| ObjectiveTo explore the clinical value of serum CA125,HE4 and the ovarian cancer risk prediction model(ROMA)index calculated based on the two alone and combined with CT score in predicting the outcome of primary cytoreductive surgery in patients with advanced epithelial ovarian cancer(including stage III and IV).To provide clinical evidence via establishment of a more accurate and effective evaluation sysytem for the tumor cytoreductive surgery.Materials and MethodThe clinical data were collected from 92 patients with advanced epithelial ovarian cancer,fallopian tube cancer,and peritoneal cancer who underwent initial surgical treatment and pathologically diagnosed from November 2015 to November2019 in the First Affiliated Hospital of Dalian Medical University.There were 73 cases of serous ovarian cancer,4 cases of clear cell carcinoma,2 cases of endometrioid adenocarcinoma,3 cases of peritoneal carcinoma,and 10 cases of fallopian tube cancer.Based on 3 clinical criteria(age ? 60 years,CA125 ? 500 U / m L,ASA3-4)and 8 CT imaging findings(spleen hilum / splenic ligament lesions,hilar hilum / liver Duodenal ligament lesions,retroperitoneal lymph nodes,extensive intestinal adhesions and peritoneal thickening,moderate and large ascites,gallbladder fossa / lobular fissure lesions,small omental sac lesions,and mesenteric lesions),the Suidan's CT scoring model was established to calculate the scores.SPSS 24.0software was used for analysis.The results were statistically significant at P <0.05.Using ROC curve method(receiver operation characteristic power,ROC)to calculate the area under curve(AUC),according to the maximum Youden index(Youden index)to calculate serum CA125,HE4,ovarian cancer risk prediction model(ovarian cancer risk prediction model,ROMA)and Suidan's CT scoring model to predict the optimal cut-off value at the end of the first tumor cytoreductive surgery for advanced epithelial ovarian cancer,and to determine sensitivity,specificity,positive predictive value(PPV),negative Predictive value(negative predict value,NPV),etc.The maximum AUC,sensitivity,and specificity of serum HE4 and ROMA index combined with CT score model for predicting the outcome of primary tumor cytoreductive surgery were analyzed by binary logistic regression and ROC curves.Result1.Of the 92 patients with advanced(stage III-IV)epithelial ovarian cancer,52 patients who underwent initial surgery for satisfactory tumor reduction surgery(the satisfied tumor reduction group)accounted for 57%;There were 40 patients who underwent initial surgery for dissatisfied tumor reduction surgery(the dissatisfied tumor reduction group)acounted for 43%.2.ROC curve analysis.Serum CA125 alone was statistically significant in predicting the outcome of primary tumor cytoreductive surgery in patients with advanced ovarian cancer(95% CI: 0.672-0.865,P = 0.000).The area under curve(area under curve,AUC)was 0.769.According to the approximate index,the optimal cutoff value was calculated to be 489.6 U / ml,the sensitivity of predicting that the initial tumor reduction is not satisfactory is 0.8,the specificity is 0.635,the positive predictive value(PPV)was 0.653,and the negative predictive value(NPV)was 0.814.Serum HE4 is statistically significant when applied alone(95% CI: 0.686-0.878,P =0.000),AUCwas 0.782,and its optimal cutoff was 416.95 pmol / L,which predicts that initial tumor cytoredutive surgery will not be satisfactory.The sensitivity was 0.8,specificity was 0.712,PPV was 0.681,and NPV was 0.822.The ROMA index was also statistically significant when applied alone(95% CI: 0.737-0.908,P = 0.000),with an AUC of 0.823,and its optimal critical value is 97.025%,predicting that the initial tumor cytoreductive surgery will not be satisfactory.The sensitivity was 0.675,the specificity was 0.846,the PPV was 0.771,and the NPV was 0.772.According to the results,it can be seen that the serum CA125,HE4 and ROMA indexes alone can predict the outcome of tumor cytoreductive surgery for the patients of advanced epithelial ovarian cancer.3.When the Suidan's CT scoring model was used to predict the outcome of primary tumor cytoreductive surgery in patients with advanced ovarian cancer(95%CI: 0.821-0.952,P = 0.000),AUC was 0.886,and its optimal critical score was also3.5.Sensitivity for predicting unsatisfactory surgical outcome was 0.925,specificity was 0.673,positive predictive value(PPV)was 0.698,and negative predictive value(negative predictive value(NPV)was 0.923.According to the results,the CT scoring model was more sensitive in predicting the outcome of the initial reduction surgery.4.Through binary logistic regression and ROC curve for further analysis,when the serum HE4 combined with the CT score model was used to predict the primary tumor cytoreductive outcome for patients with advanced ovarian cancer,the AUC was0.927.The specificity was 0.975,and the specificity was 0.865.When the ROMA index and the CT scoring model were used to predict the outcome of primary cytoreductive surgery for patients with advanced ovarian cancer,the AUC was 0.929,and the sensitivity for predicting unsatisfactory surgery was 0.875.0.904.Conclusions1.There was certain predictive value for serum CA125,HE4,and the ROMA index based on them alone for predicting the primary tumor cytoreductive outcome of advanced epithelial ovarian cancer.2.The Suidan's CT score model in predicting the initial tumor cytoreductive outcome is higher.It was once again to verify that the Suidan's CT scoring model can supply clinical preoperative evidence for the primary tumor cytoreductive outcome of advanced epithelial ovarian cancer.3.When either serum HE4 or ROMA index combining with CT scoring model,the predictive value of satisfactory cytoreductive surgery for patients with advanced epithelial ovarian cancer was better than the CT scoring model,HE4 and ROMA index were used alone.The results suggest that the combination of serum HE4 and ROMA index and Suidand's CT scoring model is important for preoperative evaluation of advanced epithelial ovarian cancer. |
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