Table 6.
Performance comparison of tumor markers in subsets of women with adnexal tumors (benign or malignant) with different symptom patterns
| Group | Marker | ROC - AUC |
ROC-AUC comparison |
Sensitivity (%) |
Specificity (%) |
PPV (%) | NPV(%) | ||
|---|---|---|---|---|---|---|---|---|---|
| HE4 vs. CA125 | HE4 vs. ROMA | CA125 vs. ROMA | (95% CI) | (95%) | |||||
|
For the differentiation between all malignant tumors from benign tumors (healthy women not included) | |||||||||
| All women |
CA 125 |
0.81 (0.75 to 0.89) |
|
|
|
65.0 (56.3 to 73.7) |
75.9 (65.6 to 86.1) |
58.2 |
80.7 |
| HE4 |
0.74 (0.66 to 0.82) |
0.09 |
0.06 |
0.37 |
58.3 (49.4 to 67.3) |
84.5 (74.7 to 94.2) |
66.0 |
79.7 |
|
| ROMA |
0.78 (0.71 to 0.86) |
|
|
|
56.7 (47.6 to 65.7) |
87.9 (78.7 to 97.1) |
70.8 |
79.7 |
|
| SI Negative |
CA 125 |
0.69 (0.52 to 0.86) |
|
|
|
46.1 (34.5 to 57.8) |
87.1 (70.2 to 100) |
40.0 |
89.7 |
| HE4 |
0.69 (0.54 to 0.84) |
0.98 |
0.45 |
0.67 |
53.1 (42.2 to 65.5) |
84.3 (67.5 to 100) |
38.9 |
90.1 |
|
| ROMA |
0.72 (0.57 to 0.87) |
|
|
|
38.5 (27.1 to 49.8) |
91.4 (74.9 to 100) |
45.0 |
90.7 |
|
| SI Positive |
CA 125 |
0.81 (0.73 to 0.90) |
|
|
|
70.2 (57.0 to 83.4) |
58.7 (45.3 to 72.1) |
63.5 |
65.8 |
| HE4 |
0.75 (0.65 to 0.85) |
0.27 |
0.25 |
0.52 |
59.6 (45.4 to 73.8) |
84.8 (72.9 to 96.7) |
80.0 |
67.2 |
|
| ROMA |
0.78 (0.69 to 0.88) |
|
|
|
61.7 (47.6 to 75.7) |
82.6 (70.4 to 94.2) |
78.4 |
67.9 |
|
|
For the differentiation between women with Stage I cancer from those with benign tumors | |||||||||
| All women |
CA 125 |
0.73 (0.63 to 0.83) |
|
|
|
46.8 (37.8 to 56.0) |
75.9 (63.1 to 88.7) |
34.9 |
83.8 |
| HE4 |
0.61 (0.50 to 0.71) |
0.06 |
0.09 |
0.25 |
34.4 (25.7 to 43.0) |
84.5 (71.3 to 97.7) |
37.9 |
82.3 |
|
| ROMA |
0.66 (0.55 to 0.74) |
|
|
|
34.4 (25.7 to 43.0) |
87.9 (75.2 to 100) |
44.0 |
82.9 |
|
| SI Negative |
CA 125 |
0.52 (0.32 to 0.73) |
|
|
|
14.3 (6.1 to 22.5) |
87.1 (66.4 to 100) |
10.0 |
91.0 |
| HE4 |
0.60 (0.39 to 0.81) |
0.67 |
0.90 |
0.66 |
28.6 (18.0 to 39.1) |
84.3 (69.5 to 100) |
15.4 |
92.2 |
|
| ROMA |
0.61 (0.40 to 0.81) |
|
|
|
14.3 (6.1 to 22.5) |
91.4 (70.9 to 100) |
14.3 |
91.4 |
|
| SI Positive | CA 125 |
0.75 (0.63 to 0.86) |
|
|
|
56.0 (41.7 to 70.3) |
58.7 (41.9 to 75.5) |
42.4 |
71.0 |
| HE4 |
0.58 (0.44 to 0.74) |
0.07 |
0.20 |
0.22 |
36.0 (22.1 to 49.9) |
84.8 (67.2 to 100) |
56.2 |
70.9 |
|
| ROMA | 0.65 (0.50 to 0.80) | 40.0 (25.8 to 54.2) | 82.6 (65.1 to 100) | 55.5 | 71.7 | ||||
Symptom index (SI) positive = presence of at least one of the symptoms included in the clusters abdomen, pain and/or eating. Cutoff points for each tumor marker were obtained with ROC analysis. Cutoff points in premenopausal women: CA125 = 69.8 U/ml, HE4 = 41.6 pMol/L, ROMA predictive index (PI) = > 5.01%. In postmenopausal women: CA125 = 21.7 U/L, HE4 = 96.6 pMol/L, ROMA-PI > 18.2%. PPV positive predictive value, NPV negative predictive value.