Construction and verification of preoperative malignant risk diagnostic model for ovarian tumors_West China Medical Journal

Authors：

WANG Lu , LI Junmei ,  MAO Xiguang

School of Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

MAO Xiguang, Email: mxg6639@163.com

Keywords：

Ovarian tumor; test index; logistic regression; diagnostic model

DOI：

10.7507/1002-0179.202312198

Video：

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Objective To construct and verify the diagnostic model of preoperative malignant risk of ovarian tumors, so as to improve the diagnostic efficiency of existing test indexes. Methods The related serological indicators and clinical data of patients with ovarian tumors confirmed by pathology who were treated in the Affiliated Hospital of Southwest Medical University between January 2019 and September 2023 were retrospectively collected, and the patients were randomly divided into a training set and a verification set at a 7∶3 ratio. Logistic regression was used to construct a diagnostic model in the training set, and the diagnostic efficacy of the model was verified through discrimination, calibration, clinical benefit, and clinical applicability evaluation. Results A total of 929 patients with ovarian tumors were included, including 318 cases of malignant ovarian tumors and 611 cases of benign ovarian tumors. The patients were randomly divided into a training set of 658 cases and a validation set of 271 cases. A diagnostic model was constructed using logistic regression in the training set, containing 5 factors namely age, percentage of neutrophil (NEU%), fibrinogen to albumin ratio (FAR), carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4): modelUAM=−3.211+0.667×age+2.966×CA125+0.792×FAR+1.637×HE4+0.533×NEU%, with a Hosmer-Lemeshow test P-value of 0.21. The area under the receiver operating characteristic (ROC) curve measured in the training set was 0.927 [95% confidence interval (0.903, 0.951)], the sensitivity was 0.947, and the specificity was 0.780. The area under the ROC curve of the validation set was 0.888 [95% confidence interval (0.840, 0.930)], the sensitivity was 0.744, and the specificity was 0.901. Conclusion A new quantitative tool based on age, NEU%, FAR, CA125 and HE4 can be used for the clinical diagnosis of ovarian malignant tumors, and it is helpful to improve the diagnostic efficiency and is worth popularizing.

Citation： WANG Lu, LI Junmei, MAO Xiguang. Construction and verification of preoperative malignant risk diagnostic model for ovarian tumors. West China Medical Journal, 2024, 39(9): 1419-1426. doi: 10.7507/1002-0179.202312198 Copy

