Cheng Yanan, Department of Clinical Laboratory, Strategic Support Force Characteristic Medical Center (formerly 306 Hospital).
Edited by Liu Yan/Cui Yan, Medical Science Popularization Center
Ovarian cancer is a relatively common gynecological malignant tumor, ranking third in incidence and first in mortality among female reproductive system malignant tumors in mainland China.
The incidence of ovarian cancer is insidious, and many patients have local or distant spread when they are diagnosed, and their survival rate is only about 45%, which has a serious impact on women's life and health. The survival rate of patients with early stage ovarian cancer will rise to 85% after effective treatment. Therefore, in order to further improve the survival rate of ovarian cancer patients, the key is early diagnosis.
High-risk subjects for ovarian cancer
(1) Menopausal women.
(2) Have a family history of ovarian, prostate, pancreatic and breast cancer, or endometrial cancer, rectal cancer and other family history.
(3) The presence of causal mutations of BRCA1 and BRCA2 in the germline, or other suspected causative mutations.
(4) Pathogenicity variants or suspicious genetic variants in embryos containing RAD51C, RAD51D, and BRIP1.
(5) Lynch syndrome.
Serologic markers of ovarian cancer
Carbohydrate antigen 125: also known as CA125, is a common ovarian cancer-related tumor marker in clinical practice, but due to the relatively low sensitivity of this marker in the early stage of ovarian cancer, about 50% of patients with stage I ovarian cancer have low serum CA125 levels, even in some benign diseases, such as ovarian mucinous cystadenoma, ovarian endometriosis or ovarian serous cystadenoma, etc., may have high expression, so the specificity for ovarian cancer diagnosis is relatively low.
Human epididymal protein 4 (HE4): In the process of tumorigenesis, HE4 will be secreted into the blood earlier than CA125, and its content is relatively low in normal ovarian tissues or most benign lesions, but it is relatively high in malignant tumor tissues, such as ovarian malignant tumors, as a tumor marker for ovarian cancer diagnosis, compared with CA125, its sensitivity and specificity are higher, and it has received more and more extensive attention and attention in clinical practice.
Application of the ROMA index
The ROMA index, which is composed of CA125 and HE4, is an important indicator used to evaluate the risk of epithelial ovarian cancer, and through the use of logistic regression analysis, the risk prediction index of ovarian cancer can be calculated, and the accuracy of prediction can be obtained according to the menopause of patients, and the risk of progression to epithelial ovarian cancer can be accurately predicted for female pelvic masses and ovarian cysts. Compared with the single detection of serum CA125 or serum HE4, the ROMA index is relatively high in sensitivity, specificity, positive and negative predictive values, etc., and the combined detection of serum HE4 and CA125, and the calculation of ROMA index on this basis, will obtain better diagnostic performance.
The ROMA index test is mainly combined with HE4, CA125 detection, and the patient's menstrual condition, for women with pelvic masses for risk stratification, its accuracy will reach about 90%, the sensitivity can also reach about 87%, and the negative predictive value is 95%. Early detection, early diagnosis, and early treatment can be achieved by using ROMA index detection.
In clinical practice, doctors usually make accurate judgments on the risk of ovarian cancer based on the results of ROMA testing, and can also effectively intervene in the treatment and prognosis of patients. ROMA index detection can not only provide reliable test results for the clinical diagnosis of ovarian cancer, but also help clinicians to detect the treatment effect and detect recurrence or metastasis in time, thereby helping to strengthen the management of ovarian cancer and avoid the missed diagnosis of disease recurrence monitoring caused by negative results of a single application.
The ROMA index is applicable to the following populations: premenopausal female patients with pelvic masses found after pelvic examination, CT examination and ultrasound examination. Reference range: Premenopausal patients: ROMA less than 11.4% indicates a relatively low risk of epithelial ovarian cancer, and if ROMA is higher than 11.4%, the risk of epithelial ovarian cancer is relatively high. Postmenopausal patients: A ROMA below 29.9% indicates a lower risk of epithelial ovarian cancer, and a ROMA higher than 29.9% indicates a higher risk of epithelial ovarian cancer.
Summary: Whether it is ovarian cancer CA125 and HE4 serological tumor markers, or ROMA index, it can provide a practical and effective reference for the early diagnosis of ovarian cancer patients, escort the realization of women's health, and make ovarian cancer no longer silent!
(The picture comes from the Internet)