Diagnostic Value of Combined Serum CEA, HE4, AFP, CA125, and CA199 Testing in Early-Stage Ovarian Cancer
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v7i2.5273
Abstract
Objective: To evaluate the diagnostic value of combined serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), and human epididymis protein 4 (HE4) in early-stage ovarian cancer. Methods: Subjects were recruited from January 2022 to December 2025 at the First Clinical Medical College of Three Gorges University (Yichang Central People's Hospital), including relevant patients and concurrent healthy examinees. Participants were stratified into three groups: early-stage ovarian cancer (n=75), benign ovarian tumors (n=71), and healthy examinees (n=70). All subjects underwent standardized testing for five serum tumor marker levels to evaluate their diagnostic utility in early-stage ovarian cancer. Results: (1) Significant differences existed in the levels of the five serum tumor markers among the three groups (P=0.000). All markers in the early-stage ovarian cancer group were significantly higher than those in the benign ovarian tumor group and the healthy examination group, far exceeding the normal range. The levels in the latter two groups decreased sequentially. (2) Serum tumor marker levels differed significantly among early-stage ovarian cancer patients at different stages (P=0.000). Marker levels in stage III–IV patients were significantly higher than those in stage I–II patients. (3) The diagnostic sensitivity and specificity of individual serum tumor marker tests were low. However, combined detection of all five markers achieved a sensitivity of 91.63% and specificity of 95.40%, significantly outperforming single-marker testing. Conclusions: (1) Serum levels of all five tumor markers were significantly higher in the early-stage ovarian cancer group compared to the other two groups. Marker levels also showed significant differences among patients with early-stage ovarian cancer at different stages. (2) Combined testing demonstrated far superior diagnostic performance compared to individual markers, indicating that combined testing reduces misdiagnosis and missed diagnosis, providing reliable evidence for the diagnosis and disease assessment of early-stage ovarian cancer.
Keywords
serum markers; combined detection; diagnosis; early-stage ovarian cancer
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[27] Chen Qin. Clinical Value of Combined Detection of CA125, CA19-9, CEA, and AFP in Ovarian Cancer Diagnosis [J]. Journal of Qiannan University for Nationalities, 2025, 38(3):306-310.
[28] Gao Xue, Zhang Junling, Wang Yilin. Study on the Value of Exosomal Proteins (CA125, HE4, C5a) in the Early Diagnosis of Epithelial Ovarian Cancer [J]. Journal of Inner Mongolia Medicine, 2025, 57(8): 944-948.
[29] Liang Cai, Yu Hongmei. Diagnostic Value of Combined Serum HE4 and CA125 Testing for Epithelial Ovarian Cancer[J]. Chinese Journal of Modern Drug Application, 2025, 19(6):58-61.
[30] Maiorano PF, Cormio G, Loizzi V, et al. Artificial intelligence in ovarian cancer: a systematic review and meta-analysis of predictive AI models in genomics, radiomics, and immunotherapy[J]. International Journal of Gynecological Cancer, 2026, 36(2S1):104224-104224.
[31] Xing Wenting, Bian Yun, Shao Chengwei. Artificial Intelligence-Assisted CT Diagnosis of Lymph Node Metastasis: Fusion Models, Multi-Cancer Applications, and Interpretability Challenges[J]. Journal of Naval Medical University, 2025, 46(12):1525-1531.
[2] Tian, C.Y., Li, T., Chen, Y.Y., et al. Detection of Serum ST2, CA125, and HE4 Levels in Ovarian Cancer Patients and Their Clinical Significance [J]. Journal of Jilin University (Medical Edition), 2025, 51(3): 778-784.
[3] Ye Qianpeng, Li Guangming. Clinical Application Progress of ^(68)Ga-FAPI PET in the Diagnosis and Treatment of Ovarian Cancer [J]. Chinese Journal of Nuclear Medicine and Molecular Imaging, 2025, 45(5): 313-316.
[4] Xu Mengli. Research Progress of Radiomics in Ovarian Cancer [J]. Chinese Journal of Medical Imaging, 2025, 33(8): 892-896.
[5] Yang Hao, Zhao Zilong, Zhou Maorong. PET Imaging and Serological Testing in the Diagnosis and Treatment of Ovarian Cancer: Standalone and Combined Applications [J]. Chinese Journal of Nuclear Medicine and Molecular Imaging, 2025, 45(7): 440-444.
[6] Huang Chenglin, Zhang Shulan. Research Progress of Nucleic Acid Aptamers in Ovarian Cancer Diagnosis [J]. Chinese Medical Frontiers (Electronic Edition), 2024, 16(8):78-84.
[7] Wu Lixian, Wu Liping, Yong Yuanyuan. Diagnostic Value of Ovarian-Adnexal Imaging Reporting and Data System Combined with Ovarian Cancer Risk Prediction Model Index for Benign and Malignant Ovarian Tumors [J]. Chinese Journal of Medical Imaging, 2024, 32(7):714-718.
[8] Jin Changhao, Wang Yang. Diagnostic Value of ROMA Index Combined with D-Dimer for Ovarian Cancer [J]. Chinese Journal of Geriatrics, 2024, 44(4):806-808
[9] Feng Zheng, Guo Qinhao, Zhu Jun et al. Advances and Prospects in the Treatment of Gynecological Malignant Tumors in 2023 [J]. Chinese Journal of Cancer, 2024, 34(4):340-360.
