Low Serum Cholinesterase Levels Linked to Poor Survival in Ovarian Cancer: Study Reveals

"Patients with ChE levels below 7600 U/L experienced lower overall and disease-free survival rates than those with higher levels. Additionally, low ChE levels were linked to clinicopathological factors such as FIGO stage and surgical completeness, emphasizing its potential as a biomarker for risk assessment," the researchers reported.

The researchers note that ovarian cancer remains one of the most aggressive gynecologic malignancies, often diagnosed at advanced stages, making the identification of reliable prognostic markers essential for risk assessment and treatment planning. Cholinesterase, an enzyme primarily produced by the liver, plays a crucial role in nervous system function and metabolism. In cancer patients, low ChE levels may signal deteriorating physiological conditions, reflecting the body’s overall response to malignancy and its progression.

Previous research has linked low cholinesterase levels to poor prognosis in several cancers, including bladder, pancreatic, lung, and colorectal malignancies. Building on this evidence, Hailan Su, Department of Gynecology, Suzhou Ninth People’s Hospital, Suzhou, People’s Republic of China, and colleagues explored the prognostic value of serum ChE levels in ovarian cancer, aiming to assess its clinical significance as a potential biomarker for disease outcomes.

For this purpose, the researchers conducted a retrospective cohort analysis of 168 patients diagnosed with epithelial ovarian cancer at Suzhou Ninth People’s Hospital between 2019 and 2020. Serum ChE levels were measured before treatment initiation and categorized into low and high groups based on the median level (7600 U/L). They collected clinical and pathological data, including FIGO stage, age, tumor histology, and survival outcomes. Kaplan-Meier analysis and Cox proportional hazards regression were employed to evaluate the association between ChE levels and overall as well as disease-free survival.

The following were the key findings of the study:

• ChE levels significantly correlated with the FIGO stage, surgery completeness, and platinum resistance in epithelial ovarian cancer.
• Patients with low ChE levels had significantly worse overall survival and disease-free survival, as demonstrated by Kaplan-Meier analysis.
• Multivariate Cox regression analysis identified low serum ChE levels as an independent predictor of poor overall and disease-free survival.

This study highlights that low serum ChE levels are independently linked to poor prognosis in ovarian cancer, reflecting systemic inflammation, malnutrition, and potential hepatic dysfunction. The researchers note that given its cost-effectiveness and non-invasive nature, ChE could be a valuable biomarker for risk stratification and prognosis in clinical practice.

"Future research should validate these findings across diverse populations, explore underlying biological mechanisms, and assess its integration into multimodal prognostic models to enhance patient management and outcomes," they concluded.

Reference:

Su H, Liao D, Huang C, Liu Q, Yu L. Low Serum Cholinesterase Levels Predict Poor Prognosis in Patients with Ovarian Cancer. Int J Gen Med. 2025;18:1023-1033. https://doi.org/10.2147/IJGM.S509718