The effectiveness of CA125 and HE4 as clinical prognostic markers in epithelial ovarian cancer patients with BRCA mutation

• Published in: Journal of gynecologic oncology Vol. 35; no. 6; pp. e80 - 12
• Main Authors: Lee, Young Joo, Kim, Woojin, Hong, Soomin, Lee, Yong Jae, Lee, Jung-Yun, Kim, Sang Wun, Kim, Sunghoon, Kim, Young Tae, Nam, Eun Ji
• Format: Journal Article
• Language: English
• Published: Korea (South) Asian Society of Gynecologic Oncology; Korean Society of Gynecologic Oncology; Japan Society of Gynecologic Oncology 01.11.2024; 대한부인종양학회
• Subjects: Adult; Aged; Biomarkers, Tumor - blood; Biomarkers, Tumor - genetics; BRCA1 Protein - genetics; CA-125 Antigen - blood; Carcinoma, Ovarian Epithelial - blood; Carcinoma, Ovarian Epithelial - genetics; Carcinoma, Ovarian Epithelial - mortality; Carcinoma, Ovarian Epithelial - pathology; Carcinoma, Ovarian Epithelial - surgery; Cytoreduction Surgical Procedures; Female; Genes, BRCA1; Humans; Membrane Proteins - blood; Membrane Proteins - genetics; Middle Aged; Mutation; Original; Ovarian Neoplasms - blood; Ovarian Neoplasms - genetics; Ovarian Neoplasms - mortality; Prognosis; Proteins - genetics; Retrospective Studies; WAP Four-Disulfide Core Domain Protein 2 - analysis; WAP Four-Disulfide Core Domain Protein 2 - genetics; 산부인과학; BRCA2 Protein; Carcinoma, Ovarian Epithelial; CA-125 Antigen; BRCA1 Protein; Biomarkers, Tumor
• ISSN: 2005-0380; 2005-0399; 2005-0399
• DOI: 10.3802/jgo.2024.35.e80

To investigate the efficacy of cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in predicting survival outcomes based on breast cancer gene (BRCA) mutational status in epithelial ovarian cancer. Medical records of 448 patients diagnosed with epithelial ovarian cancer at a single tertiary institution in Korea were retrospectively analyzed. Area under the curve, sensitivity, specificity, and accuracy were assessed using the CA125 and HE4 values after surgery and 3 cycles of chemotherapy to predict 1-year survival based on the BRCA mutational status. Kaplan-Meier analysis was used to obtain progression-free and overall survival to evaluate CA125 and HE4 effectiveness in predicting survival outcomes. A total of 423 patients were analyzed, including 180 (42.6%) who underwent interval debulking surgery (IDS) and 243 (57.4%) who underwent primary debulking surgery (PDS). BRCA mutations were observed in 37 (15.2%) and 44 (22.4%) patients in the PDS and IDS groups, respectively. CA125 and HE4 normalization demonstrated the highest specificity in patients with or without BRCA mutations, with specificities of 97.1% and 99.1% in the PDS group and 78.6% and 86.2% in the IDS group, respectively. Normalizing HE4 alone may be an effective prognostic marker, with an area under the curve of 0.774 and specificity of 75.0%, in patients with BRCA mutations. Normalizing both biomarkers emerged as the most effective predictive marker for the 1-year recurrence rate, regardless of BRCA mutational status. A negative HE4 value can be a useful predictor for 1-year recurrence-free survival in patients with BRCA mutations.