南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (12): 1393-1401.doi: 10.12122/j.issn.1673-4254.2019.12.02

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血清CA125和HE4水平及ROMA、CPH-I模型在鉴别卵巢良恶性肿瘤中的价值对比

龚时鹏，陈咏宁，张雅迪，李婵媛，江启帆   

  • 出版日期:2019-12-27 发布日期:2019-12-20

Comparison of serum cancer antigen 125, human epididymis protein 4, ROMA, and CPH- I for diagnosis of ovarian cancer in Chinese patients with ovarian mass

  • Online:2019-12-27 Published:2019-12-20

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摘要： 目的 比较CA125、HE4、ROMA、CPH-I在鉴别卵巢良恶性肿瘤中的应用价值。方法 回顾性分析719例卵巢肿瘤患者的术前血清CA125、HE4水平及基于二者计算的ROMA和CPH-I。结果 在所有符合条件的患者中，531例为卵巢良性肿瘤，44例 为交界性卵巢肿瘤，119例为上皮性卵巢癌，25例为非上皮性卵巢癌。对于卵巢良恶性肿瘤的鉴别，HE4、ROMA、CPH-I的曲线下面积分别为0.854、0.856、0.854，均优于CA125（0.792），CA125、HE4、ROMA、CPH-I的敏感性分别为70.2%、56.9%、69.1%、63.8%，特异性分别为72.9%、94.4%、87.6%、94.7%。在预测上皮性卵巢癌时，CA125、HE4、ROMA、CPH-I的曲线下面积和敏感性分别增加到0.888、0.946、0.947、0.943和84.0%、79.8%、87.4%、84.9%。在其他不同人群分析中，HE4、ROMA和CPH-I的曲线下面积均优于CA125。结论 HE4、ROMA和CPH-I在鉴别卵巢良恶性肿瘤时的效能比CA125更高。此外，HE4和CPH-I在特异性方面优于CA125和ROMA，后两者则具有更好的敏感性。

Abstract: Objective To compare the performance of serum cancer antigen 125 (CA125), human epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA) and Copenhagen index (CPH-I) for differential diagnosis of benign and malignant diseases in patients with ovarian mass. Methods We retrospectively analyzed the data of 719 women with pelvic mass, and the performance of preoperative serum levels of CA125 and HE4, ROMA and CPH-I for differential diagnosis of the masses was compared. Results Of the 710 women analyzed, 531 were diagnosed with benign ovarian lesions, 44 with borderline ovarian tumors (BOTs), 119 with epithelial ovarian cancers (EOCs), and 25 with non-EOCs. In differentiating ovarian cancer (OC) and BOT from benign lesions, the area under the receiver-operator characteristic (ROC) curve (AUC) was 0.854 for HE4, 0.856 for ROMA, 0.854 for CPH-I, and 0.792 for CA125, demonstrating better diagnostic performance of HE4, ROMA, and CPH-I than CA125 alone; the diagnostic sensitivity was 56.9% for HE4, 70.2% for CA125, 69.1% for ROMA, and 63.8% for CPH-I; the specificity was the best with HE4 (94.4% ) and CPH-I (94.7% ). In sub-analysis of EOC vs benign lesions, the AUCs of HE4, ROMA, and CPH-I increased to 0.946, 0.947, and 0.943, respectively, all greater than that of CA125 (0.888). In other sub-analyses, HE4, ROMA, and CPH-I all showed greater AUCs than CA125 alone. Conclusion This study confirms the accuracy of HE4, ROMA, and CPH-I for differentiating malignant from benign ovarian mass, and all these 3 tests show better performance than CA125. Furthermore, HE4 and CPH-I is superior to ROMA and CA125 in terms of specificity, while CA125 and ROMA have better diagnostic sensitivities.