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abstract
Highlights
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- Distinguishing stage 1 ovarian cancer from benign adnexal masses is difficult
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- Usefulness of HE4 and other biomarkers for diagnosis is debated
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- Our model using biomarkers and patient’s age will help identify malignancies
Abstract
Objective
Evaluating
the presence of possible malignant disease in women with ovarian masses
relies on medical imaging and serum marker findings. This study
considers the role of serum Human Epididymal Protein 4 (HE4) antigen in
combination with other serum markers to more effectively estimate the
risk of malignancy in patients with isolated pelvic masses.
Methods
We
used prospectively collected biospecimens held by the Australian
Ovarian Cancer Study (AOCS). Serum samples of patients with FIGO stage 1
epithelial ovarian cancer or with a benign condition, were analysed for
levels of circulating HE4 antigen, CA 125, CEA and test results were
used to predict the presence of malignancy and to differentiate benign
from malignant pelvic masses.
Results
HE4
levels were significantly elevated among postmenopausal women and among
patients with malignancy compared to premenopausal women and those with
benign disease (p < 0.001 for both). The combination of CA125 and
age, achieved an area under the ROC curve of 0.677 (95% CI: 0.584 to
0.770, p = 0.778), whilst HE4 + CA125 + CEA in combination with
patient’s age showed significantly higher AUC of 0.797 (95% CI: 0.721 to
0.874, p = 0.0052). By adjusting ROMA cut-off values the percentage of
correctly classified premenopausal patients into low and high risk
groups increased from 36.99% to 69.86%.
Conclusions
In
patients with isolated pelvic masses, the combination of HE4, CA 125
and age with or without CEA provide higher diagnostic value compared to
CA125 and age alone. It may therefore be considered for continuous
evaluation in patients with adnexal masses.
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