Song Dan, Liu Tingting, Han Chao, Zhang Chu, Kong Weimin
Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100026, China.
J Cancer. 2025 Jul 11;16(10):3192-3201. doi: 10.7150/jca.112768. eCollection 2025.
To explore the diagnostic significance of pre-surgery peripheral blood tumor markers cancer antigen 125 (CA125) and human epitope protein 4 (HE4), in conjunction with neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet count-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII), in the differential diagnosis of epithelial ovarian cancer (EOC) and benign ovarian tumors. Determine the best combination of diagnostic indicators for early diagnosis of EOC. We retrospectively analyzed clinical data from 189 patients with EOC and 202 patients with benign ovarian tumors, comparing levels of CA125, HE4, and inflammatory markers, and evaluated the efficacy of these markers in diagnosing EOC alone or in combination by calculating sensitivity, specificity, and receiver operating characteristic curve (ROC). Serum concentrations of CA125, HE4, NLR, PLR, MLR, and SII were significantly higher in the EOC group than in the benign ovarian tumor group (P < 0.001). In 189 cases of EOC, CA125 and HE4 were significantly higher in advanced stages than in early stages (P = 0.000, P = 0.012). NLR, PLR, MLR, and SII showed no significant difference between early and advanced stages (P>0.05), and this was also the case in 141 patients with high-grade serous ovarian cancer. CA125, HE4, NLR, PLR, MLR, and SII showed no significant differences across age groups, menopausal states, or pathological types (P > 0.05 for all). For diagnosing EOC, both the CA125+HE4+NLR+PLR+MLR+SII and CA125+HE4+PLR+MLR+SII models achieved the highest AUC values (AUC = 0.951 for both). No statistically significant difference was observed between these two models in AUC comparison (P=0.9305). NLR alone showed the lowest AUC at 0.696. The CA125+HE4+PLR+MLR+SII model demonstrated the highest sensitivity (84.66%), while CA125+HE4 showed the highest specificity (95.54%). Preoperative peripheral blood tumor markers combined with inflammatory markers can improve the diagnostic efficiency of EOC. Among these combinations, CA125+HE4+PLR+MLR+SII demonstrated optimal diagnostic performance with the highest efficacy and sensitivity, providing a clinical basis for enhanced EOC diagnosis.
探讨术前外周血肿瘤标志物癌抗原125（CA125）和人附睾蛋白4（HE4），联合中性粒细胞与淋巴细胞比值（NLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）及全身免疫炎症指数（SII），在上皮性卵巢癌（EOC）与卵巢良性肿瘤鉴别诊断中的意义。确定EOC早期诊断的最佳诊断指标组合。我们回顾性分析了189例EOC患者和202例卵巢良性肿瘤患者的临床资料，比较CA125、HE4及炎症标志物水平，并通过计算敏感度、特异度及受试者工作特征曲线（ROC）评估这些标志物单独或联合诊断EOC的效能。EOC组血清CA125、HE4、NLR、PLR、MLR及SII浓度显著高于卵巢良性肿瘤组（P<0.001）。189例EOC患者中，CA125和HE4在晚期显著高于早期（P=0.000，P=0.012）。NLR、PLR、MLR及SII在早期和晚期之间无显著差异（P>0.05），141例高级别浆液性卵巢癌患者亦是如此。CA125、HE4、NLR、PLR、MLR及SII在各年龄组、绝经状态或病理类型间无显著差异（均P>0.05）。对于EOC诊断，CA125+HE4+NLR+PLR+MLR+SII及CA125+HE4+PLR+MLR+SII模型均获得最高AUC值（两者AUC均=0.951）。这两个模型在AUC比较中无统计学显著差异（P=0.9305）。单独NLR的AUC最低，为0.696。CA125+HE4+PLR+MLR+SII模型显示最高敏感度（84.66%），而CA125+HE4显示最高特异度（95.54%）。术前外周血肿瘤标志物联合炎症标志物可提高EOC的诊断效率。在这些组合中，CA125+HE4+PLR+MLR+SII表现出最佳诊断性能，具有最高效能和敏感度，为加强EOC诊断提供了临床依据。
