A multicenter clinical trial validating the performance of HE4, CA125, risk of ovarian malignancy algorithm and risk of malignancy index

High throughput proteomics identifies a high-accuracy 11 plasma protein biomarker signature for ovarian cancer

Ovarian cancer is usually detected at a late stage and the overall 5-year survival is only 30-40%. Additional means for early detection and improved diagnosis are acutely needed. To search for novel biomarkers, we compared circulating plasma levels of 593 proteins in three cohorts of patients with ovarian cancer and benign tumors, using the proximity extension assay (PEA). A combinatorial strategy was developed for identification of different multivariate biomarker signatures. A final model consisting of 11 biomarkers plus age was developed into a multiplex PEA test reporting in absolute concentrations. The final model was evaluated in a fourth independent cohort and has an AUC = 0.94, PPV = 0.92, sensitivity = 0.85 and specificity = 0.93 for detection of ovarian cancer stages I-IV. The novel plasma protein signature could be used to improve the diagnosis of women with adnexal ovarian mass or in screening to identify women that should be referred to specialized examination.

Clinical value of ROMA index in diagnosis of ovarian cancer: meta-analysis

Objectives

The role of retrospective analysis has evolved greatly in cancer research. We undertook this network meta-analysis to evaluate retrospectively the diagnostic value of ROMA in ovarian cancer.

Materials and methods

We systematically retrieved 56 relevant articles published about ROMA index from 2009–2018 and about ovarian cancer from China National Knowledge Infrastructure (CNKI), PubMed and EMBASE. Data were comprehensively analyzed by Rev-Man 5.3 and MetaDisc 12.4 software.

Results

Data of 5,954 cases were retrieved from 23 literatures. Among them, 2,117 cases were in the ovarian cancer group and 3,837 cases in the control group. The pooled estimates for the ROMA index were sensitivity: 0.90 (95% CI: 0.88–0.93), specificity: 0.91 (95% CI: 0.89–0.94), positive predictive: 0.90 (95% CI: 0.88–0.95), negative predictive: 0.93 (95% CI: 0.91–0.95), and area under ROC curve: 0.96, compared to 0.71 (95% CI: 0.56–0.82), 0.87 (95% CI: 0.80–0.92), 0.82 (95% CI: 0.78–0.86), 0.92 (95% CI: 0.90–0.94), and 0.88 of HE4, respectively.

Conclusions

This meta-analysis confirms that the risk of ovarian malignancy algorithm can facilitate the diagnosis of ovarian cancer to some extent.

Quantitative assessment of serum heat shock protein 27 for the diagnosis of epithelial ovarian cancer using targeted proteomics coupled with immunoaffinity enrichment

BACKGROUND

Heat shock protein 27 (HSP27) may take part in the epithelial ovarian cancer (EOC) malignant process because it is elevated in the serum of EOC patients, suggesting that HSP27 may serve as an EOC biomarker to complement the standard serum carbohydrate antigen 125 (CA125) test. Thus, accurate quantification of serum HSP27 would assist the diagnosis of EOC.

METHODS

Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based targeted proteomics coupled with an immunoaffinity enrichment assay was developed and validated to monitor HSP27 concentrations in serum.

RESULTS

Tryptic peptide 80QLSSGVSEIR89 was selected as a surrogate analyte for quantification, and an immuno-depleted serum extract was used as a surrogate matrix. Immunoaffinity enrichment was effective for protein enrichment and sensitivity enhancement, and the resulting LOQ was 500 pg/ml (>10-fold increase). Then, serum HSP27 concentrations in EOC patients, benign ovarian tumors patients and healthy volunteers were accurately determined to be 4.95 ± 0.37 ng/ml, 2.98 ± 0.16 ng/ml and 2.82 ± 0.15 ng/ml, respectively, suggesting that the EOC samples had significantly higher concentrations of HSP27 than a sample from benign ovarian tumor patients. The experimental values for the samples were compared with those obtained from enzyme-linked immune sorbent assays (ELISAs). The ROC curve analysis showed that the combined area under the curve (AUC) for CA125 and HSP27 was 0.88, which is significantly superior to that of CA125 alone.

CONCLUSIONS

Targeted proteomics coupled with immunoaffinity enrichment may provide more accurate quantification of low-abundant proteins.

Diagnostic value of the gynecology imaging reporting and data system (GI-RADS) with the ovarian malignancy marker CA-125 in preoperative adnexal tumor assessment

Objectives

The purpose of this study is to assess the preoperative evaluation of an adnexal mass using the GI-RADS classification and to verify whether CA-125 measurement can offer any additional benefits to the GI-RADS-based prediction of ovarian tumor malignancy.

Material and methods

In this study, we assessed a total of 215 women with an adnexal tumor using the GI-RADS classification combined with CA-125 measurement. All adnexal masses underwent histological verification.

Results

Of a total of 215 lesions, we classified 2 lesions as GI-RADS 2 (0.9%), 118 lesions as GI-RADS 3 (54.9%), 86 lesions as GI-RADS 4 (40.0%) and 9 lesions as GI-RADS 5 (4.2%). For GI-RADS 4–5 lesions, the sensitivity, specificity, PPV, NPV, ACC and OR were as follows: 94.3, 72.2, 52.6, 97.5, 77.7%, and 43.3 (CI 12.0–146), respectively. The corresponding parameters resulting from combining the GI-RADS classification with the CA-125 marker were as follows: 66.0, 93.8, 77.8, 89.4, 87.0%, and 29.6 (CI 12.6–69.6), respectively, with p < 0.001. For Ca-125 > 30 IU/mL alone, the results were as follows: 70.0, 80.3, 53.8, 89.1, 77.7%, and 9.5 (4.6–19.6), respectively, with p < 0.0001.

Additionally, 47.8% of the patients had no symptoms, 36.5% had back pain, 5.2% had an increased abdominal size, 4.3% had menstrual irregularities and 2.6% had constipation. There were 152 benign and 18 malignant cases in the low risk group (GIRADS 1–3 and GIRADS 4 + CA-125 < 30 IU/mL) and 10 benign and 35 malignant tumors in the high-risk group (GIRADS 4 + CA125 > 30 IU/mL and GIRADS 5).

Conclusions

GI-RADS classification had good performance in discriminating ovarian tumors. The additional measurement of CA-125 improves the system specificity, PPV and ACC for preoperative adnexal tumor assessment.