绝经前ROMA截断值在卵巢子宫内膜异位症与上皮性卵巢癌中的鉴别价值

Premenopausal ROMA cut-off value in distinguishing ovarian endometriosis from epithelial ovarian cancer

摘要:

目的：探讨血清CA125、HE4水平和绝经前ROMA值鉴别卵巢子宫内膜异位症及上皮性卵巢癌的临床应用价值。方法：收集2013年8月至2014年9月因发现附件区包块，收住入我院行手术治疗的患者共293例，其中上皮性良性卵巢肿瘤（EOB）患者61例（绝经前35例），卵巢子宫内膜异位症（OEM）患者151例（绝经前149例），上皮性卵巢癌（EOC）患者81例（绝经前41例）。术前2~5 d抽取静脉血，化学发光法测定血清中CA125与HE4水平，用卵巢癌风险评估软件计算ROMA指数。结果：（1）OEM组年龄（中位年龄32岁）明显小于EOC组（中位年龄51岁）（P=0.000），与EOB组差异不明显（P=0.500）。（2）绝经前EOC组的CA125高于EOB组与OEM组（P=0.000）。HE4和ROMA指数也高于OEM及EOB组，差异均有统计学意义（P=0.000），二者在EOB组与OEM组间无明显差异（HE4：P=0.762，ROMA：P=0.389）。（3）早期EOC组与OEM组比较，绝经前CA125值无明显差异（P=0.861），其诊断EOC的敏感性为85.71％，特异性为20.13%；HE4和ROMA（标准截断值为7.4%）诊断敏感性、特异性，阳性预测值、阴性预测值分别为71.43%、97.32%、71.43%、97.32%和92.86%、83.89%、35.14%、99.21%。绘制CA125，HE4及ROMA诊断EOC的ROC曲线，曲线下面积分别为：0.798、0.921、0.919。根据约登指数选取最佳ROMA截断值11.65%时，诊断早期EOC的敏感性，特异性，阳性预测值，阴性预测值分别为92.86%、93.96%、59.1%、99.29%，诊断效能高于现有截断值7.4%。结论：提高绝经前ROMA截断值至11.65%可能更有助于鉴别早期上皮性卵巢癌和子宫内膜异位症。

Abstract:

Objective：To explore the value of premenopausal risk of ovarian malignancy algorithm（ROMA） based upon preopearative CA125 and HE4 in distinguishing ovarian endometriosis（OEM） from epithelial ovarian cancer（EOC）. Methods：Between August 2013 and September 2015，293 premenopausal patients with pelvic mass admitted and undergone surgery in our hospital were collected. Two to five days before the surgery，the level of preoperative serum CA125 and HE4 was measured by electrochemiluminescence immunoassay. The ROMA index of premenopausal pelvic mass was calculated using ROMA software. Results：（1）Premenopausal OEM patients were significantly younger with the medium age of 32 than those in EOC group with the medium age of 45（P=0.000），similar to EOB group（40 years old）（P=0.252）.（2）The levels of premenopausal CA125，HE4，ROMA index was higher in EOC group than those in EOB and OEM groups（P=0.000），whereas no significant difference was found in the level of HE4 and ROMA index between EOB and OEM groups（HE4：P=0.482，ROMA：P=0.992）. （3）Early EOC usually hold similar CA125 level to OEM group（P=0.808），with diagnostic sensitivity of 77.42％and specificity of 20.13%，respectively. And the sensitivity，specificity，positive predictive value，negative predictive value for diagnosing EOC were 51.61%，97.32%，80.00%，90.63%for HE4 and 67.74%，84.56%，47.73%，92.63% for premenopausal ROMA（cutoff value was 7.4%） index，respectively. In contrast，when the optimal cut-off value of preme-nopausal ROMA index was 11.65 based on the Youden index through ROC curve，the specificity and positive predictive value could be optimized to 93.96% and 70.00% for early stage EOC. Conclusion：Although it needs further testifying，the cutoff value of preme－nopausal ROMA of 11.65% might be helpful to differentiate ovarian endometriosis from epithelial ovarian cancer.