Symptom-Based Score, CA۱۲۵, and HE۴ for Prediction of Ovarian Cancer in Iranian Women with Adnexal Mass

Background & Objective: Ovarian cancer is a leading cause of gynecologic cancer mortality. Differentiating benign from malignant adnexal masses remains a key clinical challenge. This study was conducted with aim to evaluate a symptom-based score, CA۱۲۵, and HE۴, both individually and combined, for diagnosing ovarian cancer in Iranian women. Materials & Methods: This prospective analytical study was conducted in ۲۰۲۴ at Imam Hossein Hospital in Tehran. A total of ۸۴ women with adnexal masses confirmed by MRI and scheduled for surgery were enrolled. Preoperative symptom scores and serum CA۱۲۵ and HE۴ were measured. Pathological diagnosis was the gold standard. Predictive power was assessed using logistic regression and diagnostic performance metrics (sensitivity, specificity, AUC). Data analysis was performed using Stata (version ۱۷.) P<۰.۰۵ was considered statistically significant. Results: Of the ۸۴ participants, ۳۱(۳۶.۹%) had malignant tumors, ۸(۹.۵%) borderline, and ۴۵(۵۳.۶%) benign tumors. The malignant group was significantly older and had significantly higher levels of CA۱۲۵, HE۴, and symptom scores (P<۰.۰۰۱ for all biomarkers and score). In the combined multivariate model, only the symptom score remained an independent significant predictor (OR: ۱.۶۲, ۹۵% CI: ۱.۲۴-۲.۱۳). The combined model achieved the highest discriminative ability (AUC: ۰.۹۷۱). The symptom score alone demonstrated the most balanced diagnostic profile with ۸۳.۸۷% sensitivity, ۹۲.۴۵% specificity, ۹۰.۷۴% NPV, and ۸۹.۲۹% accuracy. Conclusion: The symptom-based score demonstrated superior individual predictive performance for ovarian cancer compared to CA۱۲۵ or HE۴ alone. Although the three-marker combination yielded the highest discriminative power, the symptom score offered an optimal balance of high sensitivity and accuracy for practical clinical use.

کلیدواژه ها:

Ovarian Cancer ، Symptom Score ، CA۱۲۵ ، HE۴ ، Adnexal mass ، Diagnosis