Diagnostic performance of CA125, HE4, ROMA, and CPH‐I in identifying primary ovarian cancer

• Published in: The journal of obstetrics and gynaecology research Vol. 49; no. 3; pp. 998 - 1006
• Main Authors: Luo, Hui‐Jing, Hu, Zhi‐Dong, Cui, Ming, Zhang, Xiao‐Fang, Tian, Wen‐Yan, Ma, Chao‐Qun, Ren, Ya‐Nv, Dong, Zuo‐Liang
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.03.2023; Wiley Subscription Services, Inc
• Subjects: Algorithms; Biomarkers, Tumor; CA-125 Antigen; carbohydrate antigen 125; Copenhagen index; Electronic medical records; Epididymis; Female; human epididymis protein 4; Humans; Malignancy; Menopause; Ovarian cancer; Ovarian Neoplasms - pathology; Patients; Post-menopause; Retrospective Studies; risk of ovarian malignancy algorithm; ROC Curve; Surgery; Tumor markers; Tumors; carbohydrate antigen 125; Copenhagen index; ovarian cancer; human epididymis protein 4; risk of ovarian malignancy algorithm
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.15540

Aims To evaluate the ability of carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), and Copenhagen Index (CPH‐I) to identify primary ovarian cancer (OC) from borderline and benign ovarian tumors (OTs) and explore ideal cutoff points. Methods A total of 684 OTs containing 276 OC patients, 116 ovarian borderline OTs and 292 benign OTs patients who underwent surgery in our hospital were included. We retrospectively searched the results of CA125 and HE4 before patients' surgery from the hospital's electronic medical records system. ROMA and CPH‐I were calculated according to their menopausal status and age, respectively. Diagnostic performance of these four were assessed by drawing receiver operating characteristic (ROC) curves. Results CA125, HE4, ROMA, and CPH‐I were all significantly higher in OC women compared with borderline OTs (p < 0.001), followed by benign OTs (p < 0.001). Area under the curves (AUCs) for distinguishing OC were 0.850 (0.818–0.882), 0.891 (0.865–0.916), 0.910 (0.888–0.933) and 0.906 (0.882–0.930), respectively, and the corresponding ideal cutoff values for CA125, HE4, ROMA, and CPH‐I were 132.5, 68.6, 23.8, and 6.4, respectively. The difference between ROMA and CPH‐I was not significant (p = 0.97), but both were higher than CA125 and HE4 (p < 0.05). HE4 showed a significantly higher AUC than CA125 (p < 0.05). For postmenopausal women, CA125 performed equivalently to ROMA (p = 0.73) and CPH‐I (p = 0.91). Conclusions In identifying patients with OC, ROMA and CPH‐I outperformed single tumor marker. The diagnostic performance of HE4 was significantly higher than that of CA125. CA125 was more suitable for postmenopausal women.