哥本哈根指数在绝经前及绝经后卵巢癌诊断中的价值

Diagnostic value of Copenhagen index in premenopausal and postmenopausal ovarian cancer

目的探讨哥本哈根指数(CPH-I)与血清糖类抗原125(CA125)、人附睾蛋白4(HE4)及卵巢恶性肿瘤风险模型(ROMA)在绝经前和绝经后卵巢癌诊断中的应用价值。方法回顾性分析2017年1月至2020年1月日照市人民医院收治的239例卵巢肿瘤患者资料,其中卵巢良性疾病152例,卵巢癌87例。以病理结果为金标准,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)及CPH-I、CA125、HE4、ROMA诊断卵巢癌的灵敏度和特异度,比较4项指数在总体、绝经前和绝经后患者中对卵巢癌的诊断效能。结果卵巢癌组的CA125水平、HE4水平、ROMA指数及CPH-I预测概率值均高于卵巢良性疾病组,差异均有统计学意义(均P<0.01)。全部患者中CA125、HE4、ROMA、CPH-I的AUC分别为0.935(95%CI 0.896~0.963)、0.940(95%CI 0.901~0.966)、0.964(95%CI 0.932~0.984)、0.964(95%CI 0.932~0.984),CA125与ROMA、CA125与CPH-I预测概率值、HE4与ROMA、HE4与CPH-I预测概率值的AUC比较,差异均有统计学意义(P值分别为0.036、0.009、0.018、0.019);绝经前患者中HE4、ROMA、CPH-I的AUC分别为0.947(95%CI 0.896~0.978)、0.949(95%CI 0.898~0.979)、0.944(95%CI 0.893~0.976),均大于CA125的AUC 0.921(95%CI 0.863~0.960),差异均有统计学意义(P值分别为0.036、0.036、0.026);绝经后患者中CA125、ROMA、CPH-I预测概率值的AUC分别为0.953(95%CI 0.891~0.986)、0.947(95%CI 0.882~0.982)、0.943(95%CI 0.877~0.980),均大于HE4的AUC 0.889(95%CI 0.810~0.944),差异均有统计学意义(P值分别为0.029、0.014、0.015)。结论CPH-I与ROMA对卵巢癌的诊断效能相当,且无论绝经与否,两者的诊断效能均较高。全部患者中CPH-I与ROMA对卵巢癌的诊断效能优于CA125和HE4,绝经前患者中CA125诊断效能最低,绝经后患者中HE4诊断效能最低。

Objective To compare the diagnostic value of Copenhagen index(CPH-I),serum carbohydrate antigen 125(CA125),human epididymis protein 4(HE4),and risk of ovarian malignancy algorithm(ROMA)for diagnosis of ovarian cancer in premenopausal and postmenopausal women.Methods The clinical data of 239 patients with ovarian tumor treated in People's Hospital of Rizhao in Shandong Province from January 2017 to January 2020 were retrospectively analyzed.The patients were divided into ovarian benign disease group(152 cases)and ovarian cancer group(87 cases)according to postoperative pathology.The receiver-operating characteristic curve(ROC)was drawn with surgical pathology as the gold standard;the area under the curve(AUC)and the sensitivity and specificity of CPH-I,CA125,HE4,ROMA were calculated.The diagnostic performance of CA125,HE4,ROMA and CPH-I for diagnosis of ovarian cancer was compared in overall,premenopausal and postmenopausal patients.Results The CA125 level,HE4 level,ROMA index,and CPH-I predicted probability(PP)values of ovarian cancer group were higher than those of ovarian benign disease group,and the differences were statistically significant(all P<0.01).The AUC of CA125,HE4,ROMA,and CPH-I in the overall patients was 0.935(95%CI 0.896-0.963),0.940(95%CI 0.901-0.966),0.964(95%CI0.932-0.984),0.964(95%CI 0.932-0.984);the AUC differences of CA125 and ROMA,CA125 and CPH-I(PP values),HE4 and ROMA,HE4 and CPH-I PP values were statistically significant(P values were 0.036,0.009,0.018,0.019).The AUC of HE4,ROMA,and CPH-I in the premenopausal patients was 0.947(95%CI 0.896-0.978),0.949(95%CI 0.898-0.979),0.944(95%CI 0.893-0.976),which were all larger than AUC of CA125(0.921)(95%CI 0.863-0.960),the differences were statistically significant(P values were 0.036,0.036,0.026);AUC of CA125,ROMA,CPH-I PP values in postmenopausal patients was 0.953(95%CI 0.891-0.986),0.947(95%CI 0.882-0.982),0.943(95%CI 0.877-0.980),all of which were larger than AUC of HE4(0.889)(95%CI 0.810-0.944),and the differences were statistically significant(P values were 0.029,0.014,0.015).Conclusions The diagnostic efficacy of CPH-I and ROMA for ovarian cancer is comparable,and regardless of menopause or not,the diagnostic efficacy of CPH-I and ROMA is higher.The diagnostic efficacy of CPH-I and ROMA for ovarian cancer is better than that of CA125 and HE4 in overall patients,the diagnostic efficacy of CA125 is the lowest in premenopausal patients,and the diagnostic efficacy of HE4 is the lowest in postmenopausal patients.