Feasibility Analysis Of Serum CA-125, HE4 And Multi-detector CT In Predicting Surgical Outcome In Patients With Advanced Epithelial Ovarian Cancer

Objective:In this paper,we want to explore the feasibility of multi-detector CT(MDCT)to evaluate tumor burden and to evaluate the predictive value of CT peritoneal cancer index(PCI),serum carbohydrate antigen 125(CA-125),and human epididymal protein 4(HE4)for surgical outcome in patients with advanced epithelial ovarian cancer(AEOC).Methods:This retrospective study included 71 advanced epithelial ovarian cancer patients(stage IIB-IVB)underwent full abdominal and pelvic MDCT scan,fasting serum CA-125 and HE4 examination within 2 weeks before receiving primary cytoreductive surgery(PDS).The PCI was determined on MDCT images(CT-PCI)was compared to the PCI determined during surgery(S-PCI).Receiver operating characteristic curves(ROC)of S-PCI,CT-PCI,CA125,and HE4 were also plotted for predicting optimal cytoreductive surgery.Results:The intra-class correlation coefficient(ICC)was 0.96.CT-PCI and S-PCI showed similar predictive value.The areas under the curve of CT-PCI,S-PCI,CA-125,and HE4 was 0.908,0.92,0.786,and 0.812,respectively.The best cut-off values of each predictor was : 14.0,15.0,620.6 U / ml,582.5 pM.The sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)of CT-PCI was :90.5%,92%,95.8%,82.6%;the same indicator of S-PCI was : 90.5%,94%,95.9%,86.4%;the same indicator of CA-125 was : 71.4%,84%,87.5%,65.2%;the same indicator of HE4 was : 66.7%,86%,86%,66.7%.CT-PCI combined with CA-125 and HE4 improved the predictive value: AUC = 0.93,sensitivity and specificity were90.5% and 86%,respectively.But there was no significant difference compared with the pre-combination diagnosis value(P>0.05).Conclusion:1.CT-PCI has excellent consistency with intraoperative S-PCI and it has certain value for preoperative evaluation of tumor burden in patients with advanced ovarian cancer.2.CA-125 and HE4 are of moderate diagnostic value for predicting optimal cytoreductive surgery in patients with advanced ovarian cancer,and CT-PCI is of high diagnostic value.3.The combination of CT-PCI,CA-125 and HE4 has a high predictive value of optimal cytoreductive surgery in patients with advanced ovarian cancer.The group of combination has the similar diagnostic value with CT-PCI alone without significant differences.