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ROMA和CPH-I在早期上皮性卵巢恶性肿瘤中的诊断价值

聂丹丹 王丽华 李燕华

聂丹丹, 王丽华, 李燕华. ROMA和CPH-I在早期上皮性卵巢恶性肿瘤中的诊断价值[J]. 中华全科医学, 2022, 20(2): 190-194. doi: 10.16766/j.cnki.issn.1674-4152.002309
引用本文: 聂丹丹, 王丽华, 李燕华. ROMA和CPH-I在早期上皮性卵巢恶性肿瘤中的诊断价值[J]. 中华全科医学, 2022, 20(2): 190-194. doi: 10.16766/j.cnki.issn.1674-4152.002309
NIE Dan-dan, WANG Li-hua, LI Yan-hua. Diagnostic value of ROMA and CPH-I in early epithelial ovarian cancer[J]. Chinese Journal of General Practice, 2022, 20(2): 190-194. doi: 10.16766/j.cnki.issn.1674-4152.002309
Citation: NIE Dan-dan, WANG Li-hua, LI Yan-hua. Diagnostic value of ROMA and CPH-I in early epithelial ovarian cancer[J]. Chinese Journal of General Practice, 2022, 20(2): 190-194. doi: 10.16766/j.cnki.issn.1674-4152.002309

ROMA和CPH-I在早期上皮性卵巢恶性肿瘤中的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.002309
基金项目: 

安徽高校自然科学研究项目 KJ2019A0398

详细信息
    通讯作者:

    李燕华, E-mail: bblyh1964@126.com

  • 中图分类号: R737.31  R730.4

Diagnostic value of ROMA and CPH-I in early epithelial ovarian cancer

  • 摘要:   目的  探讨卵巢恶性肿瘤风险算法(ROMA)和哥本哈根指数(CPH-I)在早期上皮性卵巢恶性肿瘤(EOC)中的诊断价值。  方法  选取2018年1月—2020年12月就诊于蚌埠医学院第一附属医院的139例上皮性卵巢肿瘤患者(其中早期EOC 52例,上皮性卵巢交界性肿瘤24例,上皮性卵巢良性肿瘤63例)进行回顾性研究,搜集入选者的年龄、绝经状态、血清人附睾蛋白4(HE4)和癌抗原125(CA125)值,计算ROMA和CPH-I值, 通过绘制曲线下面积(AUC)来衡量这些指标的诊断准确性,并计算CA125、HE4、ROMA和CPH-I在各个组别诊断中的灵敏度、特异度。  结果  在各个组别的对比中,CPH-I、ROMA、HE4的AUC均优于CA125。且组间比较结果显示,4种指标均为早期恶性组 > 交界性组 > 良性组,差异均有统计学意义(均P < 0.001)。在预测卵巢肿瘤良恶性时,CA125、ROMA较HE4和CPH-I具有更好的灵敏度(88.46%、92.31% vs. 82.69%、86.54%),而HE4和CPH-I在特异度上优于CA125、ROMA(93.65%、96.83% vs. 76.19%、90.48%)。再按照绝经状态分组后, 早期恶性组与良性组比较,绝经后患者ROMA、CPH-I的AUC、灵敏度、特异度均高于绝经前患者(0.995、0.992 vs. 0.905、0.935, 96.77%、96.77% vs. 85.71%、71.43%, 95.83%、95.83% vs. 87.18%、94.87%)。  结论  在早期EOC的诊断中,ROMA具有更好的灵敏度,而CPH-I特异度优于ROMA;ROMA、CPH-I在绝经后患者中具有更好的灵敏度及特异度。

     

  • 图  1  早期恶性组与良性组4种诊断指标的ROC曲线比较

    图  2  早期恶性组与交界性组4种诊断指标的ROC曲线比较

    图  3  交界性组与良性组4种诊断指标的ROC曲线比较

    表  1  3组卵巢肿瘤患者基本资料比较

    组别 例数 年龄[M(P25, P75), 岁] 绝经状态[例(%)]
    未绝经 已绝经
    良性组 63 40.00(27.00,59.00) 39(61.9) 24(38.1)
    交界性组 24 44.50(27.25,56.75) 15(62.5) 9(37.5)
    早期恶性组 52 53.50(47.25,60.75) 21(40.4) 31(59.6)
    统计量 12.446a 6.163b
    P 0.002 0.046
    注:aH值,b为χ2值。
    下载: 导出CSV

    表  2  3组卵巢肿瘤患者CA125、HE4、ROMA、CPH-I比较[M(P25, P75)]

