肿瘤标志物检测对鉴别卵巢畸胎瘤的临床意义
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摘要
目的:探讨肿瘤标志物CA125、HE4、AFP、CA199血清检测对鉴别卵巢成熟与未成熟性畸胎瘤的临床意义。方法:分析2010年1月至2017年6月安徽省立医院收治卵巢未成熟性畸胎瘤患者20例和成熟性畸胎瘤患者247例临床资料,分别计算CA125、HE4、AFP、CA199及CA125+HE4+AFP诊断未成熟性畸胎瘤的灵敏度、特异度,并通过绘制受试者工作曲线(ROC曲线)评估诊断准确性。结果:未成熟组患者CA125、HE4、AFP血清水平均高于成熟性组(P<0.05),CA199血清水平在两组间差异无统计学意义(P>0.05),CA125诊断未成熟性的敏感性最高(60.0%),而HE4的特异度最高(100%),联合CA125和HE4、AFP的敏感度及特异度分别为76.4%、88.9%。CA125、HE4、AFP、CA199、CA125+HE4+AFP对应的ROC曲线下面积(AUC)分别为0.856、0.799、0.833、0.509、0.899。结论:CA125诊断未成熟性畸胎瘤的灵敏度较HE4、AFP更高,且具有较高的特异度,但联合CA125、HE4、AFP诊断未成熟性畸胎瘤时灵敏度明显高于单项肿瘤标志物检测,特异度较高,对诊断有一定的意义。CA199对于鉴别诊断卵巢成熟性及未成熟性畸胎瘤无明显临床意义。
Objective:To investigate the clinical significance of serum markers CA125,HE4,AFP and CA199 in the diagnosis of ovarian mature and immature teratoma.Methods:The clinical data of 20 patients with ovarian immature teratoma and 247 patients with mature cystic teratoma from January 2010 to June 2017 in Anhui Provincial Hospital were analyzed.CA125,HE4,AFP,CA199 and CA125+HE4+AFP were calculated to evaluate the sensitivity and specificity in diagnosis of immature teratoma,and the receiver operating characteristic curve(ROC curve) was maked.Results:Compared with the mature group,the serum levels of CA125,HE4 and AFP were higher in the immature group(P<0.05).Meanwhile,the serum level of CA199 had no statistically significance between the two groups(P>0.05).In the diagnosis of immature teratoma, the sensitivity of CA125 was the highest(60.0%) but the specificity of HE4 was the highest( 100%). The sensitivity and specificity of combined CA125 and HE4,AFP were 76. 4% and 88. 9%,respectively. The area under the ROC curve( AUC) corresponding to CA125,HE4,AFP,CA199,CA125+HE4+ AFP was 0. 856,0. 799,0. 833,0. 509,and 0. 899,respectively. Conclusion: The sensitivity of CA125 in the diagnosis of immature teratoma is higher than HE4 and AFP,and it has higher specificity. However,the sensitivity of combined CA125,HE4 and AFP in the diagnosis of immature teratoma is significantly higher than single tumor marker,with a high specificity. But CA199 has no obvious clinical significance for the diagnosis of mature and immature ovarian teratoma.
Objective:To investigate the clinical significance of serum markers CA125,HE4,AFP and CA199 in the diagnosis of ovarian mature and immature teratoma.Methods:The clinical data of 20 patients with ovarian immature teratoma and 247 patients with mature cystic teratoma from January 2010 to June 2017 in Anhui Provincial Hospital were analyzed.CA125,HE4,AFP,CA199 and CA125+HE4+AFP were calculated to evaluate the sensitivity and specificity in diagnosis of immature teratoma,and the receiver operating characteristic curve(ROC curve) was maked.Results:Compared with the mature group,the serum levels of CA125,HE4 and AFP were higher in the immature group(P<0.05).Meanwhile,the serum level of CA199 had no statistically significance between the two groups(P>0.05).In the diagnosis of immature teratoma, the sensitivity of CA125 was the highest(60.0%) but the specificity of HE4 was the highest( 100%). The sensitivity and specificity of combined CA125 and HE4,AFP were 76. 4% and 88. 9%,respectively. The area under the ROC curve( AUC) corresponding to CA125,HE4,AFP,CA199,CA125+HE4+ AFP was 0. 856,0. 799,0. 833,0. 509,and 0. 899,respectively. Conclusion: The sensitivity of CA125 in the diagnosis of immature teratoma is higher than HE4 and AFP,and it has higher specificity. However,the sensitivity of combined CA125,HE4 and AFP in the diagnosis of immature teratoma is significantly higher than single tumor marker,with a high specificity. But CA199 has no obvious clinical significance for the diagnosis of mature and immature ovarian teratoma.
引文
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[14] Yan Zhenyu,Mai Chunyang,Cao Xuezeng.The value of serum tumor markers in the differential diagnosis of benign and malignant ovarian teratoma[J].Maternal and Child Health Care of China,2016,31(14):2832-2834.[闫振宇,买春阳,曹学增.血清肿瘤标志物在卵巢畸胎瘤良恶性鉴别诊断中的价值[J].中国妇幼保健,2016,31(14):2832-2834.]
