Abstract
BackgroundsRisk for Ovarian Malignancy Algorithm (ROMA) and Human epididymis protein 4 (HE4) appear to be promising predictors for epithelial ovarian cancer (EOC), however, conflicting results exist in the diagnostic performance comparison among ROMA, HE4 and CA125.MethodsRemote databases (MEDLINE/PUBMED, EMBASE, Web of Science, Google Scholar, the Cochrane Library and ClinicalTrials.gov) and full texts bibliography were searched for relevant abstracts. All studies included were closely assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2). EOC predictive value of ROMA was systematically evaluated, and comparison among the predictive performances of ROMA, HE4 and CA125 were conducted within the same population. Sensitivity, specificity, DOR (diagnostic odds ratio), LR ± (positive and negative likelihood ratio) and AUC (area under receiver operating characteristic-curve) were summarized with a bivariate model. Subgroup analysis and sensitivity analysis were used to explore the heterogeneity.ResultsData of 7792 tests were retrieved from 11 studies. The overall estimates of ROMA for EOC predicting were: sensitivity (0.89, 95% CI 0.84-0.93), specificity (0.83, 95% CI 0.77-0.88), and AUC (0.93, 95% CI 0.90-0.95). Comparison of EOC predictive value between HE4 and CA125 found, specificity: HE4 (0.93, 95% CI 0.87-0.96) > CA125 (0.84, 95% CI 0.76-0.90); AUC: CA125 (0.88, 95% CI 0.85-0.91) > HE4 (0.82, 95% CI 0.78-0.85). Comparison of OC predictive value between HE4 and CA125 found, AUC: CA125 (0.89, 95% CI 0.85-0.91) > HE4 (0.79, 95% CI 0.76-0.83). Comparison among the three tests for EOC prediction found, sensitivity: ROMA (0.86, 95%CI 0.81-0.91) > HE4 (0.80, 95% CI 0.73-0.85); specificity: HE4 (0.94, 95% CI 0.90-0.96) > ROMA (0.84, 95% CI 0.79-0.88) > CA125 (0.78, 95%CI 0.73-0.83).ConclusionsROMA is helpful for distinguishing epithelial ovarian cancer from benign pelvic mass. HE4 is not better than CA125 either for EOC or OC prediction. ROMA is promising predictors of epithelial ovarian cancer to replace CA125, but its utilization requires further exploration.
Highlights
Ovarian cancer is the leading cause of death from gynecologic cancers in the United States and the fifth-top cause of cancer death in women (Link 1)
Of the 11 studies, 6 studies [15,17,18,34,36,37] enrolling 1547 patients investigated the performance of Risk for Ovarian Malignancy Algorithm (ROMA) for epithelial ovarian cancer (EOC) prediction
Five studies [16,33-36] with 883 patients compared the performance of Human epididymis protein 4 (HE4) and Cancer antigen 125 (CA125) for Ovarian cancer (OC) prediction
Summary
Ovarian cancer is the leading cause of death from gynecologic cancers in the United States and the fifth-top cause of cancer death in women (Link 1). Cancer antigen 125 (CA125) was identify new serum biomarkers, alone or combining with CA125 to improve EOC detection [6,7]. With high-throughput technologies employed, a large number of new biomarkers have been discovered [8-10]. High levels of HE4 are found in the serum of patients with EOC, especially in serous and endometroid cancers [12]. Unlike CA125, HE4 doesn’t overexpress in endometriosis and other benign gynecological diseases [11]. HE4, as an aid in monitoring recurrence or progressive disease in patients with epithelial ovarian cancer, has been the first biomarker for EOC after CA125 to be approved by the U.S Food and Drug Administration (FDA) at the year of 2008. Conflicts arise on the sensitivity of HE4 and CA125 [5,13-16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
