The Clinical Significance Of Serum CA125, HE4、CA199、AFP And CEA To Adnexal Mass Diagnosis

Background and Objective: Adnexal mass is a common gynecologicaldisease including but not limited to ovarian benign/malignant tumor, ovarianendometrial cyst, Annex inflammatory mass and Parovarian cyst, in which themalignant ovarian tumor has the highest mortality of female reproductivesystem cancer. Currently, there are many researches and studies on value oftumor markers for early diagnosis of ovarian cancer, the most commonly usedserological tumor markers include but not limited to CA125、HE4、CA199、AFP、CEA.Methods:Electrochemiluminescence method was used to detect the levelsof serum CA125,CA199,AFP,CEA in188patients in benign adnexal diseasegroup,76patients in malignant ovarian tumor group, and40healthy womenin the control group. Eezyme-linked immunosorbent assay method was used todetect the levels of serum HE4in those groups above.Results:1.The level of serum CA125in the malignant ovarain tumorgroup was (1037.6±1154.7)U/ml，which was significantly higher than thebenign adnexal disease group and the control group,whose levels were（49.6±44.5）U/ml and (28.2±10.3)U/ml(P＜0.01).The positive rate of serumCA125in the malignant ovarain tumor group(77.63%) was significantly higherthan the benign adnexal disease group(29.79%) and the control group(1.67%)(P＜0.01).The area under curve（AUC）of serum CA125in the diagnosis ofovarian cancer was0.882. The level of serum HE4in the malignant ovaraintumor group was (319.4±231.6)pmol/L，which was significantly higher than thebenign adnexal disease group and the control group,whose levels were (57.2±23.3)pmol/L and (51.6±19.2)pmol/L (P＜0.01).The positive rate ofserum HE4in the malignant ovarain tumor group(80.26%) was significantlyhigher than the benign adnexal disease group(2.13%) and the controlgroup(0)(P＜0.01).The AUC of serum HE4in the diagnosis of ovarian cancerwas0.959. The level and positive rate of serum CA199in the malignantovarain tumor group were（42.8±82.8）U/ml and28.95%,there were nosignificant differences（P>0.05） when compared with the benign adnexaldisease group（33.1±35.6）U/ml and22.34%.The AUC of serum CA199in thediagnosis of ovarian cancer was0.527. The level of serum AFP in themalignant ovarain tumor group was（234.6±1398.6）ng/ml which was nosignificant differences（P>0.05） when compared with the benign adnexaldisease group（2.4±1.1）ng/ml.The AUC of serum AFP in the diagnosis ofovarian cancer was0.541. The level of serum CEA in the malignant ovaraintumor group（3.4±9.9）ng/ml was higher than the benign adnexal disease group（1.4±0.7）ng/ml,but no significant difference（P>0.05）.The AUC of serumCEA in the diagnosis of ovarian cancer was0.538.2. Serum CA125levels and positive rates in the patients withendometriotic cysts were（78.9±67.9）U/ml and64.81%，Serum CA125levelsand positive rates in patients with adnexal inflammatory masses were（119.9±242.3）U/ml and50%.The serum CA125levels and positive rates inpatients with endometriotic cysts and adnexal inflammatory masses weresignificantly higher than in the other patients with benign adnexal diseasesand the control group(P＜0.05). Serum CA199levels and positive rates inpatients with mature ovarian teratoma were（59.4±122.1）U/ml and40%, whichwere significantly higher than that in the other benign adnexal diseases patientsand the control group(P＜0.05)； Serum CA199levels in patients with endometriotic cysts were（27.9±26.4）U/ml，which were significantly higherthan in patients with benign epithelial ovarian tumors, paraovarian cysts,adnexal inflammatory masses and the control group(P＜0.05).3.The levels of serum CA125in patients with serous carcinoma were（1470.0±1502.9）U/ml，which were significantly higher than that in patientswith mucous carcinoma（81.4±65.0）U/m（lP＜0.01）；The levels of serum HE4in patients with serous carcinoma were （419.7±254.6）pmol/L，which weresignificantly higher than that in patients with mucous carcinoma（104.6±22.8）pmol/L (P＜0.01). The levels of serum CA125in patients with advancedovarian cancer were（1690.9±1695.8）U/ml,which were significantly higherthan that in patients with early stage ovarian cancer（138.0±138.9）U/ml（P＜0.01）; The levels of serum HE4in patients with advanced ovarian cancer were(436.5±265.3)pmol/L,which were significantly higher than that in patients withearly stage ovarian cance（r188.5±105.5)pmol/L（P＜0.01）；In the patients withearly stage ovarian cancer,the positive rate of serum HE4(58.33%)was higherthan serum CA125(45.83%),but no significant difference（P>0.05）.4.The sensitivity(80.88%) of serum CA125for the diagnosis of ovariancancer was lower than the sensitivity(89.71%) of serum HE4, but no significantdifferenc（eP>0.05）.The specificity (70.21%) of serum CA125for the diagnosisof ovarian cancer was lower than the sensitivity(97.87%) of serum HE4, Thedifference was statistically significant （P＜0.05）；The sensitivity of serumCA125and HE4in combination was92.65%,which was significantly higherthan test the serum CA125alone（P＜0.05），The specificity of serum CA125and HE4in combination was68.62%,which was significantly higher than testthe serum HE4alone（P＜0.05）.Conclusions:1. Serum CA125and HE4, which are of great significance for differential diagnosis of benign and malignant adnexal mass, can be used todetect ovarian cancer as tumor markers.2.Serum CA125has some clinicalsignificance in the diagnosis of endometriotic cysts and adnexal inflammatorymasses.2.Serum CA199has some clinical significance in the diagnosis ofmature ovarian teratoma and endometriotic cyst.4.The levels of serum CA125and HE4were positively correlated with clinical stage of ovarain cancer,andcorrelated to the histologic type of ovarian cancer.5.Single detection of serumHE4showed the best diagnostic performances, serum CA125and HE4incombination did better than the single detection of serum CA125in thediagnosis of ovarian cancer.