Preoperative serum HE4 combined with CA125 testing for predicting the risk of suboptimal cytoreduction in advanced epithelial ovarian cancer

Vollständiger Abstract

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Objective To investigate the predictive value of preoperative serum markers centered on human epididymis protein 4 (HE4) combined with carbohydrate antigen 125 (CA125) for the risk of suboptimal cytoreduction in advanced epithelial ovarian cancer. Methods We retrospectively analyzed the clinical data of 102 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIA–IV epithelial ovarian cancer who underwent primary cytoreductive surgery at the First People’s Hospital of Jiangxia District between January 2021 and December 2025. Patients were divided into an optimal cytoreduction group (n=65) and a suboptimal cytoreduction group (n=37) based on the size of postoperative residual lesions. Preoperative HE4 and CA125 levels were compared between the two groups. Restricted cubic spline (RCS) functions were used to analyze dose–response relationships. Multivariate Logistic regression was applied to screen independent risk factors and construct a combined prediction model. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results Preoperative HE4, CA125, and platelet counts were significantly higher in the suboptimal cytoreduction group than in the optimal cytoreduction group (all P