摘要
目的:评价血清HE4、CA125和ROMA指数在判断卵巢癌高风险性中的价值并分析三项指标与卵巢癌临床分期和病理特征的相关性。方法:临床回顾并随访从2011年1月到2011年9月期间在福建省肿瘤医院就诊的96例原发性卵巢癌病人、74例良性卵巢肿瘤患者及60例健康女性体检者。采用酶联免疫吸附(ELISA)法测定受试者手术前血清HE4和CA125水平。用卵巢癌风险性评估软件计算ROMA指数。以卵巢良性肿瘤+健康人为参照绘制ROC曲线以评价HE4、CA125和ROMA指数的诊断价值,并以单变量统计分析治疗前血清HE4、CA125水平和ROMA指数与临床病理学参数之间的关系。结果:卵巢良性肿瘤组和正常对照组患者血清HE4、CA125和ROMA指数水平均在正常范围内,而卵巢癌组三项指标的中位水平分别为240.40 pmol/L、88.37 U/ml和79.70%,与卵巢良性肿瘤组和正常对照组比较,差异均有统计学意义(P值均<0.05)。以卵巢良性肿瘤为对照,卵巢癌组中ROMA指数的敏感性和阴性预测值最高(83.33%和82.95%),HE4的特异性、阳性预测值和准确性最高(100%、100%和82.82%)。以良性肿瘤+健康人为参照人群,HE4、CA125和ROMA指数单项检测的受试者工作特征曲线下面积分别为0.896、0.869和0.922。三项指标的阳性率随着临床分期的升高而升高,但CA125在Ⅰ期的的阳性率仅为36.36%,与HE4和ROMA指数相比(60.61%和78.79%),差异均有统计学意义(P值均<0.05)。CA125、HE4和ROMA指数的阳性率均与卵巢癌病理特征(术前转移状态、组织学分级、肿物大小、肿瘤病理类型)显著相关,此外HE4的阳性率还与患者年龄显著相关,ROMA指数的阳性率则与患者年龄、绝经状态显著相关(P值均<0.05);HE4和ROMA指数在上皮类卵巢癌的阳性率均显著高于非上皮性卵巢癌(76.54%VS 6.67%,90.12%VS 46.67%),ROMA指数在上皮性卵巢癌的阳性率最高(90.12%),尤其是浆液性腺癌阳性率高达97.92%。而CA125在两组间差异无统计学意义。同时在子宫内膜癌组,CA125的阳性率显著低于HE4和ROMA指数,而在粘液性腺癌组,则是CA125的阳性率显著高于HE4和ROMA指数。结论:血清HE4、CA125的联合检测及ROMA指数的计算有助于评估腹盆腔肿块患者患卵巢癌的风险性,对于早期以及上皮性卵巢癌尤其是浆液性卵巢癌具有更好的预测价值,可提高卵巢癌的早期诊断效率,进而提高五年生存率。
Objective ：To evaluate the serum combination of HFA, CA125 and ROMA index value in accessing the risk of ovar- ian cancer and to analyze the correlation of the three indicators of the clinical stage and pathological features of ovarian cancer. Meth- ods：A total of 96 patients with primary ovarian cancer and 74 patients with benign ovarian tumor and 60 healthy subjects, that were treated at Fujian Provincial Cancer Hospital from January 2011 to September 2011, were considered for inclusion in this retrospective study. The serum levels of HE4 and CA125 were measured by ELISA before surgery. The ROMA index was calculated by ovarian canc- er risk assessment software. The ROC curve was drawed to evaluate the diagnostic value of HE4, CAl25 and ROMA index, as the con- trol of benign ovarian tumor and healthy subjects. Univariate analyses were used to investigate the relationship between preoperative se- rologic markers and clinicopathological parameters. Results：The median levels of serum HE4, CA125 and ROMA index in the group of benign ovarian tumors and normal control group were in the normal range, while the median levels of the three indicators in ovarian cancer patients were 240.40 pmol/L, 88.37 U/ml and 79.70% , compared with benign ovarian tumors and normal control group, the differences were statistically significant （ P 〈 0.05 ）. As a reference to the benign group, the sensitivity and negative predictive value of ROMA index were highest （83.33% and 82.95% ） , the specificity and positive predictive value and accuracy of HE4 were highest （ 100% , 100% and 82.82% ）. As the control of benign ovarian tumor and normal control group,the area under the receiver operating characteristic curve（ROC） of HE4, CA125 and the ROMA index were 0. 896,0. 869 and 0. 922. The positive rates of the three indica-tors were increased with the clinical stages, while the positive rate of CA125 was 36.36% in stage I of ovarian cancer, compared with HFA and ROMA index（60.61% and 78.79% ）, the differences were statistically significant （P 〈0.05）. The positive rates of HFA, CA125 and ROMA index were significantly correlated with pathological features （preoperative metastasis, histological grade, tumor size and histological type） （P 〈 0.05 ） ;the positive rate of HFA was associated with age and the positive rate of ROMA index was associated with age and menopausal status furthermore. The positive rate of HFA and ROMA index in epithelial ovarian cancer patients were statis- tically higher than non-epithelial ovarian cancer patients . Compared with HFA and ROMA index, the positive rate of CA125 in the en- domctrial cancer group was the lowest of the three indicators, while that in mucinous adenocarcinoma group was the highest. Conclu- sion：Serum combination of HFA, CA125 testing and the ROMA index calculation helps assess the risk of ovarian cancer, early diagno- sis and improve the five year survivals of ovarian cancer.
出处
《中国免疫学杂志》
CAS
CSCD
北大核心
2013年第2期168-174,共7页
Chinese Journal of Immunology
