Comparison of plasma amino acid profile-based index and CA125 in the diagnosis of epithelial ovarian cancers and borderline malignant tumors

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The amino acid profile-based index (API) showed comparable diagnostic accuracy to CA125 for distinguishing malignant/borderline ovarian tumors from benign growths, but was superior in differentiating from endometriotic cysts.

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The study compared a plasma amino acid profile-based index (API) with serum CA125 for distinguishing epithelial ovarian malignant tumors and borderline malignant tumors from benign tumors, using preoperative plasma/serum samples from 59 epithelial ovarian cancers, 21 borderline tumors, and 97 benign tumors that included 40 endometriotic cysts. API and CA125 diagnostic accuracy were evaluated with ROC curves and predefined cutoff performance. API and CA125 had equivalent ROC performance for discriminating malignant/borderline malignant from benign tumors (both AUC 0.77), but API was better than CA125 for separating malignant/borderline lesions from endometriotic cysts (AUC 0.75 vs. 0.59). A stated limitation is that prospective validation using the study-determined API cutoff is needed to confirm practical clinical utility. Relevance to endometriosis: the benign comparison group explicitly included endometriotic cysts, and API showed significantly lower detection of benign endometriotic cysts than CA125 (0.35 vs. 0.65), though the paper’s main focus is ovarian cancer and borderline tumor diagnosis.

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Abstract

BackgroundWe previously developed a new plasma amino acid profile-based index (API) to detect ovarian, cervical, and endometrial cancers. Here, we compared API to serum cancer antigen 125 (CA125) for distinguishing epithelial ovarian malignant tumors from benign growths.MethodsAPI and CA125 were measured preoperatively in patients with ovarian tumors, which were later classified into 59 epithelial ovarian cancers, 21 epithelial borderline malignant tumors, and 97 benign tumors including 40 endometriotic cysts. The diagnostic accuracy and cutoff points of API were evaluated using receiver operating characteristic (ROC) curves.ResultsThe area under the ROC curves showed the equivalent performance of API and CA125 to discriminate between malignant/borderline malignant and benign tumors (both 0.77), and API was superior to CA125 for discrimination between malignant/borderline malignant lesions and endometriotic cysts (API, 0.75 vs. CA125, 0.59; p < 0.05). At the API cutoff level of 6.0, API and CA125 had equal positive rates of detecting cancers and borderline malignancies (API, 0.71 vs. CA125, 0.74; p = 0.84) or cancers alone (API, 0.73 vs. CA125, 0.85; p = 0.12). However, API had a significantly lower detection rate of benign endometriotic cysts (0.35; 95 % CI, 0.21-0.52) compared with that of CA125 (0.65; 95 % CI, 0.48-0.79) (p < 0.05).ConclusionsAPI is an effective new tumor marker to detect ovarian cancers and borderline malignancies with a low false-positive rate for endometriosis. A large-scale prospective clinical study using the cutoff value of API determined in this study is warranted to validate API for practical clinical use.
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Abstract

Background We previously developed a new plasma amino acid profile-based index (API) to detect ovarian, cervical, and endometrial cancers. Here, we compared API to serum cancer antigen 125 (CA125) for distinguishing epithelial ovarian malignant tumors from benign growths.

Methods

API and CA125 were measured preoperatively in patients with ovarian tumors, which were later classified into 59 epithelial ovarian cancers, 21 epithelial borderline malignant tumors, and 97 benign tumors including 40 endometriotic cysts. The diagnostic accuracy and cutoff points of API were evaluated using receiver operating characteristic (ROC) curves.

Results

The area under the ROC curves showed the equivalent performance of API and CA125 to discriminate between malignant/borderline malignant and benign tumors (both 0.77), and API was superior to CA125 for discrimination between malignant/borderline malignant lesions and endometriotic cysts (API, 0.75 vs. CA125, 0.59; p < 0.05). At the API cutoff level of 6.0, API and CA125 had equal positive rates of detecting cancers and borderline malignancies (API, 0.71 vs. CA125, 0.74; p = 0.84) or cancers alone (API, 0.73 vs. CA125, 0.85; p = 0.12). However, API had a significantly lower detection rate of benign endometriotic cysts (0.35; 95 % CI, 0.21–0.52) compared with that of CA125 (0.65; 95 % CI, 0.48–0.79) (p < 0.05).

Conclusions

API is an effective new tumor marker to detect ovarian cancers and borderline malignancies with a low false-positive rate for endometriosis. A large-scale prospective clinical study using the cutoff value of API determined in this study is warranted to validate API for practical clinical use. Access this article We’re sorry, something doesn't seem to be working properly. Please try refreshing the page. If that doesn't work, please contact support so we can address the problem. Similar content being viewed by others

References

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Lancet 10022:945–956 Haruta S, Furukawa N, Yoshizawa Y et al (2011) Molecular genetics and epidemiology of epithelial ovarian cancer. Oncol Rep 26:1347–1356 Acknowledgments The authors thank Mae Inada and Atsuko Fukui for their skilled technical assistance; Hiroshi Miyano, Hiroo Yoshida, and Naoko Kageyama for conducting amino acid analyses; Mai Yamamoto for data management; and Mariko Takasu for her patience in coordinating this study. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest Etsuko Miyagi has no conflict of interest; Yasuyo Maruyama has no conflict of interest; Tae Mogami has no conflict of interest; Reiko Numazaki has no conflict of interest; Atsuko Ikeda serves as an employee of Ajinomoto Co., Inc.; Hiroshi Yamamoto serves as an employee to Ajinomoto Co., Inc.; Fumiki Hirahara has no conflict of interest. Additional information E. Miyagi and Y. Maruyama contributed equally to this study. About this article Cite this article Miyagi, E., Maruyama, Y., Mogami, T. et al. Comparison of plasma amino acid profile-based index and CA125 in the diagnosis of epithelial ovarian cancers and borderline malignant tumors. Int J Clin Oncol 22, 118–125 (2017). https://doi.org/10.1007/s10147-016-1035-4 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s10147-016-1035-4

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Condition tags

endometriosis

MeSH descriptors

Amino Acids CA-125 Antigen Endometriosis Neoplasms, Glandular and Epithelial Neoplasms, Glandular and Epithelial Ovarian Cysts Ovarian Neoplasms Ovarian Neoplasms Adolescent Adult Aged Aged, 80 and over Amino Acids Area Under Curve CA-125 Antigen Carcinoma, Ovarian Epithelial Endometriosis Endometriosis Endometriosis Female

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