Evaluation Of Ascitic SHLA-G For Distinguishing Malignant Ascites From Benign Ascites

Objective The aim of this study was to evaluate the efficacy of ascitic s HLA-G in the differential diagnosis between benign and malignant ascites.Methods A total of 94 patients with ascites who admitted to the First Affiliated Hospital of Xi’an Medical University from January 2016 to December 2016 were divided into malignant ascites group(64 cases)and benign ascites group(30 cases)according to the final diagnosis.The ascites samples and corresponding plasma samples were collected at the same time.An enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of s HLA-G in ascites and plasma.Receiver operating characteristic(ROC)curves were used to evaluate the diagnostic efficacy of ascitic s HLA-G for the detection of malignant ascites,in addition,s HLA-G was compared with traditional tumor markers and ascites cytopathology in regard to the diagnostic efficacy.Results 1.The ascitic s HLA-G level in the malignant ascites group was significantly higher than that in the benign ascites group(20.718±3.215 μg/L vs 12.467±3.678 μg/L,t = 7.425,P < 0.001),and the plasma s HLA-G level was also significantly higher in malignant ascites group than in benign ascites group[(19.530±4.355)μg/L vs(13.326±3.192)μg/L,t = 4.546,P < 0.001],but no statistically significance was found between the ascites and corresponding plasma in the same group(P > 0.05).However,there was no difference of ascitic and plasma s HLA-G level between tuberculosis and cirrhotic ascites(P > 0.05).2.The level of ascitic carcinoembryogenic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)in the malignant ascites group was significantly higher than in the benign ascites group(P < 0.05),but no difference was found in the level of ascitic AFP and CA125 between the two groups(P > 0.05).3.At a cut-off value of 19.60 μg/L,the sensitivity and specificity of ascitic s HLA-G were 87.5%(95% CI: 71.0%-96.5%)and 100%(95% CI: 88.4%-100%),respectively.The area under the ROC curve(AUC)of ascitic s HLA-G was 0.957(95% CI: 0.872-0.992).When the sensitivity,specificity,and AUC were compared,those of ascitic CEA(68.75%,83.33%,and 0.810,respectively)and CA19-9(65.63%,70%,and 0.710,respectively)were all significantly different(all P < 0.05).Compared with the sensitivity of ascites cytopathology(50%),the difference was statistically significant(P < 0.05),both the specificity was 100%.4.No correlations in the level of ascitic s HLA-G,CEA and CA19-9 were found in the malignant ascites group(P > 0.05).There was no significant relationship between ascitic s HLA-G levels with the patient’s gender and age,however,the difference of ascitic s HLA-G levels with different tumor types was statistically significant(P < 0.05).5.The positive rate of ascitic s HLA-G was 75%,which was higher than those of CEA(31.25%)and CA19-9(6.25%)in the 32 cases with malignant ascites which were cytology-negative but biopsy-positive(both P < 0.05).Conclusions 1.The detection of ascitic sHLA-G exhibited a good performance for diagnosing malignant ascites,it may be an independent indicator of the diagnosis of malignant ascites.2.Ascitic s HLA-G was helpful to screen for cytology-negative malignant ascites that can be used as an important adjuvant diagnosis of ascites cytology.