Diagnostic performance of CA 125, HE4, and risk of Ovarian Malignancy Algorithm for ovarian cancer
Diagnostic performance of CA 125, HE4, and risk of Ovarian Malignancy Algorithm for ovarian cancer
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DOI：
10.1002/jcla.22624
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发表时间：
2019-01-01
影响因子：
2.7
通讯作者：
Han, Sang Won
中科院分区：
文献类型：
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作者：
Kim, Boyeon;Park, Yongjung;Han, Sang Won
目的评价CA 125、HE4和ROMA对韩国人卵巢癌的诊断性能，并设定最佳临界值。方法对762例妇科良性疾病患者和70例卵巢癌患者进行血清HE 4、CA 125水平测定及ROMA评分。构建受试者工作特征曲线以计算曲线下面积（AUC）。分别确定CA 125、HE4和表现出最大约登指数的ROMA作为最佳截止值，并通过应用这些截止值来评价灵敏度和特异性。结果在良性疾病中，CA 125在子宫肌瘤、子宫腺肌病、子宫内膜病变和子宫内膜异位症患者中显著升高，而HE 4仅在子宫腺肌病患者中升高。对于卵巢癌的诊断，CA 125、HE 4和年龄的组合在绝经前组中显示出最高的AUC值0.892，并且ROMA表现出最好的诊断性能，在绝经后患者中AUC为0.935。当应用CA 125和HE 4的最佳截止值时，CA 125、HE 4和ROMA在绝经前妇女中的敏感性均相同，为0.714，而特异性分别为0.841、0.974和0.972。在绝经后组中，这些标志物的敏感性分别为0.857、0.804和0.929，特异性分别为0.836、0.887和0.800。结论虽然所有标记物均表现出良好的诊断性能，但它们因良性疾病和卵巢癌的病理类型而异。为了准确诊断卵巢癌，CA 125、HE 4和ROMA应互补使用。
Objective We evaluated the diagnostic performance of CA 125, HE4, and ROMA for ovarian cancer in Koreans and set optimal cutoffs. Method Serum levels of HE4 and CA 125 and the ROMA score were determined in 762 patients with benign gynecological disease and 70 with ovarian cancer. Receiver operating characteristic curves were constructed to calculate the areas under the curve (AUC). CA 125, HE4, and ROMA exhibiting maximum Youden index were determined, respectively, as the optimal cutoffs, and sensitivity and specificity were evaluated by applying those cutoffs. Results In benign diseases, CA 125 significantly increased in patients with uterine myoma, adenomyosis, endometrial pathology, or endometriosis, but HE4 only increased in patients with adenomyosis. For the diagnosis of ovarian cancer, the combination of CA 125, HE4, and age showed the highest AUC value of 0.892 in the premenopausal group, and ROMA demonstrated the best diagnostic performance, with an AUC of 0.935 in postmenopausal patients. When the optimal cutoff values for CA 125 and HE4 were applied, the sensitivities of CA 125, HE4, and ROMA in premenopausal women were all the same at 0.714, while the specificities were 0.841, 0.974, and 0.972, respectively. In the postmenopausal group, the sensitivities of these markers were 0.857, 0.804, and 0.929, and the specificities were 0.836, 0.887, and 0.800, respectively. Conclusion Although all markers demonstrated good diagnostic performance, they varied depending on the pathologic types of benign diseases and ovarian cancer. For accurate diagnosis of ovarian cancer, CA 125, HE4, and ROMA should be used complementarily.