A Novel Approach to Predict the Likelihood of Specific Ovarian Tumor Pathology Based on Serum CA-125: A Multicenter Observational Study

作者：Van Calster, Ben^*; Valentin, Lil; Van Hol**eke, Caroline; Zhang, Jing; Jurkovic, Davor; Lissoni, Andrea Alberto; Testa, Antonia Carla; Czekierdowski, Artur; Fischerova, Daniela; Domali, Ekaterini; Van de Putte, Gregg; Vergote, Ignace; Van Huffel, Sabine; Bourne, Tom; Timmerman, Dirk

来源：Cancer Epidemiology Biomarkers & Prevention, 2011, 20(11): 2420-2428.

DOI：10.1158/1055-9965.EPI-11-0422

• MALIGNANT ADNEXAL MASSES
• CA 125
• MATHEMATICAL-MODELS
• CANCER
• BENIGN
• DISTINGUISH
• VALIDATION
• DIAGNOSIS
• SURGERY
• ANTIGEN

Background: The CA-125 tumor marker has limitations when used to distinguish between benign and malignant ovarian masses. We therefore establish likelihood curves of six subgroups of ovarian pathology based on CA-125 and menopausal status.
Methods: This cross-sectional study conducted by the International Ovarian Tumor Analysis group involved 3,511 patients presenting with a persistent adnexal mass that underwent surgical intervention. CA-125 distributions for six tumor subgroups (endometriomas and abscesses, other benign tumors, borderline tumors, stage I invasive cancers, stage II-IV invasive cancers, and metastatic tumors) were estimated using kernel density estimation with stratification for menopausal status. Likelihood curves for the tumor subgroups were derived from the distributions.
Results: Endometriomas and abscesses were the only benign pathologies with median CA-125 levels above 20 U/mL (43 and 45, respectively). Borderline and invasive stage I tumors had relatively low median CA-125 levels (29 and 81 U/mL, respectively). The CA-125 distributions of stage II-IV invasive cancers and benign tumors other than endometriomas or abscesses were well separated; the distributions of the other subgroups overlapped substantially. This held for premenopausal and postmenopausal patients. Likelihood curves and reference tables comprehensibly show how subgroup likelihoods change with CA-125 and menopausal status.
Conclusions and Impact: Our results confirm the limited clinical value of CA-125 for preoperative discrimination between benign and malignant ovarian pathology. We have shown that CA-125 may be used in a different way. By using likelihood reference tables, we believe clinicians will be better able to interpret preoperative serum CA-125 results in patients with adnexal masses. Cancer Epidemiol Biomarkers Prev; 20(11); 2420-8.

• 出版日期2011-11
• 单位KU Leuven; 中国人民解放军总医院