| Objective:Ovarian cancer is one of the common malignant tumors in gynecological tumors.The incidence rate is rising,ranking third in gynecological malignant tumors,and the mortality rate is the first.There is still no effective method for the early diagnosis of ovarian cancer.Finding an ideal tumor marker for early diagnosis of ovarian malignancies has important clinical significance for the diagnosis and treatment of ovarian malignant tumors.In this study,the levels of serum CA125,HE4 and CA199 in patients with ovarian tumors were detected by electrochemiluminescence method.Serum REG4 levels in patients with ovarian tumors were detected by enzyme-linked immunosorbent assay.The aim was to investigate four tumor markers and ovarian tumors of CA125,HE4,REG4 and CA199.The relationship between its clinical pathological features and the diagnostic value of CA125,HE4,REG4,and CA199 in the diagnosis of ovarian malignancies.Method:Collection of 134 cases of gynecology in Yunnan Provincial Cancer Hospital from November 2017 to November 2018 due to Ovarian mass admission surgery,including 40 patients with serous ovarian cancer,23 patients with mucinous ovarian cancer,5 patients with ovarian endometrial cancer,5 patients with ovarian clear cell carcinoma,61 patients with benign ovarian tumors;18patients with physical examination in the physical examination center of Yunnan Cancer Hospital.Detection of serum REG4,CA-125,HE4 and CA199 values in these patients.The inclusion criteria were:initial visit to patients with ovarian mass in our department;postoperative pathological diagnosis was clear,and the exclusion criteria were:cases of anti-tumor treatment such as radiotherapy and chemotherapy in the external hospital;patients with incomplete postoperative recurrence and reoperation.The SPSS21.0 statistical software was used to process the measured values,and the data was tested for normality.The results showed that some of the data were skewed,some of the data were normally distributed,and the data were in a skewed distribution.(Quartile)expression,non-parametric Kruskai-Wallis rank sum test was used for comparison between groups,Mann-Whitney U test was used for comparison between groups,and mean±standard deviation(x±s)was used for data with normal distribution.),the t-test was used to compare the two sample means,the variance analysis was used to compare the multi-sample means,and the chi-square test was used to compare the rates.The results were statistically significant at P<0.05.Results:1.The average levels of serum HE4 in ovarian malignant tumor group,benign ovarian lesion group and healthy control group were 166.20(71.41-553.60)pmol/L,49.14(40.38-61.58)pmol/L,50.55(40.25-60.76)pmol/L,respectively.The mean levels of serum REG4 were(23.88±13.01)ng/ml,(16.79±10.52)ng/ml,(13.52 ±9.18)ng/ml;the average serum CA125 levels were 376.30(91.08?1291.00)u/ml,34.53(20.33?74.72)u/ml,15.72(12.55?20.41)u/ml;serum CA199 average levels were 20.02(7.08?59.36)KU/L,12.52(8.09?28.41)KU/L,9.66(6.84?17.09)KU/L.The REG4 results were compared between the three groups(using analysis of variance),and the results of HE4,CA125,and CA199 were compared between the three groups(using the Mann-Whitney U test),and serum HE4,REG4,CA125,and CA199 were There was no significant difference in the mean level between the ovarian benign lesions group and the healthy control group(P>0.05).There was a statistically significant difference between the ovarian malignant tumor group and the ovarian benign lesions and the healthy control group.(P<0.05).2.When the ovarian benign lesion group and the healthy control group were used as controls,the AUC of HE4 diagnosis of ovarian cancer was 0.88,the AUC of REG4 diagnosis of ovarian cancer was 0.681,and the AUC of CA125 diagnosis of ovarian cancer was 0.862,CA199 diagnosed AUC of ovarian cancer.The AUC of the combined diagnosis of ovarian cancer with HE4,REG4,and CA125 was 0.921,and the AUC of HE4,REG4,CA125,and CA199 combined with ovarian cancer was 0.923.3.The positive rates of serum HE4,REG4,CA125 and CA199 in the ovarian malignant tumor group were 61.64(45/73),60.27(44/73),89.04(65/73)and 35.61(26/73),respectively.The positive rate of HE4(61.64%)and the positive rate of CA125(89.04%)were statistically significant(?2=22.360,P<0.05),the positive rate of HE4(61.64%)and the positive rate of REG4(60.27%).There was no statistically significant difference(?2=0.029,P=0.873),and the positive rate of HE4(61.64%)was significantly different from that of CA199(35.61%)(?2==9.898,P<0.05).The positive rate of CA125(89.04%)and the positive rate of REG4(60.27%)were statistically significant(?2=21.578,P<0.05),the positive rate of CA125(89.04%)and the positive rate of CA199(35.61%).The difference was statistically significant(?2=45.834,P<0.05).The positive rate of REG4(60.27%)was significantly different from the positive rate of CA199(35.61%)(?2=7.015,P<0.05).In the ovarian benign lesion group,the positive rate of serum HE4 was significantly higher than that of serum REG4,CA125,CA199,and the difference was statistically significant(P<0.05),and the positive rate of REG4(31.15%)and CA125 positive rate(49.18%)and CA199 positive rate(22.95%)were higher than HE4 positive rate(0),and it can be concluded that the false positive rate of HE4 is