title: Preoperative HE4 and ROMA values do not improve the CA125 diagnostic value for borderline tumors of the ovary (BOT) - a study of the TOC Consortium.
abstract: BACKGROUND
  Borderline tumors of the ovary (BOT) are a distinct entity of ovarian tumors, characterized by lack of stromal invasion. Recent studies postulated that the presence of invasive implants, incomplete staging, fertility sparing surgery and residual tumor after surgery are major prognostic factors for BOT. There are no biomarkers that can predict BOT or the presence of invasive implants.
  
  
  OBJECTIVE
  The aim of our study was to assess the value of CA125 and HE4 alone, or within ROMA score for detecting BOT, and for predicting the presence of invasive implants.
  
  
  METHODS
  Retrospective, monocentric study on 167 women diagnosed with BOT or benign ovarian masses. Serum HE4, CA125 levels and ROMA were assessed preoperatively. Due to low number of BOT with invasive implants, we performed an unmatched analysis (consecutive patients) and a matched analysis (according to age and histology) to compare BOT with invasive implants, BOT without invasive implants and benign disease.
  
  
  RESULTS
  There were no significant differences in the HE4 and CA125 expressions in the three groups of patients (p = 0.984 and p = 0.141, respectively). The ROC analysis showed that CA125 alone is superior to ROMA and HE4 in discriminating patients with BOT with invasive implants from patients with benign diseases and BOT without invasive implants. A newly established score, ROMABOT, did not perform better than ROMA. The analysis of the matched groups revealed similar results as the analysis of all samples.
  
  
  CONCLUSIONS
  Both HE4 and CA125 are not reliable biomarkers for the diagnosis of BOT or for predicting the presence of invasive implants.
authors.affiliation: Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Elena Ioana
authors.initials: EI
authors.lastname: Braicu
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, The Netherlands.
authors.forename: Toon
authors.initials: T
authors.lastname: Van Gorp
authors.affiliation: Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Mani
authors.initials: M
authors.lastname: Nassir
authors.affiliation: Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Richter
authors.affiliation: Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Radoslav
authors.initials: R
authors.lastname: Chekerov
authors.affiliation: Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Khayal
authors.initials: K
authors.lastname: Gasimli
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital KU Leuven, Herestraat 49, Leuven 3000, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital KU Leuven, Herestraat 49, Leuven 3000, Belgium.
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.affiliation: Department of Gynecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010051:Ovarian Neoplasms / Q000097:blood* / Q000175:diagnosis; D017698:Postmenopause; D057234:Preoperative Period; D011506:Proteins / Q000378:metabolism*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D000081102:WAP Four-Disulfide Core Domain Protein 2; D055815:Young Adult
chemical_list: D018394:CA-125 Antigen; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
keywords: Borderline ovarian tumors; CA125; HE4; Invasive implants; ROMA