CPH-I and HE4 Are More Favorable Than CA125 in Differentiating Borderline Ovarian Tumors from Epithelial Ovarian Cancer at Early Stages.

Zhiheng Wang,Chunmei Ying,Xiang Tao

doi:10.1155/2019/6241743

Zhiheng Wang, Chunmei Ying + Show 1 more

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https://doi.org/10.1155/2019/6241743

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Abstract

Aim To evaluate the diagnosis value of serum human epididymis protein 4 (HE4), cancer antigen 125 (CA125), the Risk of Ovarian Malignancy Algorithm (ROMA), and Copenhagen Index (CPH-I) at early stages for differentiating borderline ovarian tumors from epithelial ovarian cancer. Methods We recruited 144 borderline ovarian tumors in FIGO stages I and II (BOT I+II), 108 epithelial ovarian cancers in FIGO stages I and II (EOC I+II), and 238 benign ovarian tumor patients with surgical treatment in the retrospective study. The concentration of HE4 and CA125 and the values of CPH-I and ROMA were assessed separately. Results The HE4 level and ROMA and CPH-I values of EOC I+II were all higher than that of BOT I+II and benign groups whether in all, pre-, or postmenopausal groups (P < 0.01). When distinguishing BOT I+II from EOC I+II, the AUC-ROC of CPH-I and HE4 were bigger than CA125 (P < 0.001), while the CPH-I has the highest sensitivities in all and postmenopausal groups (78.7%, 85.1%), and HE4 has the highest specificity and PPV (90.91%, 88.64%) in postmenopausal groups. Under pathological stratification, HE4, ROMA, and CPH-I of the serous EOC I+II were higher than that of BOT I+II (P < 0.001) and the AUC of the three indices were significantly bigger than CA125 (P < 0.001). However, the concentration of HE4 and CA125 and the values of CPH-I and ROMA have no significant difference between the two endometrioid subgroups. The index with the highest sensitivity and NPV among the four indices of different pathological subtype groups was CPH-I, and the index with the highest specificities and PPV was HE4. Conclusion CPH-I was more valuable than CA125 for differentiating BOT I+II from EOC I+II regardless of menopausal status, while HE4 might be better than CA125 for postmenopausal subgroups. HE4 and CPH-I were more favorable than CA125 for differentiating BOT I+II from EOC I+II in the case of unknown pathology or in serous type.

Highlights

The importance of preoperative differentiation between the borderline ovarian tumors (BOT) and epithelial ovarian cancer (EOC) was gradually recognized [1, 2]
cancer antigen 125 (CA125) levels in EOC I+II Post-M had no statistical difference compared with the BOT I+II Post-M subgroup (P = 0:054)
The results of the present retrospective study demonstrate that CA125, human epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA), and Copenhagen Index (CPH-I) were useful for differentiating BOT I+II from EOC I+II, with the overall diagnostic value of HE4, ROMA, and CPH-I better than CA125, while in the Post-M group, HE4 and CPH-I had the best predictive value

Summary

Introduction

The importance of preoperative differentiation between the borderline ovarian tumors (BOT) and epithelial ovarian cancer (EOC) was gradually recognized [1, 2]. Identification of BOT and EOC is very important regarding the different treatments of both, such as the extent and method of surgery, the need of preserved fertility function for women, and the need of postoperative chemotherapy and infertility treatments [4,5,6]. The preoperational differentiation between BOT and EOC has always been a clinical difficulty as abdominal distension and abdominal pain may appear in both of them and imaging cannot accurately and effectively identify both, especially in their early stages [7].

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