The Application Of CA125 And HE4 In The Prognosis Of Ovarian Epithelial Cancer

CHAPTER I SIGNIFICANCE OF CA125 AND HE4 IN THE DIAGNOSIS AND PROGNOSIS OF OVARIANOvarian caner being the leading cause of death in gynecological reproductive tract malignancy,is a serious threat to women`s health.At present,optimal debulking surgery and postoperative platinum-based adjuvant chemotherapy are the mainly treatment.Surgical treatment can quickly minimize the number of existing tumor cells,cut off tumor clumps that may be contain resistant strains,enhancing the chemosensitivity.There are large-scale multicenter clinical trials showing that optimal debulking surgery can significantly improve the prognosis of patients.And an accurate assessment before surgery can directly affect the outcome of the patient's surgery.nowaday,there are many kinds of methods and models to predicting surgical outcome in the world.We evaluate CA125 and HE4 and the combined model of them to judge the outcome of the patients.Hoping to provide theoretical basis for clinical work.CHAPTER II THE COMBINE DIAGNOSTIC VALUE OF CA125 AND HE4 IN PREDICTING AND MONITORING THE PROGNOSIS OF EPITHELIAL OVARIAN CARCINOMAObjective To explor the combined value of CA125 and HE4 in predicting surgical out come and monitoring patients' prognosis of epithelial ovarian cancer.Method Retrospective analysis of 105 epithelial ovarian cancer patients with Completed information from January 1,2012 to December31,2015,explor the value of HE4 and CA125 in predicting surgical outcome and monitoring prognosis of patients.Result 1)The median serum HE4(P=0.01)and CA125(P=0.009)of serous adenocarcinoma were significantly higher than other type of epithelial ovarian cancer patients.2)preoperative serum HE4(cut off value 544.5pmol/L)could predict non optimised debulking surgery,ROC0.806 sensitivity 0.706,Specificity 0.806,P=0.001.3)To IDS patients,the preoperative HE4(P=0.06)? CA125(P=0.616)could not reach statistical significance to predict surgical out come.4)This is the first study to evaluate the patient's prognosis(OS)by using a combination of change pattern in serum HE4 and CA125 during treatment.The results showed that patients with both HE4 and CA125 decreased rapidly to the normal during the course of treatment(within 3 course of treatment)have the best prognosis,patients with HE4 and CA125 decreased slowly(>3course treatments)have the worst prognosis,patients with one of them abnormal within 3 course treatments have a prognosis between them.Conclution :Preoperative serum HE4 level can be used to predict the non optimised debulking surgery.The changes patten of HE4 and CA125 during treatment are helpful in predicting patients' prognosis.CHAPTER III META ANALYSIS OF REOPERATIVE SERUM HE4 IN PREDICTING THE OUTCOME OF EPITHELIAL OVARIAN CANCERObjective: To evaluate the prognostic value of HE4 in patients with epithelial ovarian cancer?Methods: Pubmed,EMbas,Medline,Cochrane Library,CNKI,Chinese Biomedical Database were searched up to Dec.31,2016.English and Chinese are the main language.Result:7studies with 398 patients were included.This Meta-analysis show that the diagnostic odds ratio was 16.23(95%cl=4.74~55.57),pool sensitivity was 81%(95%cl=77%~86%),specificity was 62%(95%cl=55%~69%),positive likelihood ratio was2.67(95%cl=1.59~4.50),negative likelihood ratio was0.23(95%cl=0.13~0.41),AUC was 0.90.Conclution: Patients serum HE4 before surgery is reliable for predicting surgical outcome while the critical value still need to be discovery.CHAPTER IV PREDICTIVE VALUE OF HE4 AND CA125 IN PRIMARY CYTOREDUCTIVE SURGERY FOR EPITHELIAL OVARIAN CANCERObjective To assess the ability of serum HE4,serum CA125 and FIGO staging to predict obtimal debulking surgey at primary cytoreduction in epithelial ovarian cancerMethod A retrospective analysis of 374 patients with epithelial ovarian cancer treated in our hospital was performed.Sensitivity,specificity,positive predictive value,negative predictive value and accuracy were used to assess the predictive value of various factors,and then,developed a mathematical prediction model for non-optimal debulking surgery.Result We used the above six indicators to establish a mathematical model to predict patients with non-optimal debulking surgery,the higher score of the patients got,the lower the diagnostic sensitivity and the higher specificity the model showed.When the patient`s score ?3 points,the diagnostic accuracy of this mathematical model can reach 60% or more,and the negative predictive value can be maintained at about 66%.Conclution Preoperative serum CA125,HE4,age,pathological grade,pathological type and FIGO staging are the factors that affect the ideal cytoreductive surgery.The mathematical model developed in this study has certain value for the selection of treatment options in clinical work.