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CA-125 e HE4: o seu papel como biomarcadores em cancro do ovário
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Abstract(s)
Apesar da sua baixa prevalência e incidência, o cancro do ovário (CO) é a principal causa de morte do foro ginecológico. A sua deteção precoce é importante, porque a taxa de sobrevivência global aos 5 anos pode atingir os 90% nos estádios iniciais (I-II) mas varia entre os 20 e 50% em estádios avançados (III-IV). O CA-125 é o único marcador tumoral recomendado para o diagnóstico de CO. Embora apresente uma boa sensibilidade em estádios avançados, é pouco útil na identificação de estádios precoces e sua distinção de condições ginecológicas benignas (GB), assim como na distinção dos subtipos histológicos.
Com este estudo, avaliou-se a utilidade clínica dos marcadores CA-125 e HE4 (isoladamente, combinados ou interpretados pelo algoritmo ROMA) em prever o risco de malignidade de uma massa anexial e assim distinguir CO de GB. Foram avaliadas 45 mulheres com massa anexial (12 CO, 3 borderline e 30 GB) e 30 controlos saudáveis, recrutadas no Hospital Dr. Nélio Mendonça. Para os marcadores tumorais e algoritmo ROMA, foram determinados os índices de sensibilidade, especificidade, VPP, VPN e precisão (ROC-AUC).
O CA-125 obteve a melhor sensibilidade (83,3%) e VPN (90,9%), seguido de combinação CA-125 ou HE4 (83,3% e 90,5%), ROMA (66,7% e 85,2%), combinação CA-125 + HE4 (50,0% e 82,4%) e HE4 (50,0% e 81,8%). A combinação CA-125 + HE4 obteve a melhor especificidade (93,3%) e VPP (75,0%), seguido do HE4 (90,0% e 66,7%), ROMA (76,7% e 53,3%), CA-125 (66,7% e 50,0%) e combinação CA-125 ou HE4 (63,3% e 47,6%). O CA-125 obteve a melhor precisão (AUC 0,878), seguido do ROMA (AUC 0,875), combinação CA-125 ou HE4 (AUC 0,856) e HE4 (AUC 0,786).
Assim, o presente estudo corrobora uma utilidade clínica superior de CA-125 isolado, relativamente à da utilização de HE4 ou do algoritmo ROMA, na diferenciação de massas anexiais benignas de malignas.
The ovarian cancer (OC) is the leading cause of death from gynecological cancers despite its low prevalence and incidence. Detecting this pathology in early stages is very important because overall survival rates at 5 years may reach 90% in earlier stages (I-II) and varies between 20 and 50% in advanced stages (III-IV). The only tumor marker recommended for OC diagnosis is the CA-125 tumor marker. Although being a marker with good sensitivity in advanced stages, in early stages of the pathology it´s very ineffective as well as it´s distinction of benign gynecological conditions (BG) and distinguishing histological subtypes. This study evaluated the clinical utility of CA-125 and HE4 markers (alone, combined or interpreted by ROMA algorithm) in predicting the risk of malignancy of an adnexal mass and thus distinguish OC from BG. During the process, 45 women were evaluated with adnexal mass (12 OC, 3 borderline and 30 BG), and 30 healthy controls recruited from Dr. Nélio Mendonça Hospital. Tumor markers and ROMA algorithm were determined with: sensitivity, specificity, PPV, NPV and precision (ROCAUC). The CA-125 achieved the highest sensitivity (83,3%) and NPV (90,9%), followed by the combination CA-125 or HE4 (83,3% and 90,5%), ROMA (66,7% and 85,2%), combination CA-125 + HE4 (50,0% and 82,4%) and HE4 (50,0% and 81,8%). The combination CA-125 + HE4 had the highest specificity (93,3%) and PPV (75,0%), followed by HE4 (90,0% and 66,7%), ROMA (76,7% and 53,3%), CA125 (66,7% and 50,0%) and the combination CA-125 or HE4 (63,3% and 47,6%). The CA-125 achieved the best precision (AUC 0,878), followed by ROMA (AUC 0,875), combination CA-125 or HE4 (AUC 0,856) and HE4 (AUC 0,786). Therefore, in the differentiation of benign from malignant adnexal mass, the present study confirms a superior clinical utility for the CA-125 alone compared to the use of HE4 or even by ROMA algorithm.
The ovarian cancer (OC) is the leading cause of death from gynecological cancers despite its low prevalence and incidence. Detecting this pathology in early stages is very important because overall survival rates at 5 years may reach 90% in earlier stages (I-II) and varies between 20 and 50% in advanced stages (III-IV). The only tumor marker recommended for OC diagnosis is the CA-125 tumor marker. Although being a marker with good sensitivity in advanced stages, in early stages of the pathology it´s very ineffective as well as it´s distinction of benign gynecological conditions (BG) and distinguishing histological subtypes. This study evaluated the clinical utility of CA-125 and HE4 markers (alone, combined or interpreted by ROMA algorithm) in predicting the risk of malignancy of an adnexal mass and thus distinguish OC from BG. During the process, 45 women were evaluated with adnexal mass (12 OC, 3 borderline and 30 BG), and 30 healthy controls recruited from Dr. Nélio Mendonça Hospital. Tumor markers and ROMA algorithm were determined with: sensitivity, specificity, PPV, NPV and precision (ROCAUC). The CA-125 achieved the highest sensitivity (83,3%) and NPV (90,9%), followed by the combination CA-125 or HE4 (83,3% and 90,5%), ROMA (66,7% and 85,2%), combination CA-125 + HE4 (50,0% and 82,4%) and HE4 (50,0% and 81,8%). The combination CA-125 + HE4 had the highest specificity (93,3%) and PPV (75,0%), followed by HE4 (90,0% and 66,7%), ROMA (76,7% and 53,3%), CA125 (66,7% and 50,0%) and the combination CA-125 or HE4 (63,3% and 47,6%). The CA-125 achieved the best precision (AUC 0,878), followed by ROMA (AUC 0,875), combination CA-125 or HE4 (AUC 0,856) and HE4 (AUC 0,786). Therefore, in the differentiation of benign from malignant adnexal mass, the present study confirms a superior clinical utility for the CA-125 alone compared to the use of HE4 or even by ROMA algorithm.
Description
Keywords
Cancro do ovário Massa anexial Marcadores tumorais CA-125 HE4 Algoritmo ROMA Ovarian cancer Adnexal mass Tumor markers ROMA algorithm Bioquímica Aplicada . Faculdade de Ciências da Vida