1.	郑荣寿, 张思维, 孙可欣, 等. 2016 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2023, 45(3): 212-220.
2.	中国抗癌协会妇科肿瘤专业委员会. 卵巢恶性肿瘤诊断与治疗指南(2021 年版). 中国癌症杂志, 2021, 31(6): 490-500.
3.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4.	Rosendahl M, Høgdall CK, Mosgaard BJ. Restaging and survival analysis of 4036 ovarian cancer patients according to the 2013 FIGO classification for ovarian, fallopian tube, and primary peritoneal cancer. Int J Gynecol Cancer, 2016, 26(4): 680-687.
5.	周昌明, 王泽洲, 郑莹. 2023 年美国癌症数据解读及对中国癌症防治的启示. 中国癌症杂志, 2023, 33(2): 117-125.
6.	张杰克, 万少晖, 崔丽娟. 血清 AFP、CEA、CA19-9、CA125、HE4 水平联合检测在卵巢癌诊断中的应用价值. 中国民康医学, 2023, 35(21): 113-116.
7.	Ray-Coquard I, Pautier P, Pig-ta S, et al. Olaparib plus bevacizumab as first-line mainte-nce in ovarian cancer. N Engl J Med, 2019, 381(25): 2416-2428.
8.	Matsas A, Stefanoudakis D, Troupis T, et al. Tumor markers and their diagnostic significance in ovarian cancer. Life, 2023, 13(8): 1689.
9.	Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow?. Lancet, 2001, 357(9225): 539-545.
10.	Zhang CL, Jiang XC, Li Y, et al. Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR. J Ovarian Res, 2023, 16(1): 36.
11.	申国旗, 王琳升, 张旭东, 等. 系统性免疫炎症指数和 N 末端 B 型钠尿肽前体对老年患者对比剂急性肾损伤的预测价值. 中华老年心脑血管病杂志, 2024, 26(1): 25-29.
12.	Stewart C, Ralyea C, Lockwood S. Ovarian cancer: an integrated review. Semin Oncol Nurs, 2019, 35(2): 151-156.
13.	赵斌, 南媛, 郝妮娜, 等. 1999-2018 年间女性恶性肿瘤住院患者病例资料回顾性研究. 中国生育健康杂志, 2020, 31(4): 353-357.
14.	Warren JL, Harlan LC, Trimble EL, et al. Trends in the recepit of guideline care and survival for women with ovarian cancer: a population-based study. Gynecol Oncol, 2017, 145(3): 486-492.
15.	王璐, 韩世愈. 卵巢癌液体活检技术研究进展. 医学综述, 2022, 28(10): 1935-1940.
16.	Bast RC Jr, Feeney M, lazarus H, et al. Reactivity of a monoclonaln antibody with human ovarian carcinoma. J Clin Invest, 1981, 68(5): 1331.
17.	王一品, 赫东芸, 黄琼卫, 等. 卵巢癌风险预测模型在上皮性卵巢癌早期诊断中的应用价值. 吉林大学学报(医学版), 2019, 45(4): 905-910.
18.	Shin KH, Kim HH, Kwon BS, et al. Clinical usefulness of cancer antigen (CA) 125, human epididymis 4, and CA72-4 levels and risk of ovarian malignancy algorithm values for diagnosing ovarian tumors in Korean patients with and without endometriosis. Ann Lab Med, 2020, 40(1): 40-47.
19.	Wang H, Liu P, Xu H, et al. Early diagonosis of ovarian cancer: serum HE4, CA125 and ROMA model. Am J Transl Res, 2021, 13(12): 14141-14148.
20.	Özcan-Ekşi EE, Berikol G, Ekşi MŞ. Potential blood markers as screening tools for subjects with low back pain: an age- and gender-matched cross-sectional analysis. Curr Med Res Opin, 2024, 40(1): 77-85.
21.	Cheng G, Wang M, Sun H, et al. Age at menopause is inversely related to the prevalence of common gynecologic cancers: a study based on NHANES. Front Endocrinol (Lausanne), 2023, 14: 1218045.
22.	Lheureux S, Braunstein M, Oza AM. Epithelial ovarian cancer: evolution of management in the era of precision medicine. CA Cancer J Clin, 2019, 69(4): 280-304.
23.	Chlorogiannis DD, Pargaonkar S, Papanagiotou P, et al. Inflammation, anti-inflammatory agents, and the role of colchicine in carotid artery stenosis. Vasa, 2024, 53(1): 4-12.
24.	Yue Y, Liu Y, Lin Y, et al. A carboxymethyl chitosan/oxidized hyaluronic acid composite hydrogel dressing loading with stem cell exosome for chronic inflammation wounds healing. Int J Biol Macromol, 2024, 257(Pt 1): 128534.
25.	Tisler A, Uusküla A, Ojavee SE, et al. Polygenic risk scores for cervical HPV infection, neoplasia and cancer show potential for personalised screening: comparison of two methods. Infect Agent Cancer, 2023, 18(1): 82.
26.	Abdol Razak N, Elaskalani O, Metharom P. Pancreatic cancer-induced neutrophil extracellular traps: a potential contributor to cancer-associated thrombosis. Int J Mol Sci, 2017, 18(3): 487.
27.	Lee W, Ko SY, Mohamed MS, et al. Neutrophils facilitate ovarian cancer premetastatic niche formation in the omentum. J Exp Med, 2019, 216(1): 176-194.
28.	Cao W, Zhu MY, Lee SH, et al. Modulation of cellular NAD+attenuates cancer-associated hypercoagulability and thrombosis via the inhibition of tissue factor and formation of neutrophil extracellular traps. Int J Mol Sci, 2021, 22(21): 12085.
29.	Yang LY, Luo Q, Lu L, et al. Increased neutrophil extracellular traps promote metastasis potential of hepatocellular carcinoma via provoking tumorous inflammatory response. J Hematol Oncol, 2020, 13(1): 3.
30.	Yu W, Ye Z, Fang X, et al. Preoperative albumin-to-fibrinogen ratio predicts chemotherapy resistance and prognosis in patients with advanced epithelial ovarian cancer. J Ovarian Res, 2019, 12(1): 88.
31.	樊宁波, 陈冬妮, 温浙盛, 等. 术前血浆白蛋白与纤维蛋白原比值对食管鳞癌根治术后生存的预测价值. 中华消化外科杂志, 2019, 18(6): 563-569.
32.	张维维, 张正伟, 何朗. 342 例卵巢癌手术患者预后影响因素分析. 中华肿瘤防治杂志, 2019, 26(17): 1288-1295.

