The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass
The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass
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DOI：
10.1016/j.ygyno.2007.10.017
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发表时间：
2008-02-01
影响因子：
4.7
通讯作者：
Bast, Robert C., Jr.
中科院分区：
文献类型：
--
作者：
Moore, Richard G.;Brown, Amy K.;Bast, Robert C., Jr.
目标. CA 125肿瘤标志物用于帮助预测附件肿块患者中卵巢癌的存在。由于CA 125水平升高发生在许多良性妇科疾病，我们着手确定其他新的生物标志物，将增加CA 125的敏感性和特异性。血清和尿液样本，术前获得的妇女接受手术的附件肿块。分析样本的CA 125、SMRP、HE 4、CA 72 -4、激活素、骨桥蛋白、表皮生长因子（EGFR）和ERBB 2（Her 2）水平，并与最终病理学结果进行比较。对所有标记物和组合进行Logistic回归模型估计，进行交叉验证分析以获得90%、95%和98%的集特异性的灵敏度。259例附件包块患者入组。其中，233例患者符合分析条件，67例浸润性上皮性卵巢癌和166例良性卵巢肿瘤。良性肿块和癌症患者之间除Her 2外的所有标志物水平的平均值均显著不同。作为单一标志物，HE 4的敏感性最高，为72.9%（特异性95%）。相比之下，组合的CA 125和HE 4产生了最高的灵敏度，为76.4%（特异性95%），另外的标志物对该组合的灵敏度增加最小。HE 4是I期疾病的最佳单一标志物，与CA 125或任何其他标志物联合使用时，敏感性没有增加。作为一种单一的肿瘤标志物，HE 4对检测卵巢癌，尤其是I期疾病的敏感性最高。联合CA 125和HE 4是一个更准确的预测恶性肿瘤比单独。(C)2007年爱思唯尔公司All rights reserved.
Objectives. The CA125 tumor marker is used to help predict the presence of ovarian cancer in patients with an adnexal mass. Because elevated CA125 levels occur in many benign gynecologic conditions, we set out to identify other novel biomarkers that would increase the sensitivity and specificity of CA125.Methods. Serum and urine samples were obtained preoperatively from women undergoing surgery for an adnexal mass. The samples were analyzed for levels of CA125, SMRP, HE4, CA72-4, activin, inhibin, osteopontin, epidermal growth factor (EGFR), and ERBB2 (Her2) and were compared to final pathology results. Logistic regression models were estimated for all markers and combinations, with cross-validation analysis performed to obtain the sensitivities at set specificities of 90%, 95%, and 98%.Results. Two hundred and fifty-nine patients with adnexal masses were enrolled. Of these, 233 patients were eligible for analysis with 67 invasive epithelial ovarian cancers and 166 benign ovarian neoplasms. Mean values for all marker levels except Her2 differed significantly between patients with benign masses and cancer. As a single marker, HE4 had the highest sensitivity at 72.9% (specificity 95%). Comparatively, combined CA 125 and HE4 yielded the highest sensitivity at 76.4% (specificity 95%), with additional markers adding minimally to the sensitivity of this combination. HE4 was the best single marker for Stage I disease, with no increase in sensitivity when combined with CA125 or any other marker.Conclusions. As a single tumor marker, HE4 had the highest sensitivity for detecting ovarian cancer, especially Stage I disease. Combined CA125 and HE4 is a more accurate predictor of malignancy than either alone. (C) 2007 Elsevier Inc. All rights reserved.