血清CA125、HE4和哥本哈根指数在卵巢上皮性肿瘤良恶性鉴别诊断中的价值

摘要

目的 探讨基于治疗前血清CA125、HE4水平和年龄的哥本哈根指数在鉴别卵巢上皮性肿瘤良恶性中的应用价值.方法 回顾性分析2014年9月～2016年9月就诊于南方医科大学南方医院妇产科的208例卵巢上皮性肿瘤连续病例(良性108例+恶性100例),以手术病理诊断结果为金标准绘制ROC曲线,得出灵敏度和特异度,比较CA125、HE4、哥本哈根指数鉴别卵巢上皮性肿瘤良恶性的效能.结果 在总体人群、早期病例、晚期病例中,卵巢癌组CA125、HE4、哥本哈根指数预测值均高于良性肿瘤组,差异有统计学意义(P＜0.001);CA125、HE4、哥本哈根指数鉴别卵巢上皮性肿瘤良恶性的灵敏度依次是81.0％、86.0％、91.0％(总体人群),64.0％、68.0％、72.0％(早期病例),86.7％、92.0％、97.3％(晚期病例),特异度依次是88.0％、93.5％、96.3％.其中哥本哈根指数灵敏度、特异度均最高,HE4次之,CA125最低,两两相比,除在早期人群中的灵敏度外,余差异均有统计学意义(P＜0.001).结论 基于患者血清CA125、HE4值及年龄的哥本哈根指数较单独应用HE4或CA125具有更为良好的诊断效能,可用于卵巢上皮性肿瘤良恶性的鉴别诊断,提高卵巢癌早期诊断率.%Objective To analyze diagnostic value of Copenhagen Index based on pretreatment serum CA125,HE4 and age in differentiating benign and malignant epithelial ovarian tumors.Methods The clinical data were analyzed for 208 consecutive patients with epithelial ovarian tumors (including 100 with malignant and 108 with benign tumors) treated in our department between September,2014 and September,2016.The receiver-operating characteristic curve was drawn based on the golden standard of pathological diagnosis for calculation of the diagnostic sensitivity and specificity of CA125,HE4 and the Copenhagen Index.Results In the overall cases,early stage cases and advanced stage cases,the prediction probabilities of CA125,HE4 and Copenhagen Index were all significantly higher for malignant than in benign tumors (P＜0.001).The sensitivities of CA125,HE4,Copenhagen Index for differentiating benign and malignant tumors were 81.0％,86.0％ and 91.0％ in the overall cases,64.0％,68.0％ and 72.0％ in early stage cases,and 86.7％,92.0％ and 97.3％ in advanced stage cases,and their diagnostic specificities were 88.0％,93.5％ and 96.3％,respectively.Copenhagen Index had the highest diagnostic sensitivity (but not in early stage cases) and specificity followed by HE4 and then by CA125 (P＜0.001) (P＞0.05).Conclusion Copenhagen Index combined with CA125,HE4 and age hase better diagnostic value than HE4 or CA125 alone for differentiation between benign and malignant epithelial ovarian tumors,and can be used clinically to improve the early diagnostic rate of epithelial ovarian cancer.