应用ROMA指数评估卵巢良恶性肿瘤的诊断价值

Diagnostic value of ROMA index in evaluating ovarian benign and malignant tumor

目的研究恶性肿瘤风险评估(ROMA)指数在卵巢良恶性肿瘤的诊断价值。方法回顾性分析卵巢肿瘤接受手术治疗的患者288例,采用Cobas 602全自动免疫分析仪检测132例卵巢良性肿瘤和156例卵巢癌患者血清中人附睾分泌蛋白4(HE4)与糖类抗原(CA)125水平,计算ROMA指数及ROMA风险评估的截断值,联合绝经状态评估患者患卵巢恶性肿瘤的风险性。结果血清CA125、HE4及ROMA指数在卵巢癌组中分别为302.60(104.69,595.03)U/mL、222.65(116.38,485.30)pmol/L、83.85%(58.89%,95.46%),均高于对照组和卵巢良性肿瘤组(P<0.017)。卵巢良性肿瘤组与对照组比较仅CA125水平有升高(P<0.017)。ROMA指数最优截断值拟定为绝经前9.96%,绝经后43.35%。绝经前各指标在鉴别卵巢良恶性肿瘤中的价值如下:ROMA指数(Youden指数0.639,灵敏度83.8%,特异度80.1%,曲线下面积0.896),HE4(Youden指数0.662,灵敏度66.2%,特异度100.0%,曲线下面积0.886),CA125(Youden指数0.578,灵敏度88.2%,特异度69.6%,曲线下面积0.854)。绝经后分别是:ROMA指数(Youden指数0.882,灵敏度93.2%,特异度95.0%,曲线下面积0.958),HE4(Youden指数0.750,灵敏度75.0%,特异度100.0%,曲线下面积0.953)、CA125(Youden指数0.748,灵敏度89.8%,特异度85.0%,曲线下面积0.952)。结论应用ROMA指数能显著提高卵巢恶性肿瘤风险评估的灵敏度、特异度以及准确性,提高诊断效能。

Objective To observe the diagnostic value of ROMA index in ovarian benign and malignant tumors.Methods A total of 288 patients underwent surgical treatment of ovarian tumors were retrospectively analyzed.The levels of HE4 and CA125 in serum of 132 patients with ovarian benign tumors and 156 patients with ovarian cancer were detected by Cobas 602 automatic immunoassay.The ROMA index and its cut-off were calculated,combined with menopausal status to assess the risk of ovarian cancer in patients.Results The levels of serum CA125,HE4 and ROMA were 302.60（104.69,595.03）U/mL,222.65（116.38,485.30）pmol/L and 83.85%（58.89%,95.46%）,respectively,which were significantly higher than control group and benign tumor group（P0.017）.Compared with the healthy control group,only the level of CA125 was significantly increased in the benign ovarian tumor group（P0.017）.The optimal cut-off value of ROMA index was 9.96% for menopause and 43.35% for postmenopausal.Pre-menopausal diagnostic evaluations were as following：ROMA index（Youden index 0.639,sensitivity 83.8%,specificity80.1%,area under curve 0.896）,HE4（Youden index 0.662,sensitivity 66.2%,specificity 100.0%,area under curve 0.886）,CA125（Youden index 0.578,sensitivity 88.2%,specificity 69.6%,area under curve 0.854）,and the postmenopausal diagnostic criteria were as following：ROMA index（Youden index 0.882,sensitivity 93.2%,specificity 95.0%,area under curve 0.958）,HE4（Youden index 0.750,sensitivity 75.0%,specificity 100.0%,area under curve 0.953）,CA125（Youden index 0.748,sensitivity89.8%,specificity 85.0%,area under curve 0.952）.Conclusion The ROMA index could significantly improve the sensitivity,specificity and accuracy of ovarian cancer risk assessment and improve the diagnostic efficiency.