Assessment of the efficacy of use of new serum markers as a panel, whi̇ch are presented as candidates for the diagnosis of ovarian cancer

Despite improvements in treatments, ovarian cancer is still the most fatal one among the gynecologic cancers in developed countries. 90% of ovarian cancers consist of epithelium-originated tumors. When the ovarian cancer is early diagnosed, 5-year survival is more than 90%. However, the most cases are diagnosed as advanced stages, since there is no disease-specific symptoms and no reliable method that will allow an early diagnosis. Another issue which is important as much as early diagnosis is to be able to differentiate benign from malignant ovarian tumors in patients with adnexial mass, and to ensure the referral of patients with high-risk of malignity to the tertiary care centers which have been specialized in the treatment of ovarian cancer. Currently, methods which are most frequently used for detection of epithelial ovarian cancer and for differentiation of adnexial masses are ultrasonography and measurement of serum CA125 level. However, the sensitivity and specificity of these methods are limited for the diagnosis of ovarian cancer. Therefore, the studies have been focused on non-invasive and relatively inexpensive markers which are established through quantitative measurements and which will ensure repeatability and consistency between the centers. As a result, a great number of potential markers have been defined. The objective of this study is to elucidate the utility of a panel of markers which consists of HE4, YKL-40, Mesothelin, LyGDI and CA125 in diagnosis of epithelial ovarian cancer and in differentiation of benign ovarian tumors from epithelial ovarian cancers. It was aimed to evaluate the validity of each marker and several combinations of markers according to pathological diagnosis, to compare them with CA125, and to investigate the association of these markers with menopausal status, histological type and stage. In present study, 31 patients with epithelial ovarian cancer, 30 patients with benign ovarian tumors and 32 healthy women were included. In serum samples which were obtained preoperatively, the levels of HE4, YKL-40, Mesothelin and LyGDI were determined by ELISA, while the levels of CA125 were determined by electrochemiluminescence immunoassay. Regarding each marker and several marker combinations, the diagnostic performances were evaluated by estimating the logistic regression models. The median values of all markers showed significant differences between benign vs. malignant and healthy vs. malignant groups. Markers, except CA125 and HE4, showed no significant differences between healthy vs. benign groups. All markers, except LyGDI, were determined to have ability to differentiate between benign and malignant cases, as well as between healthy and malignant cases. Regarding the differentiation between benign and malignant cases, the panel of markers including CA125, HE4, Mesothelin and YKL-40 showed a sensitivity of 93,6% which is higher than all other markers and combinations of markers, at the specificity level of 95%. The panel of markers including CA125, HE4, Mesothelin, YKL-40 is a successful panel which has been tested for the first time, and deserves to be further investigated.