The Risk of Ovarian Malignancy Algorithm (ROMA) as a Predictive Marker of Peritoneal Dissemination in Epithelial Ovarian Cancer Patients

Abstract

Background: This study aimed to determine the efficacy of the risk of ovarian malignancy algorithm (ROMA), calculated using the carbohydrate antigen 125 (CA125) and human epididymis protein 4 (HE4) levels and the menopausal status, as a predictor of peritoneal dissemination in ovarian cancer. Methods: The CA125 and HE4 levels and the ROMA were compared between ovarian cancer patients (n = 122) with or without peritoneal dissemination. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and the results were compared with those of computed tomography (CT). Results: The CA125, HE4, and ROMA values differed significantly depending on the presence of peritoneal dissemination (p < 0.0001). The cut-off values were 181 U/ml for CA125, 161 pmol/ml for HE4, 44% for the ROMA (premenopausal), and 86% for the ROMA (postmenopausal). Among these markers, the ROMA (premenopausal) was the strongest predictor of peritoneal dissemination, with a specificity of 85.0% and a positive predictive value of 81.3%. In addition, the detection rates of small disseminations with less than 2 cm in diameter for the ROMA (93%) and HE4 (60%) were superior to that of CT (53%). Conclusions: The ROMA was a significant predictor of peritoneal dissemination and may be superior to CT for the detection of patients with small disseminations.

Modification of cut-off values for HE4, CA125 and the ROMA algorithm for early-stage epithelial ovarian cancer detection: Results from 1021 cases in South China

“…Previous reports on HE4 in the differential diagnosis of pelvic mass included mostly patients with advanced (stage III or IV) ovarian cancer [15][16][17][18]33]. For those patients, tumor markers such as HE4 are of marginal clinical value because the risk of malignancy is easily established by the presence of clinical indicators (omental caking, peritoneal deposits and ascites) alone.…”

“…However, there are conflicting reports regarding the benefit of HE4 and ROMA, with some studies showing that HE4 and ROMA can better predict the likelihood of malignancy than CA125 [15][16][17], while others show no benefit of HE4 and ROMA [18,19]. In addition, it is important to remember that detection of HE4 has been applied in clinical centers in South China for just one and a half years.…”

Modified HE4, CA125, and ROMA cut-off values and predicted probability of ovarian tumor in Chinese patients

“…The risk of ovarian malignancy algorithm (ROMA) combines HE4 with CA125 measurements into an algorithm based upon menopausal status and has been recommend to classify patients with OT as either low-or high-risk (9). Some studies have reported that ROMA yields more accurate predictions of the presence of malignant OTs than either CA125 or HE4 alone (10,11) while others have reported no benefits from using either CA125 or HE4 in calculating OC risk (12). There is controversy in the literature regarding the cut-off values for HE4, CA125, and ROMA in differentiating between benign and malignant OTs (13,14).…”