The Value Of CA125,HE4 And ROMA In The Diagnosis Of Ovarian Epithelial Tumors

Objective:The objective of this retrospective analysis was to expand the cutoff values of CA125,HE4 and ROMA for different pathological types of epithelial ovarian tumors based on real-world data.To evaluate its clinical application in differentiating benign and malignant ovarian epithelial tumors compared to current recommendations.Methods:Patients with postoperative pathologically confirmed ovarian epithelial tumors who were treated in Dalian Women and Children Medical Center(Group)(Chunliu Campus)during 2017-2021 were collected.In this study,information was collected on 468 patients with epithelial ovarian tumors,including 400 benign tumors and 68 malignant and borderline tumors(including 37 borderline tumors and 31 malignant tumors).For borderline and malignant tumours,the staging is carried out according to the International Federation of Obstetrics and Gynecology(FIGO)2021 standard.The preoperative serum CA125 and HE4 values were collected,the ROMA index was calculated,and SPSS 25.0 was used for data analysis.Results:1.Median values for CA125,HE4,and ROMA were higher in the borderline and malignant tumor groups than in the benign tumor group,and median values for CA125 were higher than recommended.In benign tumor group,CA125,HE4 and ROMA indices did not exceed the recommended values.2.At recommended values,CA125 has the highest sensitivity(60.47%)for premenopausal women,HE4 has the highest specificity,reaching 100%,and the Youden Index of CA125 is the highest.CA125 sensitivity remains high(64%)for postmenopausal females and elevated compared with premenopausal;HE4 has the highest specificity(100%),Youden index ranked the highest for CA125(0.57),and Youden index for all three diagnostic indicators were elevated compared with pre-menopause.When all data are combined,CA125 has the highest sensitivity(61.76%)and Youden index(0.28),while HE4 has the highest specificity(100%)and positive predictive value(100%),ROMA index has the highest concordance rate(82.69%)and negative predictive value(77.35%).3.The optimal cut-off value was calculated from the ROC curve data,with a cut-off value of 36.2u/ml for CA125,and a cut-off value of 53 pmol/L for HE4,the cutoff value of the ROMA index was 9.6% for pre-menopausal and 22.2% for post-menopausal,and both benign and malignant tumors could be distinguished(P < 0.05).4.Compared with the original recommendation value,at the optimal cutoff value,at the optimal cutoff,ROMA’s sensitivity increased by 60% and its specificity decreased by5.8%.The sensitivity of HE4 was 17 times higher than the original value,while the specificity decreased by 17%,and the sensitivity increased by much more than the specificity decreased.The sensitivity of CA125 decreased by 2.4% and specificity increased by 2.3%,showing little change.There were significant differences in sensitivity and specificity between the recommended cutoff and the optimal cutoff for HE4(P<0.05),but not between CA125 and ROMA index(P > 0.05).5.CA125 shows the best diagnostic efficacy for serous tumors(AUC = 0.891),and HE4 has the best diagnostic efficacy for endometrioid tumors(AUC = 0.937,and ROMA index similarly has the best diagnostic efficacy for endometrioid tumors(AUC= 0.942).The diagnostic efficacy of all three indexes for mucinous tumors could not be clearly established(P > 0.05).6.For serous ovarian tumors,ROMA index has the highest diagnostic efficacy for premenopausal women(AUC = 0.859),and CA125 has the highest diagnostic efficacy for postmenopausal women(AUC = 0.889).The optimal cut-off values of the three diagnostic indexes were calculated according to the maximum Youden index,CA125:30.0u/ml,HE4: 48.9pmol/l,and ROMA index:7.2% and 22.2% for pre-menopausal and post-menopausal.The sensitivity and specificity of the recommended critical value of HE4 and the optimal critical value were significantly different(P<0.05),but there was no significant difference in CA125 and ROMA index.Compared with the recommended value,the sensitivity of HE4 in the diagnosis of serous tumors at the 48.9 pmol/L threshold increased by 48.2%,the specificity decreased by 35.5%,and the sensitivity increased significantly.7.For endometrioid tumors,ROMA index has the highest diagnostic efficacy(AUC =0.942).According to the ROC curve,the optimal cut-off value of CA125 and HE4 was calculated to be 68.7U/m L and 56.3pmol/L.CA125 specificity increased by 55.6%;HE4 was specifically reduced by 19.1%.Conclusions:1、CA125,HE4 and ROMA index were increased in borderline ovarian and malignant tumors compared with benign tumors.2.When used alone,in terms of diagnostic efficacy,HE4 is higher than CA125.The ROMA index has the best diagnostic efficacy regardless of menopausal status,while the diagnostic efficacy was higher for postmenopausal women.3.When used alone,in terms of diagnostic efficacy,HE4 is higher than CA125.The ROMA index has the best diagnostic efficacy regardless of menopausal status,while the diagnostic efficacy was higher for postmenopausal women.4.CA125 has the best diagnostic efficacy for serous tumors.HE4 has the best diagnostic efficacy for endometrioid tumors.ROMA index similarly has the best diagnostic efficacy for endometrioid tumors.The diagnostic efficacy of all three indicators for mucinous tumors could not be clearly established.5.Downregulation of the HE4 threshold resulted in higher diagnostic efficacy for both serous and endometrioid tumors.