Combining a symptoms index with CA 125 to improve detection of ovarian cancer.
Combining a symptoms index with CA 125 to improve detection of ovarian cancer.
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作者：
Andersen MR;Goff BA;Lowe KA;Scholler N;Bergan L;Dresher CW;Paley P;Urban N
目前的研究试图检验基于卵巢癌女性常见症状的特定模式的指数是否可以与CA125结合使用，以提高卵巢癌筛查实验方法的敏感性或特异性。采用前瞻性病例对照研究设计。参与者包括254名因家族史而有高患病风险的健康女性和75名患有卵巢癌的女性。用Logistic回归分析确定症状指数是否预示癌症。在控制CA125水平后，症状指数信息对卵巢癌的预测有显著的独立贡献(P<；0.05)。CA125与症状指数相结合，对女性癌症的确诊率为89.3%，对早期癌症的确诊率为80.6%，对晚期癌症的确诊率为95.1%。症状指数在CA125水平没有升高的受影响女性中发现了50%的癌症。不幸的是，11.8%的未患癌症的高危女性也获得了阳性症状指数得分。与单独使用CA125相比，CA125增加了一个症状指数，在检测卵巢癌方面具有更高的敏感性，并确定了80%患有早期疾病的妇女。像这样的复合标记物可以作为多步骤筛查计划的第一个筛查，在转诊手术之前通过经阴道超声识别假阳性发现，从而为多步骤筛查计划带来足够的阳性预测价值。
The current study sought to examine whether an index based on the specific pattern of symptoms commonly reported by women with ovarian cancer could be used in combination with CA 125 to improve the sensitivity or specificity of experimental methods of screening for ovarian cancer. A prospective case-control study design was used. Participants included 254 healthy women at high risk for disease because of family history, and 75 women with ovarian cancer. Logistic regression analysis was used to determine whether the symptom index predicted cancer. Symptom index information was found to make a significant independent contribution to the prediction of ovarian cancer after controlling for CA 125 levels (P <.05). The combination of CA 125 and the symptom index identified 89.3% of the women with cancer, 80.6% of the early-stage cancers, and 95.1% of the late-stage cancers. The symptom index identified cancer in 50% of the affected women who did not have elevated CA 125 levels. Unfortunately, 11.8% of the high-risk women without cancer also received a positive symptom index score. The addition of a symptom index to CA 125 created a composite index with a greater sensitivity for the detection of ovarian cancer than CA 125 alone and identified >80% of women with early-stage disease. A composite marker such as this could serve as a first screen in a multistep screening program in which false-positive findings are identified via transvaginal sonography before referral for surgery, leading to an adequate positive predictive value for the multistep program.
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