lower than REG4,CA125 and CA199.The positive predictive value of HE4 was higher than REG4,CA125 and CA199.4.The sensitivity of serum REG4,HE4,CA125 and CA199 were 60.2%,61.64%,89.04%and 35.61%,respectively.The sensitivity of combined detection of HE4,REG4,CA125 and CA199 was 100%,HE4S REG4,CA125,The sensitivity of the combined detection was 98.63%,and the sensitivity of HE4 and CA125 combined detection of ovarian cancer was:90.41%;the combined detection sensitivity of the four was compared with each individual test,and the combined detection was higher than each individual test.The results show that joint detection can increase sensitivity.5.Serum REG4 test in all patients showed that the average level of REG4 in patients with mucinous ovarian cancer was(29.49± 13.33)ng/ml higher than that in serous cancer patients(20.51±11.89)ng/ml(P<0.05).Serum HE4 test results showed that the average levels of ovarian endometrial cancer and serous ovarian cancer were(879.50±551.31)pmol/L,(444.04±404.87)pmol/L,which was significantly higher than ovarian clear cell carcinoma(112.37±78.73)and mucinous ovarian cancer(99.94±55.62)pmol/L(P<0.05).Serum CA125 test results showed that the median(interquartile range)of serum CA125 in patients with serous ovarian cancer was 932.55(341.42?2248.75)u/ml higher than mucous ovarian cancer 85.15(52.66?211)u/ml and ovarian transparency cell carcinoma 104.8(29.22?378.4)u/ml(P<0.05).Serum CA199 test results showed that the median(interquartile range)of serum CA199 in patients with mucinous ovarian cancer was 46.56(18.75?221.20)KU/L higher than that of serous cancer patients 12.45(5.83?22.55)KU/L(P<0.05).The expression levels of serum REG4 were different in different pathological types.The expression levels of mucinous ovarian cancer group and ovarian endometrioid carcinoma group were higher than other pathological types.The average serum REG4 level in patients with primary ovarian mucinous carcinoma was(31.21 ±11.20)ng/ml,and the average serum REG4 level in patients with secondary ovarian.mucinous carcinoma was(25.56±17.66)ng/ml.Primary and secondary phase The difference was not statistically significant(P>0.05),indicating that the mean serum REG4 level was not different between ovarian primary and secondary mucinous cancer patients.6.The median(interquartile range)of serum HE4 in patients with stage ?-?ovarian cancer was 104.85(55.37?241.88),104.85(55.37?241.88)pmol/L,and the median(interquartile range)of serum HE4 in patients with stage ?-? ovarian cancer was 513.60(116.80?617.55)pmol/L,which was statistically significant(P<0.05).The average level of serum REG4 in patients with stage ?-? ovarian cancer was(27.59±12.73)ng/ml,which was statistically significant compared with the average level of REG4 in patients with stage III-IV ovarian cancer(21.34±11.89)ng/ml(P<0.05).The median(interquartile range)of serum CA125 in patients with stage ?-?ovarian cancer was 153.35(59.46-794.47)u/ml,and the median(interquartile range)of serum CA125 in patients with stage ?-? ovarian cancer was 978.90(310.30?2408.50)u/ml was statistically significant(P<0.05).The median(interquartile range)of serum CA199 in patients with stage ?-? ovarian cancer was 16.49(6.89?85.22)KU/L,and the median(interquartile range)of serum CA199 in patients with stage ?-? ovarian cancer was 19.39(6.61-33.62)KU/L with no statistically significant difference(P>0.05).The positive rate of serum REG4+HE4+CA125 in patients with stage ?-? ovarian cancer was higher than that of any tumor marker alone,and the difference was statistically significant(P<0.05).7.1n patients with serous ovarian cancer,the positive rate of serum CA125 was 95.00%,the positive rate of HE4 was 85.00%,and the positive rate of CA125 combined with HE4 was 97.5%.The positive rate of combined diagnosis of ovarian serous carcinoma was increased.However,there was no significant difference compared with single test(P>0.05).In mucinous ovarian patients,the positive rate of serum CA199 was 56.52%,the positive rate of REG4 was 76.26%,and the positive rate of CA199 combined with REG4 was 91.3%.The positive rate of combined diagnosis of ovarian mucinous carcinoma was increased.The difference of CA199 was statistically significant(P<0.05),and there was no significant difference compared with REG4(P>0.05).There was no significant difference in the positive rate of REG4 compared with the positive rate of CA199(P=0.052).Conclusions:1.The combined detection of REG4,HE4 and CA125 may make up for the deficiency of HE4 and CA125 in the diagnosis of mucinous ovarian cancer,improve the sensitivity of detection and reduce the rate of missed diagnosis,which may improve the diagnosis rate of ovarian cancer.2.HE4 has a high specificity and a low false positive rate.It is more specific than REG4,CA125 and CA199 in the differential diagnosis of benign and malignant ovarian tumors,and plays an important role in the diagnosis of ovarian malignant tumors.3.REG4 has high sensitivity to ovarian mucinous carcinoma and ovarian endometrioid carcinoma,and may have important significance for predicting the classification of pathological types of ovarian cancer.4.The combined detection of REG4 and CA199 can improve the diagnosis rate of mucinous ovarian cancer. |
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