    组别 例数 CA125(IU/mL) HE4(pmol/L) ROMA(%) CPH-I(%)
    良性组 63 16.00(10.70,26.30) 44.30(39.20,56.30) 6.21(4.79,12.77) 0.97(0.54,2.33)
    交界性组 24 53.05(28.98,73.93)a 98.40(49.95,167.90)a 32.18(7.57,58.06)a 6.82(1.61,20.70)a
    早期恶性组 52 167.55(48.00,490.93)ab 244.95(108.75,542.01)ab 76.97(35.62,95.10)ab 57.87(10.84,93.54)ab
    H 60.291 77.030 75.764 81.557
    P < 0.001 < 0.001 < 0.001 < 0.001
    注:与良性组比较,aP < 0.05;与交界性组比较,bP < 0.05。
    下载: 导出CSV

    表  3  4种指标的鉴别诊断价值

    组别 AUC(95% CI) 灵敏度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
    早期恶性组与良性组
        CA125 0.889(0.829~0.949) 88.46 76.19 75.41 88.89
        HE4 0.949(0.904~0.993) 82.69 93.65 91.49 86.76
        ROMA 0.944(0.897~0.991) 92.31 90.48 88.89 95.00
        CPH-I 0.959(0.925~0.993) 86.54 96.83 93.75 89.55
    早期恶性组与交界性组
        CA125 0.765(0.662~0.869) 88.46 76.19 74.19 57.14
        HE4 0.769(0.665~0.874) 82.69 95.24 76.79 55.00
        ROMA 0.776(0.674~0.878) 92.31 90.48 76.19 75.00
        CPH-I 0.799(0.701~0.896) 86.54 96.83 78.95 63.16
    交界性组与良性组
        CA125 0.803(0.707~0.898) 76.19 76.19 51.61 85.71
        HE4 0.826(0.720~0.932) 95.24 93.65 76.47 84.29
        ROMA 0.821(0.706~0.935) 90.48 90.48 71.43 86.36
        CPH-I 0.833(0.737~0.929) 96.83 96.83 80.00 83.33
    下载: 导出CSV

    表  4  不同绝经状态下4种指标的诊断效能

    组别 绝经状态 指标 AUC(95% CI) 灵敏度(%) 特异度(%) 阳性预测值(%) 阴性预测值(%)
    早期恶性组与良性组 绝经前 CA125 0.785(0.664~0.906) 95.24 71.79 59.26 84.85
    HE4 0.900(0.804~0.996) 71.43 92.31 83.33 85.71
    ROMA 0.905(0.804~0.999) 85.71 87.18 78.26 91.89
    CPH-I 0.935(0.875~0.996) 71.43 94.87 88.24 86.05
    绝经后 CA125 0.958(0.910~1.000) 96.77 83.33 88.24 95.24
    HE4 0.991(0.974~1.000) 90.32 95.83 96.55 88.46
    ROMA 0.995(0.983~1.000) 96.77 95.83 96.77 95.83
    CPH-I 0.992(0.976~1.000) 96.77 95.83 96.77 95.83
    早期恶性组与交界性组 绝经前 CA125 0.627(0.445~0.809) 95.24 60.00 64.00 54.55
    HE4 0.643(0.453~0.832) 71.43 53.33 65.22 53.85
    ROMA 0.653(0.464~0.841) 85.71 60.00 66.67 66.67
    CPH-I 0.701(0.521~0.882) 71.43 46.67 68.18 57.14
    绝经后 CA125 0.878(0.773~0.983) 96.77 77.77 81.08 66.67
    HE4 0.892(0.792~0.993) 90.32 55.55 84.85 57.14
    ROMA 0.907(0.816~0.998) 96.77 66.67 83.33 75.00
    CPH-I 0.914(0.826~1.000) 96.77 55.55 85.71 80.00
    交界性组与良性组 绝经前 CA125 0.771(0.641~0.901) 60.00 71.79 45.00 82.35
    HE4 0.817(0.679~0.955) 53.33 92.31 80.00 84.09
    ROMA 0.826(0.693~0.959) 60.00 87.18 64.29 85.00
    CPH-I 0.846(0.737~0.956) 46.67 94.87 87.50 82.61
    绝经后 CA125 0.852(0.712~0.992) 77.77 83.33 63.64 90.91
    HE4 0.921(0.829~1.000) 55.55 95.83 83.33 85.19
    ROMA 0.944(0.867~1.000) 66.67 95.83 60.00 68.97
    CPH-I 0.894(0.782~1.000) 55.55 95.83 83.33 85.19
    下载: 导出CSV
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  • 收稿日期:  2021-04-30
  • 网络出版日期:  2022-03-04

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