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

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

蚌埠医学院第一附属医院肿瘤妇科，安徽蚌埠 233004

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
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出版历程
- 收稿日期: 2021-04-30
- 网络出版日期: 2022-03-04

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

Department of Gynaecologic Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

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。
- 卵巢恶性肿瘤风险模型 /
- 哥本哈根指数 /
- 血清人附睾分泌蛋白4 /
- 糖类抗原125 /
- 卵巢上皮性肿瘤
Abstract: Objective To investigate the diagnostic value of risk of ovarian malignancy algorithm (ROMA) and Copenhagen index (CPH-I) in early epithelial ovarian cancer (EOC). Methods A total of 139 patients with epithelial ovarian tumour (including 52 patients with early EOC, 24 patients with epithelial ovarian borderline tumour and 63 patients with epithelial ovarian benign tumour) admitted to the First Affiliated Hospital of Bengbu Medical College from January 2018 to December 2020 were retrospectively studied. Age, menopausal status and serum HE4 and CA125 values were collected for ROMA and CPH-I. The diagnostic accuracy of these indicators was measured by plotting the area under the curve (AUC), and the sensitivity and specificity of CA125, HE4, ROMA and CPH-I for each group were calculated. Results The AUC of CPH-I, ROMA and HE4 was superior to that of CA125 in all groups. The Results of inter-group comparison showed that the four indexes were early malignant group>borderline group>benign group. The differences were statistically significant (P < 0.001). CA125 and ROMA were more sensitive than HE4 and CPH-I in predicting benign or malignant ovarian neoplasms (88.46%, 92.31% vs. 82.69%, 86.54%). HE4 and CPH-I were more specific than CA125 and ROMA (93.65%, 96.83% vs. 76.19%, 90.48%). After grouping according to menopausal status, in the comparison between the early malignant group and the benign group, post-menopausal ROMA and CPH-I had higher AUC, sensitivity and specificity than pre-menopausal ROMA (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%). Conclusion ROMA is more sensitive to early EOC diagnosis, and CPH-I is more specific than ROMA. ROMA and CPH-I have high sensitivity and specificity in post-menopausal patients.
- Risk of Ovarian Malignancy Algorithm /
- Copenhagen index /
- Human epididymis protein 4 /
- Cancer antigen 125 /
- Epithelial ovarian cancer

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图 1 早期恶性组与良性组4种诊断指标的ROC曲线比较

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图 2 早期恶性组与交界性组4种诊断指标的ROC曲线比较

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图 3 交界性组与良性组4种诊断指标的ROC曲线比较

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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(%)]
组别	例数	年龄[M(P₂₅, P₇₅), 岁]	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		12.446^a	6.163^b
P值		0.002	0.046
注：^a为H值，^b为χ²值。

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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值		60.291	77.030	75.764	81.557
P值		< 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。

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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

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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

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