术前 HE4 水平能否预测晚期卵巢癌患者的最佳肿瘤细胞减灭术效果？

Can the preoperative HE4 level predict optimal cytoreduction in patients with advanced ovarian carcinoma?

机构信息

Department of Obstetrics and Gynaecology Campus Bio Medico University of Rome, Italy.

出版信息

Gynecol Oncol. 2013 Mar;128(3):579-83. doi: 10.1016/j.ygyno.2012.11.040. Epub 2012 Dec 7.

DOI:10.1016/j.ygyno.2012.11.040

PMID:23220563

Abstract

OBJECTIVE

Optimal surgical outcome has been proved to be one of the most powerful survival determinants in the management of ovarian cancer patients. Actually, for ovarian cancer patients there is no general consensus on the preoperatively establishment of cytoreducibility.

METHODS

Between January 2011 and June 2012 patients affected by suspicious advanced ovarian cancer, referred to the Department of Gynecology of Campus Biomedico of Rome were enrolled in the study. All patients had serum CA125 and HE4 measured preoperatively. After a complete laparoscopy to assess the possibility of optimal debulking surgery defined as no visible residual tumor after cytoreduction (RT=0), patients were submitted to primary cytoreductive surgery (Group A) or addressed to neoadjuvant chemotherapy (Group B).

RESULTS

After diagnostic open laparoscopy, 36 patients underwent optimal primary cytoreductive surgery (Group A) and 21 patients were addressed to neoadjuvant chemotherapy (Group B). In our population, based on ROC curve, the HE4 value of 262pmol/L is the best cut-off to identify patients candidates to optimal cytoreduction with a sensitivity of 86.1% and a specificity of 89.5% (PPV=93.9% and NPV=77%). In addition, CA125 has a sensitivity of 58.3% and a specificity of 84% at cut-off of 414 UI/mL (AUC is 0.68, 95% C.I.=0.620 to 0.861).

CONCLUSION

Our data indicate that preoperative HE4 is a better predictor for optimal cytoreduction compared to CA125. The best combination in predicting cytoreduction is HE4≤262 pmol/L and ascites <500mL with a sensitivity of 100% and a specificity of 89.5% (PPV=94% and NPV=100%).

摘要

目的

已证实，手术的最佳效果是卵巢癌患者治疗中最有力的生存决定因素之一。实际上，对于卵巢癌患者，在术前确定减瘤能力方面尚未达成普遍共识。

方法

本研究纳入了 2011 年 1 月至 2012 年 6 月期间被转诊至罗马 Campus Biomedico 妇科的疑似晚期卵巢癌患者。所有患者均在术前测量了血清 CA125 和 HE4。在完全腹腔镜检查评估了最佳减瘤手术的可能性（定义为减瘤后无可见残留肿瘤（RT=0））后，患者接受了原发性细胞减灭术（A 组）或新辅助化疗（B 组）。

结果

在诊断性开腹腹腔镜检查后，36 例患者接受了最佳原发性细胞减灭术（A 组），21 例患者接受了新辅助化疗（B 组）。在我们的人群中，基于 ROC 曲线，HE4 值为 262pmol/L 是识别适合进行最佳细胞减灭术的患者的最佳截断值，其灵敏度为 86.1%，特异性为 89.5%（PPV=93.9%，NPV=77%）。此外，CA125 的截断值为 414 UI/mL 时，其灵敏度为 58.3%，特异性为 84%（AUC 为 0.68，95%CI.0.620 至 0.861）。