Comparison Of Serum CA125,HE4,ROMA And CPH-I In The Differential Diagnosis Of Benign And Malignant Ovarian Tumors

Objective:To compare the diagnostic value of carbohydrate antigen 125(CA125)and human epididymal protein 4(human epididymal protein 4,HE4),and the combined application of the two to calculate the risk of ovarian malignancy(risk of ovarian malignancy algorithm,ROMA)and Copenhagen index(Copenhagen index,CPH-I)in the differential diagnosis of benign and malignant ovarian tumors.Method:This research enrolled 856 female patients with pelvic masses treated in theDepartment of Gynecology of Shandong Provincial Hospital during January 2019 to January 2020,and divide them into benign ovarian tumors,borderline ovarian tumors(BOT),epithelial ovarian cancer(EOC)and non-epithelial ovarian cancer(non-EOC)based on the pathological diagnosis results,according to Figo staging criteria(2014)for ovarian cancer,fallopian tube cancer,and peritoneal cancer.Serum was collected for CA125 and HE4 detection before surgery.The ROMA index and CPH-I were calculated.The sensitivity and specificity of the 4 indicators in the diagnosis of ovarian malignant tumors were compared,and the receiver operating characteristic curve(ROC)was drawn.All statistical analysis was performed by SPSS software.The measurement data are presented in the median(M)and interquartile range(P25,P75),and Mann-Whitney U test was used for pairwise comparison,Kruskal-Wallis analysis was used for multiple comparisons.The χ2 test was used for the comparison of count data between groups.Calculate the sensitivity and specificity,positive predictive value,and negative predictive value of different indicators,draw ROC curve and calculate area under the curve(AUC),and compare the diagnostic efficacy of four indicators.P<0.05 was regard as statistically significant.Result:The age distribution of all patients was 18-85 years old.with an average age of 41.4 years;607 cases were premenopausal,and 249 were postmenopausal:the pathological diagnosis results were 665 cases(77.7%)with benign tumors and 32 cases(3.7%)with borderline tumor.138(16.1%)EOC patients and 21(2.5%)Non-EOC patients;The age distribution of different groups and the proportion of menopausal population are different.The age distribution and proportion of menopausal population of BOT group.EOC group and Non-EOC group are larger than that of benign group.and statistically significant difference exists;EOC group patients accounted for a higher proportion(66.7%)of late stage(Ⅲ,Ⅳ).while patients in the BOT group and Non-EOC group were mainly early stage(stage Ⅰ.Ⅱ)(90.6%.71.4%).and the difference was statistically significant:When comparing the levels of CA125.HE4.ROMA and CPH-Ⅰ in the benign group.BOT group.EOC group and Non-EOC group,the data have significant differences,and the orders were EOC group>Non-EOC group>BOT group>benign group;in pairwise comparison,the four indicators of the benign group are lower than the other groups,the difference is statistically significant:the four indicators of the EOC group are higher than the other groups,the difference is statistically significant;There was no statistically significant difference between the BOT group and the Non-EOC group.Using the benign group as controls,compare the performance of the four indicators in diagnosing malignant ovarian tumors,the order of AUC is:ROMA>CPH-Ⅰ>HE4>CA125(0.934、0.924、0.915、0.873);The order of sensitivity is:ROMA>CA125>CPH-1>HE4(84.9%,83.0%,81.8%.68.6%);the order of specificity is HE4>CPH-Ⅰ>ROMA>CA125(97.3%,92.5%,85.7%,69.8%).Result:Compared with patients with benign and borderline malignant tumors.the serum CA125,HE4,ROMA and CPH-Ⅰ levels of patients with ovarian malignant tumors are all elevated to varying degrees;in patients with epithelial ovarian cancer.the four indicators have increased higher;In the diagnosis of ovarian malignant tumors.CA125 has good sensitivity but poor specificity;HE4 has the highest specificity but insufficient sensitivity;both ROMA and CPH-Ⅰ have good diagnostic specificity and sensitivity,and their diagnostic efficacy is better than that of CA125 or HE4 alone.In addition.CPH-Ⅰ incorporates age as a reference factor.which is easier to obtain and more clearly defined than the state of extremity used by ROMA.Therefore,we can think that CPH-Ⅰ is simpler and more useful than ROMA.