Meta-analysis Of The Diagnostic Accuracy Of Serum HE4, CA125and ROMA In Patients With Ovarian Cancer

Objective：CA125, human epididymis secretary protein4(HE4) and the Risk ofOvarian Malignancy Algorithm (ROMA) could be used for diagnosing ovarian cancer(OCa). However, it has not been conclusively determined which of these markers yieldsthe best diagnostic accuracy.Therefore, we conducted a meta-analysis to evaluate thediagnostic value of these markers.Method：We systematically searched the VIP、CNKI、CBM、Pubmed and Medlinedatabases, and identified16studies that evaluated the role of CA125, HE4and ROMAin diagnosing OCA.The software Meta-Disc l.4was used to calculate the pooledestimates by considering the heterogeneity of major related parameters such as themenopausal status, International Federation of Gynecology and Obstetrics stages,histological type, detection method and blinded design. The Deek’s regression test wasapplied to evaluate the publication bias by Stata12.0software. The AUCs of HE4,CA125and Roma detection in ovarian cancer were detected by Z test, and P <0.05wasconsidered statistically significant.Result：Three tests yielded similar discriminatory performances in the OCA diagnosis(AUC[95%CI]0.88[0.85–0.91]for HE4;0.86[0.83–0.89]for CA125;0.90[0.87–0.92]forROMA).HE4yielded a higher specificity than CA125and ROMA(HE493.60[90.00–95.90]>CA12582.10[76.60–86.50] and ROMA82.40[77.40–86.50]),especially in the premenopausal subgroup(HE493.80[88.40–96.80]>CA12576.30[63.30–85.70]and ROMA85.10[80.40–88.80]).In contrast,CA125and ROMAperformed significantly better in the postmenopausal Subgroup than in thepremenopausal subgroup (AUC[95%CI]CA125-premenopausal0.84[0.81–0.87]<post 0.91[0.88–0.93];ROMA-premenopausal0.85[0.82–0.88]<post0.92[0.89–0.94]).Conclusion：HE4might be useful for diagnosing OCA due to its high specificity,especially in the premenopausal population. CA125and ROMA are more suitable fordiagnosing OCA in the postmenopausal population. More high-quality RCTs areneeded.