A novel diagnostic index combining HE4, CA125 and age may improve triage of women with suspected ovarian cancer - An international multicenter study in women with an ovarian mass

TY - JOUR

T1 - A novel diagnostic index combining HE4, CA125 and age may improve triage of women with suspected ovarian cancer - An international multicenter study in women with an ovarian mass

AU - Karlsen, Mona Aarenstrup

AU - Høgdall, Estrid V S

AU - Christensen, Ib J

AU - Borgfeldt, Christer

AU - Kalapotharakos, Grigorios

AU - Zdrazilova-Dubska, Lenka

AU - Chovanec, Josef

AU - Lok, Christianne A R

AU - Stiekema, Anna

AU - Mutz-Dehbalaie, Irene

AU - Rosenthal, Adam N

AU - Moore, Elizabeth K

AU - Schodin, Beth A

AU - Sumpaico, Walfrido W

AU - Sundfeldt, Karin

AU - Kristjansdottir, Björg

AU - Zapardiel, Ignacio

AU - Høgdall, Claus K

N1 - Copyright © 2015 Elsevier Inc. All rights reserved.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - AIM: To develop and validate a biomarker-based index to optimize referral and diagnosis of patients with suspected ovarian cancer. Furthermore, to compare this new index with the Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA).PATIENTS AND METHODS: A training study, consisting of patients with benign ovarian disease (n=809) and ovarian cancer (n=246), was used to develop the Copenhagen Index (CPH-I) utilizing the variables serum HE4, serum CA125 and patient age. Eight international studies provided the validation population; comprising 1060 patients with benign ovarian masses and 550 patients with ovarian cancer.RESULTS: Overall, 2665 patients were included. CPH-I was highly significant in discriminating benign from malignant ovarian disease. At the defined cut-off of 0.070 for CPH-I the sensitivity and specificity were 95.0% and 78.4% respectively in the training cohort and 82.0% and 88.4% in the validation cohort. Comparison of CPH-I, ROMA and RMI demonstrated area-under-curve (AUC) at 0.960, 0.954 and 0.959 respectively in the training study and 0.951, 0.953 and 0.935 respectively in the validation study. Using a sensitivity of 95.0%, the specificities for CPH-I, ROMA and RMI in the training cohort were 78.4%, 71.7% and 81.5% respectively, and in the validation cohort 67.3%, 70.7% and 69.5% respectively.CONCLUSION: All three indices perform well at the clinically relevant sensitivity of 95%, but CPH-I, unlike RMI and ROMA, is independent of ultrasound and menopausal status, and may provide a simple index to optimize referral of women with suspected ovarian cancer.

AB - AIM: To develop and validate a biomarker-based index to optimize referral and diagnosis of patients with suspected ovarian cancer. Furthermore, to compare this new index with the Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA).PATIENTS AND METHODS: A training study, consisting of patients with benign ovarian disease (n=809) and ovarian cancer (n=246), was used to develop the Copenhagen Index (CPH-I) utilizing the variables serum HE4, serum CA125 and patient age. Eight international studies provided the validation population; comprising 1060 patients with benign ovarian masses and 550 patients with ovarian cancer.RESULTS: Overall, 2665 patients were included. CPH-I was highly significant in discriminating benign from malignant ovarian disease. At the defined cut-off of 0.070 for CPH-I the sensitivity and specificity were 95.0% and 78.4% respectively in the training cohort and 82.0% and 88.4% in the validation cohort. Comparison of CPH-I, ROMA and RMI demonstrated area-under-curve (AUC) at 0.960, 0.954 and 0.959 respectively in the training study and 0.951, 0.953 and 0.935 respectively in the validation study. Using a sensitivity of 95.0%, the specificities for CPH-I, ROMA and RMI in the training cohort were 78.4%, 71.7% and 81.5% respectively, and in the validation cohort 67.3%, 70.7% and 69.5% respectively.CONCLUSION: All three indices perform well at the clinically relevant sensitivity of 95%, but CPH-I, unlike RMI and ROMA, is independent of ultrasound and menopausal status, and may provide a simple index to optimize referral of women with suspected ovarian cancer.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Algorithms

KW - Biomarkers, Tumor

KW - CA-125 Antigen

KW - Cohort Studies

KW - Diagnosis, Differential

KW - Female

KW - Humans

KW - Membrane Proteins

KW - Middle Aged

KW - Models, Statistical

KW - Multivariate Analysis

KW - Ovarian Diseases

KW - Ovarian Neoplasms

KW - Prospective Studies

KW - Proteins

KW - Severity of Illness Index

KW - Young Adult

U2 - 10.1016/j.ygyno.2015.06.021

DO - 10.1016/j.ygyno.2015.06.021

M3 - Journal article

C2 - 26086566

SN - 0090-8258

VL - 138

SP - 640

EP - 646

JO - Gynecologic Oncology

JF - Gynecologic Oncology

IS - 3

ER -