Prediction of Epithelial Ovarian Cancer in Low Resource-Setting Countries: Single or Combined Biomarkers?

Purpose To compare the accuracy of using single biomarker, dual biomarkers or triple biomarkers for prediction of ovarian cancer patients with considering the economic burden of each method. Research question What is the most suitable prediction test for epithelial ovarian cancer to be applied for the low resource-setting countries? Methods Fifty-six patients with EOC, forty-two patients with benign ovarian tumor undergoing surgery and ten healthy female as a control were included in the study, and serum values were measured for the following biomarkers: CA125, HE4, and CA72-4. The sensitivity, specificity, and predictive values of single and combined biomarkers were calculated using postoperative histopathology as gold standard test. Results Levels of CA125, HE-4, and CA72-4 were found to be significantly higher in malignant group when compared with benign group ( P < 0.05). CA125 had the highest sensitivity (88 %), while HE4 had the highest specificity (96 %).The prediction of malignancy using both (CA125 and HE4) was significantly better than using HE4 as a predictor ( P = 0.0002) but was not significantly better than using CA125 alone as a predictor ( P = 0.08). No further specificity or sensitivity was added when CA72-4 combined with CA125 and HE4 ( P = 0.08). Conclusion Preoperative testing using the dual (CA125, HE4) or triple (CA125, HE4 and CA72-4) biomarkers was not significantly better than using CA125 alone as a predictor of epithelial ovarian cancer. Although CA125 has lower specificity than HE4, it still can be used alone in low resource-setting countries due to higher sensitivity and lower cost.