Preoperative serum concentration of hCGβ as a prognostic factor in ovarian cancer

In spite of a gradual improvement, survival in epithelial ovarian cancer is disappointingly low. New therapeutic regimens are emerging, and it would be important to be able to predict the prognosis and to stratify patients for clinical trials before therapy. We have evaluated the prognostic value of the pretreatment serum concentrations of 3 tumor markers. The free beta subunit of human chorionic gonadotropin (hCG beta), CAI 25 and tumor-associated trypsin inhibitor (TATI) were measured in pretreatment serum samples from 146 patients treated for ovarian cancer between 1990-1995. The patients were followed up until 1998. Elevated concentrations of hCG beta, CAI 25 and TATI were observed in 29%,79% and 33%, respectively. When tested as single variables in Cox's proportional hazards model, stage, grade, size of residual tumor and hCG beta (all p < 0.001) and CAI 25 (p = 0.004) correlated with prognosis. However, when fitted as multiple variables together with stage, grade and age in the same model, hCG beta (RR = 3.42) stage (RR = 2.77) and grade (RR = 3.80) were the only significant variables. When serum hCG beta was normal, 5-year survival was 80%, but it was only 22% when hCG beta was elevated. In patients with stage III or IV and minimal residual disease, 5-year survival was 75% if hCG beta was normal compared with 0% if hCG beta was elevated. hCG beta in serum is a strong independent prognostic factor in epithelial ovarian cancer, and its prognostic value is similar to that of grade and stage. The availability of this marker before surgery could facilitate selection of treatment modalities. (C) 2001 Wiley-Liss, Inc.