title: Usefulness of human epididymis protein 4 in predicting optimal cytoreductive therapy in patients with advanced ovarian cancer.
abstract: OBJECTIVE
  Human Epididymis Protein 4 (HE4) is a novel promising serum biomarker of high sensitivity and specificity for ovarian cancer (OC). We investigated the usefulness of HE4 in predicting the outcome of surgery of advanced OC.
  
  
  METHODS
  Fifty patients with OC (FIGO stage III and IV) entered the study. Serum concentrations of HE4 and CA125 were evaluated preoperatively. All patients had been operated between January 2014 - January 2016.
  
  
  RESULTS
  Preoperatively, the mean concentration of HE4 was 628pmol/L. Optimal cytoreduction was achieved in 44% of the patients, accompanied with decline of the mean values to HE4 478pmol/L, while in patients with suboptimal cytoreduction these values were 756pmol/L (p<0.001). Optimal cytoreduction was achieved in 52.9% of the patients with ascites ≤1,000 ml and in 48% of those with ascites >1,000 ml (p=0.023). These patients had preoperative values of HE4 405 and 713pmol/L, respectively (p=0.001). Optimal debulking was achieved in those patients with positive lymph nodes and ascites >1000ml, whose preoperative values of HE4 and CA125 were <413pmol/L and <500U/ mL, respectively. Our results indicated that the significant predictor of optimal cytoreduction was the value of HE4≤413pmol/L. In patients whose preoperative values HE4 were ≥413pmol/L the optimal cytoreduction was less probable (odds ratio 4.921, p=0.021).
  
  
  CONCLUSIONS
  Preoperative concentrations of HE4 can be of predictive value for the achievement of optimal debulking of OC. Additional research in larger populations is necessary to prove the ability of preoperative values of HE4 in helping answer the question of whether or not optimal cytoreduction would be achieved.
authors.affiliation: University Clinic of Obstetrics & Gynecology "Narodni Front", Department of Surgery, Belgrade, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Paunovic
authors.forename: Zoran
authors.initials: Z
authors.lastname: Protrka
authors.forename: Daniela
authors.initials: D
authors.lastname: Ardalic
authors.forename: Tomislav
authors.initials: T
authors.lastname: Paunovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000601:surgery*; D011506:Proteins / Q000032:analysis*; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D018394:CA-125 Antigen; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human