Epitel Over Kanserleri ve Benign Adneksiyal Kitlelerde Human Epididymis Protein 4 ile Hesaplanan Malignite Risk İndeksi
Öz
Amaç: Over kanseri kadınlarda kanser türleri arasında 7. sırada yer almaktadır ancak jinekolojik kanserler arasında en yüksek mortaliteye sahiptir. Adneksiyel kitlelerde malignite ayrımı için yüksek sensitivite ve spesifisitesi olan testlerin kullanılması yalancı pozitif sonuçlara bağlı morbiditeyi arttırmadanEpitelyalOver Kanserlerinin EOK ’lerinin erken tanısına yardımcı olmaktadır. Bu çalışmanın amacı CA 125 yerine HE4 ile hesaplanan RMI’inin malignite ayrımındaki öngörü değerini CA 125 ile hesaplanan RMI ile kıyaslamaktı.Gereç ve Yöntem: Şubat 2015 ve Ekim 2015 arasında adneksiyel kitle öntanısı ile ameliyat olan 78 hasta prospektif olan bu çalışmaya dahil edildi.Preoperatif olarak CA 125 ve HE4 ile ayrı RMI hesaplandı. Ameliyat sonrasında Epitelyal over karsinomları ve benign kist tanısı alan hastalar arasında HE4 ve CA 125 ile ayrı hesaplanan RMI’lerinin malignite ayrımındaki etkinlikleri kıyaslandı.Bulgular: Benign kist ile EOK tanıları alan hastalar arasında serum HE4 seviyelerinde anlamlı fark saptanmadı p=0.24 . RMI-CA125’in hem de RMI-HE4’ün over kanserini öngörmede anlamlı tanısal karar verdirici özelliklerinin olduğu ve RMI-CA125’in karar verdirici özelliğinin RMI-HE4’ten daha yüksek olduğu görüldü.Sonuç: RMI’inin spesifitesi ve HE4’ün önceki çalışmalarda bildirilen yüksek öngörü değerleri nedeniyle RMI’in HE4 ile hesaplanmasının CA 125 ile hesaplanan RMI’ine üstünlük sağlayacağı düşünülmüştür. Ancak HE4 ile ilgili yapılan çalışmaların çoğunluğunun aksine, çalışmamızda HE4 değerlerinin malign ve benign kitlelerde anlamlı şekilde değiştiğini saptayamadık. RMI-HE4’ün Epitelyal over karsinomundaki artışının ultrasonografi skoru ile menopoz durumuna bağlı olduğu görüldü. Toplam hasta sayısının kısıtlı olması ve özellikle over kanseri histolojik alt sınıflarını temsil eden vaka sayılarının kısıtlı olması nedeniyle çalışmanın daha geniş nüfusta ve daha yüksek alt sınıf sayılarıyla beraber yapılması daha aydınlatıcı olabilir
Anahtar Kelimeler
Over kanseri Malignite risk indeksi Human epididymis protein 4
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Je- mal A. Global cancer statistics 2018: GLOBOCAN estima- tes of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
- Barnholtz-Sloan JS, Schwartz AG, Qureshi F, et al. Ovarian cancer: changes in patterns at diagnosis and relative survi- val over the last three decades. Am J Obstet Gynecol 2003; 189:1120.
- Drapkin R, von Horsten HH, Lin Y, et al. Human epididy- mis protein 4 (HE4) is a secreted glycoprotein that is ove- rexpressed by serous and endometrioid ovarian carcino- mas. Cancer Res 2005;65:2162–9.
- Moore RG, Miller MC, Steinhoff MM, et al. Serum HE4 levels are less frequently elevated than CA-125 in women with benign gynecologic disorders. Am J Obstet Gynecol 2012;206:351 e1–351 e8.
- Prat J; FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and pe- ritoneum. Int J Gynecol Obstet 2014;124:1-5.
- Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990; 97:922.
- Enakpene CA, Omigbodun AO, Goecke TW, Odukogbe AT, Beckmann MW. Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malig- nancy index. J Obstet Gynaecol Res 2009;35:131–8.
- Johnson CC, Kessel B, Riley TL et al. The epidemiology of CA 125 in women without evidence of ovarian cancer in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial. Gynecol Oncol 2008;110:3839.
- Lowe KA, Shah C, Wallace E et al. Effects of personal cha- racteristics on serum CA 125, mesothelin, and HE4 levels in healthy postmenopausal women at high-risk for ovarian cancer. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Rese- arch, cosponsored by the American Society of Preventive Oncology 2008;17:24807.
- Myers ER, Bastian LA, Havrilesky LJ, et al. Management of Adnexal Mass. Evidence Report/Technology Assessment No.130 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025). AHRQ Publi- cation No. 06-E004, Agency for Healthcare Research and Quality, Rockville, MD February 2006.
- Bozkurt M, Yumru AE, Aral I. Evaluation of the importance of the serum levels of CA-125, CA15-3, CA-19-9, carcino- embryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy. Eur J Gynaecol Oncol 2013;34:540-4.
- Sen S, Kuru O, Akbayır O, Oğuz H, Yasasever V, Berkman S. Determination of serum CRP, VEGF, Leptin, CK-MB, CA- 15-3 and IL-6 levels for malignancy prediction in adnexal masses.J Turk Ger Gynecol Assoc 2011;12:214-9.
