| Objective: At present,serum CA125 is a biomarker commonly used in clinic to distinguish benign and malignant ovarian tumors,but its early diagnosis of ovarian malignant tumors has the limitations of low specificity and low positive predictive value.The purpose of this study is to evaluate the comparison of several candidate biomarkers used alone or in combination with CA125 in predicting benign and malignant ovarian epithelial tumors.Methods: From June 1,2019 to June 1,2022,we collected 575 patients who were treated by surgery in the Affiliated Hospital of Jining Medical College.After the operation,they were diagnosed as epithelial ovarian tumors by routine pathology.After exclusion according to the standard of nano-discharge,we collected the clinical hematological parameters and tumor markers of 73 patients with epithelial ovarian malignant tumors and 116 patients with epithelial ovarian benign tumors.The clinical manifestations and pathological features of ovarian epithelial benign and malignant tumors were collected,and the data of biomarkers collected from clinic were tested for normality.Independent sample T test was used for those who met the normal distribution,and Wilcoxon rank sum test was used for those who met the skewed distribution,and the significance of the differences between the two groups was compared.P< 0.05 means that the difference between the two groups is statistically significant;ROC was used to evaluate the diagnostic efficacy of biomarkers with differences between the two groups;Biomarkers with area(AUC)greater than 0.8 under the ROC curve were selected to fit a binary Logistic regression model individually OR jointly,and the ROC curve of each biomarker and prediction model and its corresponding 95%confidence interval(95%CI),OR value and P value were determined.Results:(1)The age,CA125,HE4,white blood cell count,neutrophil count,monocyte count,platelet count,FIB and plasma D-dimer in ovarian epithelial malignant tumor group were significantly higher than those in ovarian epithelial benign tumor group(P < 0.05),while hemoglobin,hematocrit,lymphocyte count,thrombin time and albumin were significantly lower(P < 0.05).(2)According to ROC curve analysis,CA125,white blood cell count,HE4,neutrophil count,monocyte count,platelet count,FIB,plasma Ddimer,hemoglobin,hematocrit,lymphocyte count,lymphocyte percentage,thrombin time and albumin all have differential diagnosis functions in ovarian epithelial benign and malignant tumors.Among them,the area under the biomarker curve(AUC)is greater than 0.8: the best cutoff value of CA125 is 34.7(AUC: 0.968,sensitivity: 94.52,specificity:92.24);The best cutoff value of HE4 is 51.60(AUC: 0.971,sensitivity:93.15,specificity: 91.38);The best cutoff value of neutrophil count was3.85(AUC: 0.839,sensitivity: 78.08,specificity: 78.45).The best cutoff value of FIB is 3.00(AUC: 0.830,sensitivity: 82.19,specificity: 74.14);The optimal cutoff value of plasma D-dimer was 0.53(AUC: 0.918,sensitivity: 83.56,specificity: 91.38).(3)HE4+ plasma D-dimer is combined with neutrophil count and FIB,and the area under the curve of HE4+ plasma D-dimer +FIB is the largest,with the best cutoff value of 0.19,AUC of 0.990,sensitivity of97.26 and specificity of 93.10.(4)The accuracy of FIB,HE4 and plasma D-dimer FIB in differentiating benign and malignant ovarian epithelial tumors was lower than that of CA125,and the AUC of CA125+HE4+ plasma D-polymer+FIB and CA125+HE4+FIB were both 0.992,the sensitivity was 93.15,and the specificity was 97.41.Compared with CA125,the P values were0.0432 and 0.0437 respectively(P < 0.05).(5)There were significant differences in the four biomarkers of CA125,HE4,plasma D-dimer and FIB between the two groups(P <0.001).Bivariate multivariate Logistic regression showed that high levels of CA125 and HE4 were independent risk factors for ovarian cancer(P <0.001).Conclusion: This study found that there were differences in CA125,HE4,plasma D-dimer and FIB between ovarian epithelial malignant tumor group and ovarian epithelial benign tumor group,and no biomarker was superior to CA 125 in differential diagnosis of ovarian epithelial tumor.However,CA125+HE4+ plasma D-polymer +FIB and CA125+HE4+FIB are superior to CA125 as new biomarkers with high specificity,which is helpful for differentiating benign and malignant ovarian epithelial tumors before operation.CA125,HE4,plasma Ddimer and FIB are four biomarkers related to ovarian epithelial malignant tumor,among which CA125>34.7 and HE4>51.6 are independent risk factors for ovarian epithelial malignant tumor. |
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