The Diagnostic Accuracy of Human Epididymis Factor 4 for the Prediction of Optimal Debulking in Patients With Ovarian Cancer: A Meta-Analysis of Observational Studies.

OBJECTIVE: Human epididymis factor-4 (HE4) has been studied in the field of ovarian cancer with promising results during the last decade. The purpose of the present meta-analysis is to investigate the diagnostic accuracy of HE4, in terms of sensitivity and specificity, as a minimally invasive method to predict optimal debulking in women that experience ovarian cancer.

METHODS: We used the Medline (1966-2017), Scopus (2004-2017), EMBASE, ClinicalTrials.gov (2008-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases in our primary search, along with the reference lists of electronically retrieved full-text articles.

RESULTS: Eleven articles were finally retrieved that enrolled 1065 women with ovarian cancer. Three of those were excluded because data were insufficient to introduce them in the meta-analysis. The sensitivity of HE4 for the prediction of optimal debulking was 0.81 (95% confidence interval [CI] 0.74-0.86) and the pooled specificity 0.80 (95% CI 0.75-0.84). The diagnostic odds ratio was 13.88 (95% CI 7.18-26.84) and the area under the curve, 0.86±0.03. After selecting only studies that enrolled patients with advanced disease who had primary debulking surgery, we observed that the pooled sensitivity reached 0.81 (95% CI 0.72-0.88), and the pooled specificity 0.70 (95% CI 0.62-0.78), with an area under the curve of 0.88±0.04.

CONCLUSIONS: Human epididymis factor-4 seems to be promising as a minimally invasive method to predict optimal cytoreduction among patients with ovarian cancer. However, interpretation of our findings should be approached with caution because of the significant heterogeneity of included studies.