The aim of this study was to establish a preoperative model to predict the outcome of primary debulking surgery (PDS) for advanced ovarian cancer (AOC) patients by combing Suidan predictive model with HE4, CA125, CA153 and ROMA index. 76 AOC Patients in revised 2014 International Federation of Gynecology and Obstetrics (FIGO) stage III-IV who underwent PDS between 2017 and 2019 from Yunnan Cancer Hospital were included. Clinical data including the levels of preoperative serum HE4, CA125, CA153 and mid-lower abdominal CT-enhanced scan results were collected. The logistics regression analysis was performed to find factors associated with sub-optimal debulking surgery (SDS). The receiver operating characteristic curve was used to evaluate the predictive performances of selected variables in the outcome of primary debulking surgery. The predictive index value (PIV) model was constructed to predict the outcome of SDS. Optimal surgical cytoreduction was achieved in 61.84% (47/76) patients. The value for CA125, HE4, CA153, ROMA index and Suidan score was lower in optimal debulking surgery (ODS) group than SDS group. Based on the Youden index, which is widely used for evaluating the performance of predictive models, the best cutoff point for the preoperative serum HE4, CA125, CA153, ROMA index and Suidan score to distinguish SDS were 431.55 pmol/l, 2277 KU/L, 57.19 KU/L, 97.525% and 2.5, respectively. Patients with PIV≥5 may not be able to achieve optimal surgical cytoreduction. The diagnostic accuracy, NPV, PPV and specificity for diagnosing SDS were 73.7%, 82.9%, 62.9% and 72.3%, respectively. In the constructed model, the AUC of the SDS prediction was 0.770 (95% confidence interval: 0.654-0.887), P<0.001. Preoperative serum CA153 level is an important non-invasive predictor of primary SDS in advanced AOC, which has not been reported before. The constructed PIV model based on Suidan's predictive model plus HE4, CA125, CA153 and ROMA index can noninvasively predict SDS in AOC patients, the accuracy of this prediction model still needs to be validated in future studies.

中文翻译：

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术前血清 CA153 水平和预测晚期上皮性卵巢癌患者次优初次减瘤手术的新模型

本研究的目的是将 Suidan 预测模型与 HE4、CA125、CA153 和 ROMA 指数相结合，建立术前模型来预测晚期卵巢癌（AOC）患者初次减瘤手术（PDS）的结果。纳入 2017 年至 2019 年间在云南省肿瘤医院接受 PDS 的 76 名 2014 年修订的国际妇产科联合会 (FIGO) III-IV 期 AOC 患者。收集术前血清HE4、CA125、CA153水平及中下腹部CT增强扫描结果等临床资料。进行逻辑回归分析以寻找与次优减瘤手术（SDS）相关的因素。受试者工作特征曲线用于评估所选变量对初次减瘤手术结果的预测性能。构建预测指数值（PIV）模型来预测 SDS 的结果。61.84% (47/76) 的患者获得了最佳的细胞减灭术。最佳减瘤手术（ODS）组的CA125、HE4、CA153、ROMA指数和Suidan评分值均低于SDS组。基于广泛用于评估预测模型性能的Youden指数，术前血清HE4、CA125、CA153、ROMA指数和Suidan评分区分SDS的最佳切点分别为431.55 pmol/l、2277 KU/L 、57.19 KU/L、97.525% 和 2.5。PIV≥5的患者可能无法实现最佳的细胞减灭术。诊断SDS的准确率、NPV、PPV和特异性分别为73.7%、82.9%、62.9%和72.3%。在构建的模型中，SDS预测的AUC为0.770（95%置信区间：0.654-0.887），P<0.001。术前血清CA153水平是晚期AOC原发性SDS的重要无创预测因子，此前尚未有报道。基于Suidan预测模型加上HE4、CA125、CA153和ROMA指数构建的PIV模型可以无创预测AOC患者的SDS，该预测模型的准确性仍需在未来的研究中验证。