1. 郑荣寿, 张思维, 孙可欣, 等. 2016 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2023, 45(3): 212-220.
2. 中国抗癌协会妇科肿瘤专业委员会. 卵巢恶性肿瘤诊断与治疗指南(2021 年版). 中国癌症杂志, 2021, 31(6): 490-500.
3. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4. Rosendahl M, Høgdall CK, Mosgaard BJ. Restaging and survival analysis of 4036 ovarian cancer patients according to the 2013 FIGO classification for ovarian, fallopian tube, and primary peritoneal cancer. Int J Gynecol Cancer, 2016, 26(4): 680-687.
5. 周昌明, 王泽洲, 郑莹. 2023 年美国癌症数据解读及对中国癌症防治的启示. 中国癌症杂志, 2023, 33(2): 117-125.
6. 张杰克, 万少晖, 崔丽娟. 血清 AFP、CEA、CA19-9、CA125、HE4 水平联合检测在卵巢癌诊断中的应用价值. 中国民康医学, 2023, 35(21): 113-116.
7. Ray-Coquard I, Pautier P, Pig-ta S, et al. Olaparib plus bevacizumab as first-line mainte-nce in ovarian cancer. N Engl J Med, 2019, 381(25): 2416-2428.
8. Matsas A, Stefanoudakis D, Troupis T, et al. Tumor markers and their diagnostic significance in ovarian cancer. Life, 2023, 13(8): 1689.
9. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow?. Lancet, 2001, 357(9225): 539-545.
10. Zhang CL, Jiang XC, Li Y, et al. Independent predictive value of blood inflammatory composite markers in ovarian cancer: recent clinical evidence and perspective focusing on NLR and PLR. J Ovarian Res, 2023, 16(1): 36.
11. 申国旗, 王琳升, 张旭东, 等. 系统性免疫炎症指数和 N 末端 B 型钠尿肽前体对老年患者对比剂急性肾损伤的预测价值. 中华老年心脑血管病杂志, 2024, 26(1): 25-29.
12. Stewart C, Ralyea C, Lockwood S. Ovarian cancer: an integrated review. Semin Oncol Nurs, 2019, 35(2): 151-156.
13. 赵斌, 南媛, 郝妮娜, 等. 1999-2018 年间女性恶性肿瘤住院患者病例资料回顾性研究. 中国生育健康杂志, 2020, 31(4): 353-357.
14. Warren JL, Harlan LC, Trimble EL, et al. Trends in the recepit of guideline care and survival for women with ovarian cancer: a population-based study. Gynecol Oncol, 2017, 145(3): 486-492.
15. 王璐, 韩世愈. 卵巢癌液体活检技术研究进展. 医学综述, 2022, 28(10): 1935-1940.
16. Bast RC Jr, Feeney M, lazarus H, et al. Reactivity of a monoclonaln antibody with human ovarian carcinoma. J Clin Invest, 1981, 68(5): 1331.
17. 王一品, 赫东芸, 黄琼卫, 等. 卵巢癌风险预测模型在上皮性卵巢癌早期诊断中的应用价值. 吉林大学学报(医学版), 2019, 45(4): 905-910.
18. Shin KH, Kim HH, Kwon BS, et al. Clinical usefulness of cancer antigen (CA) 125, human epididymis 4, and CA72-4 levels and risk of ovarian malignancy algorithm values for diagnosing ovarian tumors in Korean patients with and without endometriosis. Ann Lab Med, 2020, 40(1): 40-47.
19. Wang H, Liu P, Xu H, et al. Early diagonosis of ovarian cancer: serum HE4, CA125 and ROMA model. Am J Transl Res, 2021, 13(12): 14141-14148.