[15] Nagy B,Krasznai ZT,Balla H,et al.Elevated human epididymis protein 4 concentrations in chronic kidney disease[J].Ann Clin Biochem,2012,49(Pt 4):377-380.
[16] Granato T,Porpora MG,Longo F,et al.HE4 in the differential diagnosis of ovarian masses[J].Clinica Chimica Acta,2015,446:147-155.
[17] Chan KKL,Chen CA,Nam JH,et al.The use of HE4 in the prediction of ovarian cancer in Asian women with a pelvic mass[J].Gynecologic Oncology,2013,128(2):239-244.
[18] Chen JM,Gao HY,Wang Q,et al.Expression and clinical significance of tumor markers in ovarian mature cystic teratoma[J].Clin Exp Obstet Gynecol,2016,43(3):397-400.
[2] Deeba F,Khatun S,Alam MM,et al.Serum LDH and CA125:Markers for diagnosis of ovarian malignancy[J].Mymensingh MedJ,2015,24(2):334-340.
[3] Kim JH,Park JY.The significance of preoperative serum cancer antigen 125 in malignant ovarian germ cell tumors[J].Gynecologic Oncology,2017,145(1):215-216.
[4] Kim JH,Park JY,Kim JH,et al.The role of preoperative serum cancer antigen 125 in malignant ovarian germ cell tumors[J].Taiwanese Journal of Obstetrics & Gynecology,2018,57(2):236-240.
[5] Moore RG,Miller MC,Steinhoff MM,et al.Serum HE4 levels are less frequently elevated than CA125 in women with benign gynecologic disorders [J].Obstet Gynecol,2012,206(4):351.e1-8.
[6] Moore RG,Miller MC,Eklund EE,et al.Serum levels of the ovarian cancer biomarker HE4 are decreased in pregnancy and increase with age[J].American Journal of Obstetrics & Gynecology,2012,206(4):349.e1-7.
[7] Wan He,Zhang Yaling,Wang Yuxi,et al.Clinical value of serum human epididymis secretory protein 4 in the diagnosis of mature ovarian teratoms[J].Journal of Practical Obsterics and Gynecology,2013,29(3):211-214.[万赫,张雅玲,王宇熙,等.人附睾分泌蛋白4在卵巢成熟畸胎瘤诊断中的临床应用价值[J].实用妇产科杂志,2013,29(3):211-214.]
[8] Fan JT,Yan HQ,Malla S,et al.The clinical significance of CA19-9 in ovarian mature cystic teratoma[J].Clin Exp Obstet Gynecol,2016,43(4):522-525.
[9] Isobe N,Takano M,Chikuie H,et al.A case of occipital diploic dermoid tumor with perforation of the dura [J].No Shinkei Geka,2013,41(4):329-335.
[10] Medeiros F,Strickland KC.Chapter 26-germ cell tumors of the ovary,diagnostic gynecologic and obstetric pathology (third edition) [M].Philadelphia:Elsevier,2018:949-1010.
[11] Li Shuilian.Diagnostic value of tumor markers carbohydrate antigen 125 and alpha fetal protein for immature and mature ovarian teratomas[J].Journal of Clinical Medicine in Practice,2013,23(3):36-38.[李水莲.肿瘤标志物糖类抗原 125、甲胎蛋白对卵巢未成熟畸胎瘤及成熟畸胎瘤的诊断价值[J].实用临床医药杂志,2013,23(3):36-38.]
[12] Ortiz-Munoz B,Aznar-Oroval E,García AG,et al.HE4,Ca125 and ROMA algorithm for differential diagnosis between benign gynaecological diseases and ovarian cancer[J].Tumor Biology,2014,35(7):7249-7258.
[13] Lei Zhang,Ying Chen,Ke Wang.Comparison of CA125,HE4,and ROMA index for ovarian cancer diagnosis[J].Current Problems in Cancer,2018,13(9):1-10.
[14] Yan Zhenyu,Mai Chunyang,Cao Xuezeng.The value of serum tumor markers in the differential diagnosis of benign and malignant ovarian teratoma[J].Maternal and Child Health Care of China,2016,31(14):2832-2834.[闫振宇,买春阳,曹学增.血清肿瘤标志物在卵巢畸胎瘤良恶性鉴别诊断中的价值[J].中国妇幼保健,2016,31(14):2832-2834.]
[15] Nagy B,Krasznai ZT,Balla H,et al.Elevated human epididymis protein 4 concentrations in chronic kidney disease[J].Ann Clin Biochem,2012,49(Pt 4):377-380.
[16] Granato T,Porpora MG,Longo F,et al.HE4 in the differential diagnosis of ovarian masses[J].Clinica Chimica Acta,2015,446:147-155.
[17] Chan KKL,Chen CA,Nam JH,et al.The use of HE4 in the prediction of ovarian cancer in Asian women with a pelvic mass[J].Gynecologic Oncology,2013,128(2):239-244.
[18] Chen JM,Gao HY,Wang Q,et al.Expression and clinical significance of tumor markers in ovarian mature cystic teratoma[J].Clin Exp Obstet Gynecol,2016,43(3):397-400.