Comparative Analysis Of ROMA And CPH-I In Differentiating Of Ovarian Tumors

Objective: In this study,the risk of ovarian malignant tumor(ROMA)and Copenhagen index(CPH-I)were calculated,and the value of the two indexes in differentiating ovarian tumors was compared and analyzed.Methods: Included patients with ovarian tumors confirmed by postoperative pathology who visited Dalian Maternal and Child Health Hospital from April 2017 to April 2018.A total of 326 cases were included,including 253 benign tumors,26 borderline ovarian tumors(BOT),39 epithelial ovarian cancer(EOC)and 8 non-epithelial ovarian cancer(non-EOC)(including 4 primary non-epithelial ovarian cancer and 4metastatic cancer).Ovarian malignant tumors were staged according to the 2014 FIGO standard.ROMA and CPH-I were calculated using carbohydrate antigen125(carbohydrate antigen 125,CA125)and human epididymis epithelial secretory protein 4(HE4).ROMA is positive with ≥ 11.4% before menopause,≥ 29.9% after menopause,and CPH-I is positive with ≥ 7%.Statistical analysis was processed by SPSS18.0 statistical software.Results: 1.HE4,CA125,ROMA and CPH-I in benign tumors were within normal range.Except for CA125 value higher than normal level in borderline tumors group,HE4,ROMA and CPH-I were within normal range.The median levels of HE4,CA125,ROMA and CPH-I in ovarian cancer group were significantly higher than those in benign and borderline tumors group.2.Analysis and comparison between groups:benign tumor group was vs borderline tumor and ovarian cancer group;benign tumor group vs borderline tumor and epithelial ovarian cancer group;benign tumor group vs ovarian cancer group;borderline tumor group vs epithelial ovarian cancer group;borderline tumor group vs ovarian cancer group;borderline tumor group vs epithelial ovarian cancer group,CA125,HE4,ROMA and CPH-I were significantly increased in the latter,with statistically significant difference(P<0.05).Compared with the borderline tumor group,CA125,ROMA and CPH-I in the benign tumor group were significantly increased,except HE4,the difference was statistically significant(P<0.05).3.Comparison of diagnostic efficiency between ROMA and CPH-I index: Comparison between benign tumor group and borderline tumor group: The specificity of CPH-I(98.8%)was higher than ROMA,and the difference was statistically significant(P<0.05).The area under CPH-I ROC curve is 0.698(95%CI is 0.575-0.820,P=0.001);The area under the ROMA ROC curve is 0.627(95%CI is 0.501-0.754,P=0.032),and the diagnostic efficiency of CPH-I is better than ROMA.Comparison between benign tumor group,ovarian cancer group and borderline tumor group: The specificity 98.8% and positive predictive value 92.1% of CPH-I were significantly higher than ROMA,the difference was statistically significant(P<0.05).The area under CPH-I ROC curve is 0.854(95%CI is 0.794-0.913,P=0.000);The area under ROMA ROC curve is 0.815(95%CI is 0.749-0.882,P=0.000),and the diagnostic efficiency of CPH-I is better than ROMA.Comparison between benign tumor group and epithelial ovarian cancer group: The specificity of CPH-I was 98.8% and the positive predictive value was 90% significantly higher than ROMA,the difference was statistically significant).The area under CPH-I ROC curve is 0.959(95%CI is 0.923-0.995,P=0.000);The area under ROMA ROC curve is 0.931(95%CI is 0.878-0.984,P=0.000),and the diagnostic efficiency of CPH-I is better than ROMA.Comparison between epithelial benign tumor group and epithelial ovarian cancer group: The sensitivity of CPH-I was 93.1% and the positive predictive value was 97.3% higher than ROMA,with no significant difference(P>0.05).The area under CPH-I ROC curve is0.0937(95%CI was 0.884-0.990,P=0.000);The area under the ROMA ROC curve is0.920(95%CI was 0.861-0.979,P=0.000).The diagnostic efficiency of CPH-I is better than ROMA. 4.Comparison of positive rate of ROMA and CPH-I index:Ovarian cancer is divided into early stage(FIGO stage,II stage)and late stage(FIGO stage III and IV stage).The positive rates of CPH-I in borderline tumors and early ovarian cancer were 11.5%and 56.7%,respectively,lower than ROMA 19.2%,63.6%,The positive rate of diagnosis of the two in advanced ovarian cancer was similar and the difference is statistically significant(P<0.05).The positive rates of ROMA and CPH-I index in menopausal women(74.2%,74.2%)were higher than those in non-menopausal women(68.8%,56.3%),with no significant difference(P<0.05).Conclusion: The serum HE4,CA125,ROMA index and CPH-I index of ovarian cancer patients are increased in different degrees compared with benign ovarian tumors.CPH-I is superior to ROMA in the diagnostic value of ovarian cancer risk assessment for ovarian cancer patients.CPH-I also has the same clinical application value in epithelial ovarian cancer.CPH-I also has higher specificity in the diagnostic value of borderline tumor risk assessment.ROMA is superior to CPH-I in the positive rate of diagnosing early ovarian cancer and borderline tumors,but the age factor applied in CPH-I is clearer and easier to obtain than the menstrual state applied in ROMA,so CPH-I is considered to be more convenient and practical in application.However,the number of borderline tumors and malignant tumors included in this study is limited.Whether CPH-I has higher diagnostic efficiency in differentiating benign and malignant ovarian tumors than ROMA still needs a larger sample size and multi-center study to confirm.