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CPH-I、CA12-5和HE4对伴乳头状结节的卵巢肿瘤恶性风险的预测价值评估

Assessment of the diagnostic value of CPH-I,CA12-5 and HE4 for cancer prediction in women with ovarian masses with papillary projections diagnosed by ultrasound
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摘要 背景与目的:超声提示囊腔内有乳头状结节的卵巢肿瘤因其被怀疑有恶性可能而存在过度治疗风险,轻率的手术无疑会对年轻有生育需求的患者造成卵巢功能损害,因此对这类特殊的卵巢肿瘤进行恶性风险预测,就有可能为恶性风险低的年轻患者争取延缓手术的机会。评估哥本哈根指数(Copenhagen index,CPH-I)、糖类抗原12-5(carbohydrate antigen 12-5,CA12-5)和人附睾蛋白4(human epididymis protein 4,HE4)对超声提示有乳头状结节的卵巢肿瘤恶性风险预测价值。方法:收集2015年7月-2019年6月复旦大学附属妇产科医院术前超声提示存在乳头状结节的192例卵巢肿瘤患者的临床资料,包括年龄、绝经与否、乳头状结节数量、肿瘤最大直径、病理学分期分型、术前CA12-5和HE4值,并求出CPH-I值。根据术后病理学检查结果分为良性组、恶性组和交界组,绘制受试者工作特性(receiver operating characteristic,ROC)曲线,评估CPH-I、CA12-5和HE4对卵巢良恶性肿瘤的鉴别能力。结果:CPH-I、CA12-5和HE4对良性组和恶性组均有较好的鉴别能力,其中CPH-I的鉴别能力优于HE4(P<0.01),其余两两比较差异均无统计学意义。CA12-5三者在良性组与恶性组+交界组中均具有良好的鉴别能力,其中CPH-I和CA12-5的鉴别能力均优于HE4(P<0.001,P<0.05)。将≤5 cm的卵巢肿瘤进行独立分组进行分析,其结果与不分组时相类似。无论未分组前还是对≤5 cm独立分组后,CPH-I在鉴别良性组与恶性组时,均有较高的灵敏度、特异度、阳性预测值及阴性预测值。结论:CPH-I、CA12-5和HE4对超声提示有乳头状结节的卵巢肿瘤的恶性风险具有一定的预测价值,总体而言,CPH-I优于CA12-5及HE4,CA12-5优于HE4。因此对于年轻有生育需求的患者,即使B超提示卵巢肿瘤存在乳头状结节,尤其当肿瘤体积不大(≤5 cm)时,可以通过定期监测肿瘤生物标志物和B超检查进行随访和评估。 Background and purpose:Ovarian masses with papillary projections diagnosed by ultrasound are suspected to be malignant,and there is a risk of overtreatment.Hasty operation would undoubtedly damage the ovarian function of young patients with reproductive needs.Therefore,the prediction of malignant risk of such special ovarian tumors may strive for the opportunity of delaying surgery for young patients with low malignant risk.The purpose of this study was to evaluate the values of the Copenhagen Index(CPH-I),carbohydrate antigen 12-5(CA12-5)and human epididymis protein 4(HE4)in predicting the malignant potential of ovarian masses with papillary projections diagnosed by ultrasound.Methods:The clinical data of 192 patients with ovarian tumors with papillary nodules detected by preoperative ultrasound in Obstetrics and Gynecology Hospital of Fudan University from Jul.2015 to Jun.2019 were collected.Clinical information included age,menopause status,number of papillary projections,maximum diameter of tumor,pathological classification and preoperative CA12-5,HE4 and CPH-I values.Receiver operating characteristic(ROC)curve was drawn to evaluate the abilities of CPH-I,CA12-5 and HE4 in differentiating benign from malignant ovarian tumors.Results:CPH-I,CA12-5 and HE4 discriminated well between the benign ovarian tumors and epithelial ovarian cancers(EOC),and the discrimination ability of CPH-I was superior to that of HE4(P<0.01).CPH-I,CA12-5 and HE4 all discriminated well between benign ovarian tumors and malignant plus borderline ovarian tumors(EOC+BOT).The abilities of CPH-I and CA12-5 to discriminate between benign and EOC+BOT groups were significantly better than that of HE4(P<0.001 and P<0.05,respectively).The results for the≤5 cm group were similar to the results obtained when all ovarian masses were considered.CPH-I had high sensitivity,specificity,positive predictive value,and negative predictive value in discriminating between the benign and malignant ovarian masses.Conclusion:Tumor markers can differentiate bet
作者 王志恒 毛佩敏 蒋红元 范灵玲 WANG Zhihen;MAO Peimin;JIANG Hongyuan;FAN Lingling(Clinical Laboratory,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China;Department of Obstetrics and Gynecology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)
出处 《中国癌症杂志》 CAS CSCD 北大核心 2020年第8期599-604,共6页 China Oncology
基金 上海市科学技术委员会西医引导项目(17411960800)。
关键词 哥本哈根指数 糖类抗原12-5 人附睾蛋白4 交界性卵巢肿瘤 上皮性卵巢肿瘤 CPH-I CA12-5 HE4 Borderline ovarian tumor Epithelial ovarian cancer
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