| Objective: This study was to evaluate the clinical application value of CA125,HE4,NLR,LDH,CT score and ROMA alone and combined in preoperative prediction of surgical outcomes in patients with advanced epithelial ovarian cancer,in order to improve the accuracy of preoperative evaluation and avoid unnecessary surgery or patients who could have missed the time of surgery.Method: The clinical data of 75 patients with advanced epithelial ovarian cancer who underwent initial surgical treatment in Guilin Medical University Affiliated Hospital from January 2018 to April 2022 were retrospectively collected.Among 36 patients who completed satisfactory tumor cytoreductive surgery were marked as the completed group.A total of 39 patients did not undergo satisfactory cytoreductive surgery,most of them were clinically considered to be ovarian malignant tumors but lack of pathological results,and were found to be unable to perform satisfactory surgery after laparoscopic exploration and only underwent biopsy,which were marked as the uncompleted group.The clinical data such as age,CA125,HE4,LDH,NLR,CT score,ROMA model score and other related data were collected.The general clinical data and economic indicators of the two groups were compared.SPSS 26.0statistical software was used for data analysis and collation.ROC curves of CA125,HE4,NLR,LDH,CT score and ROMA score were drawn and analyzed to show the predictive evaluation value of each serological index and score respectively.The area under the ROC curve(AUC)of each study indicator was obtained when used alone and in combination.The sensitivity and specificity were calculated according to the maximum Youden index,and the positive predictive value and negative predictive value were calculated.Results: 1.The intraoperative blood loss and operation time in the completed group were significantly higher than those in the uncompleted group(P<0.05).There was no significant difference in age,menopausal status,ASA classification,and pathological stage between the two groups(P>0.05).The levels of CA125,HE4,NLR and LDH in the complete group were significantly lower than those in the incomplete group,and the differences between the two groups were statistically significant(P<0.05).2.In a single test,CT score had the best predictive effect on surgical outcome(AUC=0.927),HE4 and ROMA had the same predictive value(AUC=0.796),better than CA125(AUC=0.764)and NLR(AUC=0.759).Each index was reliable in preoperative evaluation and prediction of the feasibility of radical surgery(P<0.05),and with the increase of CT score,the possibility of residual lesions increased.3.The most clinically valuable cut-off values of CA125,HE4,NLR,LDH,CT score and ROMA index were 446.5 U/ml,423.45 pmol/L,2.985,219.2 U/L,3.5 points and 94.535%,respectively,and the sensitivity was 0.795,0.795,0.744,0.718,0.949 and 0.795 respectively,and the specificity was 0.694,0.833,0.722,0.639,0.833 and 0.806 respectively.4.The two serological markers combined and the detection of serological markers,NLR and LDH combined with CT score and ROMA model respectively can be used to predict the surgical results of advanced epithelial ovarian cancer without satisfactory tumor reduction(AUC>0.7,P<0.05),and the combined index detection is better than each index alone.In the combined prediction,NLR combined with CT and ROMA had the highest diagnostic efficiency,with AUC of 0.942.5.The cost-effectiveness ratios of CA125,HE4,NLR,LDH,ROMA and CT were 0.67,1.11,0.34,1.19,1.75 and 18.07,respectively,the lowest cost-effectiveness ratio is NLR(0.34)and the highest is CT(18.07).Conclusions: 1.The application of CA125,HE4,NLR,LDH,CT score and ROMA alone has certain predictive value for the completion of satisfactory debulking surgery in patients with advanced ovarian cancer.CT score has the best effect,HE4 and ROMA are better than CA125 than NLR,and LDH is the worst.2.In a separate diagnosis,the best cut-off values of CA125,HE4,NLR,LDH,CT score and ROMA were 446.5 U/ml,423.45 pmol/L,2.985 and 219.2U/L,3.5 points and 94.535%,respectively.3.The CT score was reliable in evaluating tumor spread and predicting the outcome of radical surgery.The sensitivity,specificity,positive predictive value and negative predictive value of predicting unsatisfactory surgery were 0.949,0.833,86.05% and 93.75%respectively when the CT score was 3.5;With the increase of CT score,the possibility of residual lesions in patients undergoing surgery also increased.4.The combined detection was superior to the single diagnosis of each index.In the combined prediction,the highest diagnostic efficiency was the combined application of NLR combined with CT and ROMA.The AUC was 0.942,the sensitivity was 1.000,and the specificity was 0.833.5.From a health economics perspective,CT is recommended to provide reliable clinical information when economic conditions permit because of its optimal diagnostic efficacy,despite its relatively high cost-effectiveness. |
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