Simona Ferraro1, Cristina Robbiano2, Nicoletta Tosca3, Andrea Panzeri2, Anna Maria Paganoni4, Mauro Panteghini5. 1. Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy. Electronic address: simona.ferraro@asst-fbf-sacco.it. 2. Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy. 3. Oncology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy. 4. MOX - Laboratory of Modeling and Scientific Computing, Department of Mathematics 'Francesco Brioschi', Polytechnic University of Milan, Italy. 5. Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy.
Abstract
BACKGROUND: The addition of human epididymis protein 4 (HE4) to carbohydrate antigen 125 (CA125) in ovarian cancer (OC) assessment has been proposed. We compared the clinical value of biomarker changes in a prospective series of patients undergoing OC monitoring. METHODS: We studied 43 patients (79% post-menopausal), followed for 3.5 ± 3.1 years. Serous OC was prevalent (53.5%), with 81.4% of patients diagnosed at late stages. Both cut-offs and reference change values (RCV) were used for assessing significant marker changes. RESULTS: The use of cut-offs for CA125 and HE4 interpretation appeared equally fitting the evaluation of disease progression defined according to running guidelines, performing better than RCV criterion. However, both markers were simultaneously over cut-offs only in 46% of samples and changed in agreement in 35% of cases. The inspection of individual longitudinal trends indicated as main causes of disagreement the influence of renal impairment on HE4 concentrations and the more significant rate of decrease of CA125 vs. HE4 concentrations early after treatment. CA125 and HE4 changes according to RCV were not predictive of OC progression. CONCLUSIONS: CA125 appears the most reliable biomarker for OC monitoring, whereas HE4 contributes additional information only in a minority of cases.
BACKGROUND: The addition of humanepididymis protein 4 (HE4) to carbohydrate antigen 125 (CA125) in ovarian cancer (OC) assessment has been proposed. We compared the clinical value of biomarker changes in a prospective series of patients undergoing OC monitoring. METHODS: We studied 43 patients (79% post-menopausal), followed for 3.5 ± 3.1 years. Serous OC was prevalent (53.5%), with 81.4% of patients diagnosed at late stages. Both cut-offs and reference change values (RCV) were used for assessing significant marker changes. RESULTS: The use of cut-offs for CA125 and HE4 interpretation appeared equally fitting the evaluation of disease progression defined according to running guidelines, performing better than RCV criterion. However, both markers were simultaneously over cut-offs only in 46% of samples and changed in agreement in 35% of cases. The inspection of individual longitudinal trends indicated as main causes of disagreement the influence of renal impairment on HE4 concentrations and the more significant rate of decrease of CA125 vs. HE4 concentrations early after treatment. CA125 and HE4 changes according to RCV were not predictive of OC progression. CONCLUSIONS:CA125 appears the most reliable biomarker for OC monitoring, whereas HE4 contributes additional information only in a minority of cases.