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Background <p>The low sensitivity of CA-125 for early-stage epithelial ovarian carcinoma (EOC) necessitates more accurate biomarkers. This study evaluated the diagnostic accuracy of a panel combining CA-125 with apolipoproteins A1 and B (ApoA1, ApoB) for discriminating EOC from benign adnexal masses.</p> Methods <p>A prospective diagnostic accuracy study was conducted involving 60 patients with adnexal masses scheduled for surgery. Preoperative serum levels of CA-125 (chemiluminescent immunoassay, Abbott Architect), ApoA1, and ApoB (immunonephelometry, Siemens BN II) were measured. After excluding three non-epithelial malignancies, 57 patients (19 histologically confirmed EOC, 38 benign controls) were analyzed. Receiver operating characteristic (ROC) curve analysis, multivariate logistic regression, and decision curve analysis were performed.</p> Results <p>The triple-marker panel (CA-125 + ApoA1 + ApoB) demonstrated a significantly higher area under the ROC curve (AUROC) of 0.980 (95% CI 0.952–1.000) compared to 0.952 (95% CI 0.912–0.992) for CA-125 alone (<i>p</i> = 0.028). The panel achieved a sensitivity of 100% in this cohort and a specificity of 86.8% at an optimal cutoff, correctly identifying all five stage I EOCs that were missed by CA-125. In multivariate analysis, ApoA1 was the strongest independent predictor of EOC (odds ratio [OR] 0.10, 95% CI 0.02–0.40, <i>p</i> = 0.001). Decision curve analysis confirmed the superior clinical utility of the panel across a wide range of threshold probabilities.</p> Conclusions <p>The CA-125/ApoA1/ApoB panel significantly outperforms CA-125 alone, offering high sensitivity for early-stage EOC detection. Utilizing standardized, automated assays, this panel presents a highly scalable triage tool for adnexal masses, especially in resource-limited settings. Multicenter validation is warranted to confirm these findings.</p>

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Diagnostic Accuracy of a Triple-Marker Panel (CA-125, ApoA1, and ApoB) for Epithelial Ovarian Carcinoma

  • 期刊论文

  • 发表日期：

    2026年7月10日

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  • Arti Agarwal,
  • Vikas Jakhar,
  • Shikhar Chohan,
  • Ravi Pratap Singh,
  • Sanjeev Kumar Singh,
  • Roopak Aggarwal,
  • Himanshu Joshi

摘要

Background

The low sensitivity of CA-125 for early-stage epithelial ovarian carcinoma (EOC) necessitates more accurate biomarkers. This study evaluated the diagnostic accuracy of a panel combining CA-125 with apolipoproteins A1 and B (ApoA1, ApoB) for discriminating EOC from benign adnexal masses.

Methods

A prospective diagnostic accuracy study was conducted involving 60 patients with adnexal masses scheduled for surgery. Preoperative serum levels of CA-125 (chemiluminescent immunoassay, Abbott Architect), ApoA1, and ApoB (immunonephelometry, Siemens BN II) were measured. After excluding three non-epithelial malignancies, 57 patients (19 histologically confirmed EOC, 38 benign controls) were analyzed. Receiver operating characteristic (ROC) curve analysis, multivariate logistic regression, and decision curve analysis were performed.

Results

The triple-marker panel (CA-125 + ApoA1 + ApoB) demonstrated a significantly higher area under the ROC curve (AUROC) of 0.980 (95% CI 0.952–1.000) compared to 0.952 (95% CI 0.912–0.992) for CA-125 alone (p = 0.028). The panel achieved a sensitivity of 100% in this cohort and a specificity of 86.8% at an optimal cutoff, correctly identifying all five stage I EOCs that were missed by CA-125. In multivariate analysis, ApoA1 was the strongest independent predictor of EOC (odds ratio [OR] 0.10, 95% CI 0.02–0.40, p = 0.001). Decision curve analysis confirmed the superior clinical utility of the panel across a wide range of threshold probabilities.

Conclusions

The CA-125/ApoA1/ApoB panel significantly outperforms CA-125 alone, offering high sensitivity for early-stage EOC detection. Utilizing standardized, automated assays, this panel presents a highly scalable triage tool for adnexal masses, especially in resource-limited settings. Multicenter validation is warranted to confirm these findings.