20. Özcan-Ekşi EE, Berikol G, Ekşi MŞ. Potential blood markers as screening tools for subjects with low back pain: an age- and gender-matched cross-sectional analysis. Curr Med Res Opin, 2024, 40(1): 77-85.
21. Cheng G, Wang M, Sun H, et al. Age at menopause is inversely related to the prevalence of common gynecologic cancers: a study based on NHANES. Front Endocrinol (Lausanne), 2023, 14: 1218045.
22. Lheureux S, Braunstein M, Oza AM. Epithelial ovarian cancer: evolution of management in the era of precision medicine. CA Cancer J Clin, 2019, 69(4): 280-304.
23. Chlorogiannis DD, Pargaonkar S, Papanagiotou P, et al. Inflammation, anti-inflammatory agents, and the role of colchicine in carotid artery stenosis. Vasa, 2024, 53(1): 4-12.
24. Yue Y, Liu Y, Lin Y, et al. A carboxymethyl chitosan/oxidized hyaluronic acid composite hydrogel dressing loading with stem cell exosome for chronic inflammation wounds healing. Int J Biol Macromol, 2024, 257(Pt 1): 128534.
25. Tisler A, Uusküla A, Ojavee SE, et al. Polygenic risk scores for cervical HPV infection, neoplasia and cancer show potential for personalised screening: comparison of two methods. Infect Agent Cancer, 2023, 18(1): 82.
26. Abdol Razak N, Elaskalani O, Metharom P. Pancreatic cancer-induced neutrophil extracellular traps: a potential contributor to cancer-associated thrombosis. Int J Mol Sci, 2017, 18(3): 487.
27. Lee W, Ko SY, Mohamed MS, et al. Neutrophils facilitate ovarian cancer premetastatic niche formation in the omentum. J Exp Med, 2019, 216(1): 176-194.
28. Cao W, Zhu MY, Lee SH, et al. Modulation of cellular NAD+attenuates cancer-associated hypercoagulability and thrombosis via the inhibition of tissue factor and formation of neutrophil extracellular traps. Int J Mol Sci, 2021, 22(21): 12085.
29. Yang LY, Luo Q, Lu L, et al. Increased neutrophil extracellular traps promote metastasis potential of hepatocellular carcinoma via provoking tumorous inflammatory response. J Hematol Oncol, 2020, 13(1): 3.
30. Yu W, Ye Z, Fang X, et al. Preoperative albumin-to-fibrinogen ratio predicts chemotherapy resistance and prognosis in patients with advanced epithelial ovarian cancer. J Ovarian Res, 2019, 12(1): 88.
31. 樊宁波, 陈冬妮, 温浙盛, 等. 术前血浆白蛋白与纤维蛋白原比值对食管鳞癌根治术后生存的预测价值. 中华消化外科杂志, 2019, 18(6): 563-569.
32. 张维维, 张正伟, 何朗. 342 例卵巢癌手术患者预后影响因素分析. 中华肿瘤防治杂志, 2019, 26(17): 1288-1295.

West China Medical Journal

Construction and verification of preoperative malignant risk diagnostic model for ovarian tumors

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