血清糖类抗原CA125和CA19-9对鉴别卵巢交界性肿瘤及上皮性卵巢癌的价值

Value of serum carbohydrate antigen 125 and 19-9 on the differential diagnosis of borderline ovarian tumor and epithelial ovarian cancer

目的探讨血清糖类抗原（carbohydrate antigen,CA）125、CA19-9对卵巢交界性肿瘤（borderline ovarian tumor,BOT）及上皮性卵巢癌（epithelial ovarian cancer,EOC）的诊断价值。方法以术后组织病理为金标准,180例卵巢上皮性肿瘤患者中60例BOT者为BOT组,120例EOC者为EOC组。比较2组患者血清CA125、CA19-9水平与其临床病理特征。结果 EOC组血清CA125水平（361.75u/mL）高于BOT组（17.61u/mL）（P〈0.01）,EOC组和BOT组血清CA19-9水平（10.20、10.26u/mL）比较差异无统计学意义（P〉0.05）;CA125、CA19-9鉴别BOT、EOC的AUC分别是0.850（95%CI：0.794～0.907,P=0.000）、0.448（95%CI：0.363～0.533,P=0.078）,当CA125的cut-off值为51.21u/mL时,其敏感性、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为80%、80%、88.9%、66.7%、4.00、0.25,CA125鉴别BOT、EOC的准确性为80%;浆液性EOC、浆液性肿瘤（包括BOT、EOC）的CA125阳性率（88.2%、73.0%）高于CA19-9（18.6%、17.7%）（P〈0.05）;浆液性肿瘤的CA125阳性率（73.0%）高于黏液性肿瘤（30.8%）,黏液性肿瘤的CA19-9阳性率（34.6%）高于浆液性肿瘤（17.7%）（P〈0.05）。结论当CA125〉51.21u/mL,对EOC和BOT的鉴别诊断有重要价值,而CA19-9对其鉴别无意义。

Objective To explore the value of the detection of carbohydrate antigen（CA）125 and CA19-9 to the differential diagnosis of borderline ovarian tumor（BOT）and epithelial ovarian cancer（EOC）.Methods Regarding the postoperative pathology results as the gold standard,180 patients with epithelial ovarian tumors were divided into BOT group（n=60）and EOC group（n=120）,and the levels of serum CA125 and CA19-9and the clinicopathological features were analyzed and compared between two groups.Results The serum CA125 level was significantly higher in EOC group（（361.75）u/mL）than that in BOT group（（17.61）u/mL）（P〈0.05）,and there was no significant difference in the CA19-9level between two groups（10.20,10.26u/mL）（P〉0.05）.The AUC values of CA125 and CA19-9for BOT and EOC were 0.850（95% CI：0.794 to 0.907,P=0.000）and 0.448（95% CI：0.363 to 0.533,P=0.078）.When the cut-off value of CA125 was 51.21u/mL,the sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were 80%,80%,88.9%,66.7%,4 and 0.25.The accuracy of CA125 for BOT and EOC was 80%.The positive rates of CA125（88.2%,73.0%）were significantly higher than those of CA19-9（18.6%,17.7%）in serous EOC and serous tumors（including BOT,EOC）（P〈0.05）.The positive rate of CA125 in serous tumors（73.0%）was significantly higher than that of mucinous tumors（30.8%）（P〈0.05）,and the positive rate of CA19-9 in mucinous tumors（34.6%）was significantly higher than that in serous tumors（17.7%）（P〈0.05）.Conclusion CA125〉51.21u/mL has an important value to the differential diagnosis of EOC and BOT,and CA19-9 has no value.