- Partheen K, Kristjansdottir B, Sundfeldt K. Evaluation of ovarian cancer biomarkers HE4 and CA-125 in women presenting with a suspicious cystic ovarian mass. J Gynecol Oncol 2011;22:244–52.
- Bast RC Jr, Skates S, Lokshin A, Moore RG. Differential diagnosis of a pelvic mass: improved algorithms and novel biomarkers. Int J Gynecol Cancer 2012; 22 Suppl 1:S5.
Öz
Objective: Ovarian cancer is the seventh leading cancer in women. Tests having high sensitivity and specificity in the discrimination of malignancy in patients with adnexal mass help to reach a diagnosis without increasing morbidity from false positive results. The aim of this study was to compare the predictive value of the Risk of Malignancy Index RMI calculated using Human Epididymis Protein 4 HE4 with that of RMI incorporating CA 125 in differentiating benign from malignant adnexal mass.Material and Methods: This prospective study included 78 patients who were treated between February and October 2015. RMI was calculated separately with CA 125 and HE4. Their predictive values in discriminating malignancy in adnexal mass were compared between patients with Epithelial Ovarian cancer EOC and benign cysts.Results: There was no statistically significant difference in HE4 levels between patients diagnosed with benign cyst and EOC p=0.24 . RMICA 125 and RMI-HE4 displayed a statistically significant predictive value in the diagnosis of malignancy and the predictive value of RMI-CA 125 was significantly higher than that of RMI-HE4.Conclusion: The specificity of RMI in discriminating adnexal masses in previous studies suggested that RMI calculated using HE4 values instead of CA 125 could improve diagnostic performance. However, no difference was noted in HE4 values between the two groups. The RMI-HE4 values were statistically significantly higher in malignant tumor group when compared to the benign cyst group yet were not superior to the original RMI. Increasing the number of patients in both groups should enable better comparison of tests between tumors with different etiologies
Anahtar Kelimeler
Ovarian cancer - Risk of malignancy index - Human epididymis protein 4
Kaynakça
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Je- mal A. Global cancer statistics 2018: GLOBOCAN estima- tes of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.
- Barnholtz-Sloan JS, Schwartz AG, Qureshi F, et al. Ovarian cancer: changes in patterns at diagnosis and relative survi- val over the last three decades. Am J Obstet Gynecol 2003; 189:1120.
- Drapkin R, von Horsten HH, Lin Y, et al. Human epididy- mis protein 4 (HE4) is a secreted glycoprotein that is ove- rexpressed by serous and endometrioid ovarian carcino- mas. Cancer Res 2005;65:2162–9.
- Moore RG, Miller MC, Steinhoff MM, et al. Serum HE4 levels are less frequently elevated than CA-125 in women with benign gynecologic disorders. Am J Obstet Gynecol 2012;206:351 e1–351 e8.
- Prat J; FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and pe- ritoneum. Int J Gynecol Obstet 2014;124:1-5.
- Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990; 97:922.
- Enakpene CA, Omigbodun AO, Goecke TW, Odukogbe AT, Beckmann MW. Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malig- nancy index. J Obstet Gynaecol Res 2009;35:131–8.
- Johnson CC, Kessel B, Riley TL et al. The epidemiology of CA 125 in women without evidence of ovarian cancer in the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial. Gynecol Oncol 2008;110:3839.
- Lowe KA, Shah C, Wallace E et al. Effects of personal cha- racteristics on serum CA 125, mesothelin, and HE4 levels in healthy postmenopausal women at high-risk for ovarian cancer. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Rese- arch, cosponsored by the American Society of Preventive Oncology 2008;17:24807.
- Myers ER, Bastian LA, Havrilesky LJ, et al. Management of Adnexal Mass. Evidence Report/Technology Assessment No.130 (Prepared by the Duke Evidence-based Practice Center under Contract No. 290-02-0025). AHRQ Publi- cation No. 06-E004, Agency for Healthcare Research and Quality, Rockville, MD February 2006.
- Bozkurt M, Yumru AE, Aral I. Evaluation of the importance of the serum levels of CA-125, CA15-3, CA-19-9, carcino- embryonic antigen and alpha fetoprotein for distinguishing benign and malignant adnexal masses and contribution of different test combinations to diagnostic accuracy. Eur J Gynaecol Oncol 2013;34:540-4.
- Sen S, Kuru O, Akbayır O, Oğuz H, Yasasever V, Berkman S. Determination of serum CRP, VEGF, Leptin, CK-MB, CA- 15-3 and IL-6 levels for malignancy prediction in adnexal masses.J Turk Ger Gynecol Assoc 2011;12:214-9.
- Partheen K, Kristjansdottir B, Sundfeldt K. Evaluation of ovarian cancer biomarkers HE4 and CA-125 in women presenting with a suspicious cystic ovarian mass. J Gynecol Oncol 2011;22:244–52.
- Bast RC Jr, Skates S, Lokshin A, Moore RG. Differential diagnosis of a pelvic mass: improved algorithms and novel biomarkers. Int J Gynecol Cancer 2012; 22 Suppl 1:S5.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Original Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2019 Cilt: 29 Sayı: 3 |
Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.