卵巢癌风险预测模型在诊断卵巢上皮性癌中的应用价值

Application value of ROMA in diagnosis of epithelial ovarian carcinoma

目的评价应用卵巢癌风险预测模型(ROMA)在卵巢上皮性癌发病风险预测中的价值。方法临床回顾并随访139例原发性卵巢上皮性癌患者(卵巢癌组)和123例卵巢良性肿瘤患者(卵巢良性肿瘤组),用酶联免疫吸附(ELISA)法(化学发光法)测定受试者手术前血清人附睾蛋白4(HE4)和CA125水平,用卵巢癌风险评估软件计算ROMA指数,以卵巢良性肿瘤为参照并绘制ROC曲线,通过计算最大曲线下面积(AUC)来评价HE4、CA125、ROMA指数的诊断价值。结果卵巢良性肿瘤组患者血清HE4、CA125和ROMA指数水平均在正常范围内,而卵巢癌组患者3项指标的中位水平分别为268.30 pmol/L、243.40 U/ml和81.60%,两组间差异有统计学意义(P<0.01)。与卵巢良性肿瘤组患者比较,卵巢癌组患者ROMA指数的敏感性和阴性预测值最高(93.1%和91.32%),HE4特异性和阳性预测值及准确性最高,分别为98.9%和98.71%及90.467%。以卵巢良性肿瘤患者为参照人群绘制ROC曲线,HE4、CA125、ROMA指数的最大AUC分别为0.916、0.853、0.952。结论联合检测血清HE4、CA125并计算ROMA指数有助于预测卵巢肿瘤患者卵巢癌的风险性,从而提高早期诊断卵巢癌的可行性。

Objective To evaluate the application value of risk of ovarian malignancy algorithm（ ROMA） in diagnosis of epithelial ovarian carcinoma. Methods A total of 139 patients with epithelial ovarian carcinoma（ epithelial ovarian carcinoma group） and 123 patients with benign ovarian tumor（ benign ovarian tumor group） were reviewed clinically and followed up. ELISA and chemiluminescence method were used to measure the levels of serum human epididymis protein 4（ HE4） and CA125 before operation. Ovarian cancer risk assessment software was used to calculate ROMA index. ROC curve was drawn taking benign ovarian tumor as a reference,the diagnostic value of HE4,CA125,and ROMA index was assessed by calculating the area under the curve（ AUC）. Results The levels of HE4,CA125,and ROMA index in benign ovarian tumor group were within the normal ranges,the medians of the three indicators were 268. 30 pmol/L,243. 40 U/ml,and 81. 60% in epithelial ovarian carcinoma group,there were statistically significant differences between the two groups（ P〈0. 01）. Compared with benign ovarian tumor group,the sensitivity and negative predictive value of ROMA index in epithelial ovarian carcinoma group were the highest（ 93. 1% and 91. 32%）; the specificity,positive predictive value,and accuracy of HE4 were the highest（ 98. 9%,98. 71%,90. 467%）. ROC curve was drawn taking benign ovarian tumor as a reference,the AUCs of HE4,CA125,and ROMA were0. 916,0. 853,and 0. 952,respectively. Conclusion Joint detection of HE4 and CA125 combined with calculation of ROMA index is helpful in evaluating the risk of ovarian cancer and improve the efficiency of early diagnosis of ovarian cancer.