卵巢肿瘤恶性风险模型和哥本哈根指数在卵巢良恶性肿瘤中的辅助诊断价值评估

Evaluation of risk of ovarian malignancy algorithm and Copenhagen index in the diagnosis of benign and malignant ovarian tumors

目的 评估卵巢肿瘤恶性风险模型(ROMA)和哥本哈根指数(CPH-I)在卵巢良恶性肿瘤中的辅助诊断价值。方法 回顾性分析189例卵巢癌、46例交界性卵巢肿瘤、362例卵巢良性肿瘤患者及161例健康对照者血清CA125和HE4水平,并计算相应的ROMA和CPH-I进行分析。结果 交界性卵巢肿瘤组及早、晚期卵巢癌组绝经前后ROMA、CPH-I均明显高于健康对照组(P<0.001)和卵巢良性肿瘤组(P<0.001)。相同特异度下的灵敏度(Sn)和受试者工作特征(ROC)曲线下面积(AUC)分析表明,ROMA和CPH-I在早期卵巢癌+交界性卵巢肿瘤组的Sn和AUC均显著高于CA125(均P<0.05),与HE4相当;单独早期卵巢癌组的Sn显著高于CA125(P<0.05),与HE4相当;ROMA的AUC显著高于CA125(P<0.05),与HE4相当,CPH-I的AUC明显低于ROMA和HE4而显著高于CA125,差异均有统计学意义(均P<0.05)。早期卵巢癌患者绝经后ROMA灵敏度显著高于绝经前,差异有统计学意义(P<0.05)。在各指标诊断效能评估中,ROMA的灵敏度及阴性预测值高于CPH-I、CA125及HE4;HE4、ROMA及CPH-I三者准确度相当且优于CA125。结论 ROMA和CPH-I优于CA125而与HE4相当,可用于卵巢肿瘤良恶性风险评估。

Objective To evaluate the Risk of Ovarian Malignancy Algorithm(ROMA) and the Copenhagen Index(CPH-I)in the diagnosis of benign and malignant ovarian tumors.Methods Serum carbohydrate antigen 125(CA125) and human epididymis protein 4(HE4) levels were retrospectively analyzed in 189 cases of ovarian cancer, 46 cases of borderline ovarian tumor, 362 cases of benign ovarian tumor and 161 healthy controls, and the corresponding ROMA and CPH-I were calculated for analysis.Results Both ROMA and CPH-I in borderline ovarian tumor and early or advanced stages of ovarian cancer were significantly higher than that in healthy control(P<0.001) and the benign ovarian tumor control(P<0.001).Sensitivity(Sn) under the condition of same specificity and the area under the receiver operating characteristic(ROC) curves(AUC) analysis showed that both Sn and AUC of ROMA and CPH-I were significantly higher than that of CA125(P<0.05) in the early ovarian cancer + borderline ovarian tumor while Sn in the early ovarian cancer alone shows same value, but there was no difference between them with HE4;AUC of ROMA in the early ovarian cancer alone was significantly higher than that of CA125(P<0.05) and was comparable to HE4,but AUC of CPH-I was significantly lower than that of ROMA and HE4 and was significantly higher than that of CA125(P<0.05).There was a significantly higher sensitivity of ROMA in postmenopausal than that in premenopausal women with early stage ovarian cancer(P<0.05).The sensitivity and negative predictive value of ROMA were higher than those of CPH-I,CA125 and HE4;HE4、ROMA and CPH-I had similar and better accuracy than CA125.Conclusion ROMA、CPH-I and HE4 have better performance than CA125 for discriminating ovarian cancer from benign ovarian tumors.