independent prognostic factors. Multicenter studies are needed to draw firm conclusions about the applicability of HE4 and ROMA in clinical practice.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2011