Nahla El-Attar - Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Lamiaa Kamel - Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Amany Abdelghany - Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Rasha Haggag - Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Heba Taha - Department of Medical Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Entesar Mahdy - Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Nadia Madkour - Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

Background: Risk of ovarian malignancy algorithm (ROMA) combining human epididymis secretory protein ۴ (HE۴) and CA۱۲۵ is a novel score, specific for epithelial ovarian cancer (EOC). Method: Our cohort prospective study aimed to evaluate the role of HE۴ and ROMA score in the diagnosis of EOC. We determined CA۱۲۵ and HE۴ serum levels in ۵۶ premenopausal women with ovarian mass (۳۸ women with benign ovarian mass and ۱۸ women with malignant ovarian mass), ۵۶ postmenopausal women with ovarian mass (۲۰ women with benign ovarian mass and ۳۶ women with malignant ovarian mass), and ۵۶ healthy women as control. Results: Serum CA۱۲۵ and HE۴ and ROMA score were significantly higher among postmenopausal group compared with premenopausal and control groups (P< ۰.۰۰۱), and the median serum CA۱۲۵ and HE۴ and ROMA levels were statistically higher among malignant lesions compared with benign lesions and control group (P< ۰.۰۰۱). The sensitivity and specificity of HE۴ and ROMA vs. CA۱۲۵ in discriminating ovarian cancer from benign ovarian tumor was (۸۸% and ۹۸% vs. ۹۰%) and (۹۷% and ۹۹% vs. ۸۰%), respectively. ROMA had better sensitivity and specificity compared to CA۱۲۵ and HE۴ in premenopausal and postmenopausal women (P <۰.۰۰۱) In premenopausal patients, there was a statistically significant difference regarding the area under the curve (AUC) of ROMA vs. CA۱۲۵ (P=۰.۰۰۴) and ROMA vs. HE۴ (P =۰.۰۲). Conclusion: ROMA score showed a better performance in comparison with either CA۱۲۵ or HE۴ alone in premenopausal patients. HE۴ and ROMA score significantly differentiated early from late stage ovarian cancer.

Ovarian Cancer, Prognosis, ROMA score, CA۱۲۵, HE۴