卵巢癌风险预测模型在上皮性卵巢癌早期诊断中的应用价值

Application value of risk ovarian malignancy algorithm in early diagnosis of epithelial ovarian cancer

目的:探讨卵巢癌风险预测模型(ROMA)对上皮性卵巢癌患病风险的评估价值及与患者临床病理分期的关联性,为上皮性卵巢癌的临床诊疗及预后分析提供依据。方法:回顾性分析经术后石蜡切片病理确诊的135例卵巢肿瘤患者的临床资料,将其分为卵巢良性肿瘤组(n=66)、上皮性卵巢癌组(n=58)和非上皮性卵巢癌组(n=11)。根据各组患者术前检测的血清人附睾蛋白4(HE4)和糖类抗原125(CA125)水平计算其ROMA值,根据各组患者HE4、CA125和ROMA临界值计算HE4、CA125和ROMA阳性率,分析卵巢癌患者血清HE4、CA125和ROMA阳性率与患者临床分期之间的关系,评价其对卵巢肿瘤患者的诊断效能。结果:上皮性卵巢癌组患者血清HE4 、CA125水平和ROMA值均明显高于卵巢良性肿瘤组及非上皮性卵巢癌组(P<0.05)。上皮性卵巢癌组患者HE4、CA125和ROMA阳性率均高于卵巢良性肿瘤组(P<0.01),并随着临床分期的升高而升高。与HE4和CA125阳性率比较,卵巢良性肿瘤患者ROMA阳性率最低,在各期上皮性卵巢癌中ROMA阳性率均高于CA125阳性率。ROMA在绝经后卵巢肿瘤患者组的敏感度及阴性预测值均高于绝经前卵巢肿瘤患者组(P<0.05),而特异度及阳性预测值在绝经前及绝经后卵巢肿瘤患者组间比较差异无统计学意义(P>0.05)。3项指标中,ROMA的各项诊断效能指标最高,CA125的各项诊断效能指标最低。结论: ROMA对上皮性卵巢癌风险的诊断价值高于CA125或HE4,对绝经后患者具有更好的诊断价值,可提高卵巢癌的早期诊断效能。

Objective:To investigate the value of risk ovarian malignancy algorithm (ROMA) in evaluation of the risk of epithelial ovarian cancer and its association with the clinical pathological stages,and to provide a basis for the clinical diagnosis and treatment and prognosis analysis of epithelial ovarian cancer.Methods: The clinical materials of 135 patients with ovarian tumor confirmed by paraffin section pathology after operation were retrospectively analyzed.The patients were divided into benign ovarian tumor group(n=66),epithelial ovarian cancer group (n=58) and non-epithelial ovarian cancer group(n=11).According to the cutoff values of HE4,CA125,and ROMA of the patients in various groups,the positive rates of HE4,CA125,and ROMA of the patients in various groups were calculated.Based on the serum levels of human epididymis protein 4(HE4) and carbohydrate antigen 125(CA125) detected before operation of the patients in various groups,the relationships between the positive rates of serum HE4,CA125 and ROMA and the clinical stages of the patients with ovarian cancer;their diagnosis efficacies in the patients with ovarian cancer were evaluated.Results:The serum CA125,HE4 levels and ROMA value of the patients in epithelial ovarian cancer group were significantly higher than those in benign ovarian tumor group and non-epithelial ovarian cancer group (P <0.05).The positive rates of HE4,CA125,and ROMA of the patients in epithelial ovarian cancer group were higher than those in benign ovarian tumor group (P <0.01),and showed an increasing trend with the increase of clinical stages.Compared with the positive rates of HE4 and CA125,the ROMA had the lowest positive rate in the patients with ovarian benign tumor,and the positive rates of ROMA in all stages of epithelial ovarian cancer were higher than those of CA125.The sensitivity and the negative predictive value of ROMA in postmenopausal patients with ovarian cancer group were higher than those in premenopausal patients with ovarian cancer group (P <0.05),while the specificity and the positive predictive value were not significantly different between premenopausal and postmenopausal patients with ovarian cancer groups (P >0.05).Among the three indexes,ROMA had the highest diagnostic efficacy index and CA125 had the lowest.Conclusion:The diagnostic value of ROMA for evaluating the risk of epithelial ovarian cancer was higher than those of CA125 and HE4,which has a better diagnostic value for the postmenopausal patients and can improve the early diagnosis efficiency of ovarian cancer.