[10] Xu Lixiu. Application Value and Imaging Index Analysis of Color Doppler Ultrasound in Diagnosis and Staging of Ovarian Cancer [J]. Journal of Rare Diseases, 2026, 33(1):116-118.
[11] Wang Xuejun, Li Meixiang. Analysis of the Value of Routine Histopathology and Immunohistochemistry in Differential Diagnosis of Ovarian Cancer [J]. Science & Health, 2025, 4(7): 41-44.
[12] Sun Yongmin, Wang Peng, Yang Yafei. Analysis of the Value of Combined Serum Tumor Marker Detection in the Early Diagnosis of Ovarian Cancer [J]. Journal of Practical Oncology, 2025, 40(8):1258-1260.
[13] Gynecologic Oncology Committee of the Chinese Geriatric Health Association, Obstetrics and Gynecology Branch of the Chinese Medical Doctor Association, Shen Yang, Chen Xiaojun, Chen Xiaoxiang, Gao Qinglei, Li Bin, Liang Zhiqing, Meng Yuanguang, Shen Zhen, Song Kun, Sun Pengming, Sun Yang, Wang Danbo, Wang Jinhua, Wen Hao, Wu Peng, Yin Xia, Zhang Guonan, Zhou Ying, Zhu Tao. Chinese Expert Consensus on Early Screening for Ovarian Cancer (2025 Edition) [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2025, 41(2):204-211.
[14] Wang Jingjing, Li Ying, Xiang Shifeng. Application Value of MRI Combined with Serum SDF-1 and NDRG4 in Diagnosing Ovarian Cancer [J]. Chinese Journal of CT and MRI, 2025, 23(1):137-139.
[15] Xiao Hua, Zhu Yuanyuan. Application Value of Tumor Markers CA125, CEA, and CCR in Diagnosing Epithelial Ovarian Cancer [J]. Chinese Journal of Rehabilitation Medicine, 2025, 33(8):40-44.
[16] Wang Yanmin. Clinical Diagnostic Value of Serum CA72-4, CA125, and hCG Testing for Ovarian Cancer [J]. Tibetan Medicine, 2025, 46(6): 26-28.
[17] Wang Yicong, Wang Yijun, Yu Yongai et al. Value of Combined Peripheral Blood PLR, NLR, MLR, and CA125 in Ovarian Cancer Diagnosis [J]. Chinese Journal of Maternal and Child Health, 2025, 40(1):9-12.
[18] Wang Yaozhen, Liu Yue. Analysis of the Diagnostic Efficacy of Combined HE4 and TK1 Testing for Early Ovarian Cancer Detection [J]. Guizhou Medicine, 2026, 50(1):118-121.
[19] Wang Xinyue, Zhang Shaohua. Advances in the Diagnostic Application of CA125, HE4, and ROMA Index in Ovarian Cancer [J]. Advances in Clinical Medicine, 2025, 15(12): 639-644.
[20] Zhang Caihong. Investigation of the Value of Combined Serum Tumor Marker Detection in Ovarian Cancer Diagnosis [J]. Heilongjiang Medicine, 2025, 49(20): 2487-2489.
[21] Wu Lele. Auxiliary Diagnostic Value of Combined Serum CA125, CA199, HE4, and AFP Testing for Ovarian Cancer [J]. Journal of Practical Oncology, 2025, 40(11):1751-1754.
[22] Zhang Jinlian. Clinical Application Value of Serum Tumor Markers CA-199, CA-153, and CA-125 in Ovarian Cancer Diagnosis [J]. Chinese Journal of Modern Drug Application, 2025, 19(14): 60-63.
[23] Han Jieqiong, Yang Xiyong. Analysis of the Diagnostic Value of Combined Serum CA19-9, HE4, CEA, and AFP Testing in Ovarian Cancer [J]. Journal of Practical Oncology, 2025, 40(11):1755-1758.
[24] Zheng Shuangzhu. Diagnostic Efficacy of Combined Serum Alpha-Fetoprotein, Carcinoembryonic Antigen, Carbohydrate Antigen 125, and Carbohydrate Antigen 199 in Ovarian Cancer [J]. Primary Medical Forum, 2025, 29(28):33-35.
[25] Xu Hengye, Guo Yuwen. Sensitivity and Specificity Analysis of Combined Serum Tumor Marker Detection for Ovarian Cancer Diagnosis [J]. China Medical Guide, 2025, 23(23):124-127.
[26] Xiao Hua, Zhu Yuanyuan. Application Value of Tumor Markers CA125, CEA, and CEA in Diagnosing Epithelial Ovarian Cancer [J]. Chinese Journal of Disability Medicine, 2025, 33(8):40-44.
[27] Chen Qin. Clinical Value of Combined Detection of CA125, CA19-9, CEA, and AFP in Ovarian Cancer Diagnosis [J]. Journal of Qiannan University for Nationalities, 2025, 38(3):306-310.
[28] Gao Xue, Zhang Junling, Wang Yilin. Study on the Value of Exosomal Proteins (CA125, HE4, C5a) in the Early Diagnosis of Epithelial Ovarian Cancer [J]. Journal of Inner Mongolia Medicine, 2025, 57(8): 944-948.
[29] Liang Cai, Yu Hongmei. Diagnostic Value of Combined Serum HE4 and CA125 Testing for Epithelial Ovarian Cancer[J]. Chinese Journal of Modern Drug Application, 2025, 19(6):58-61.
[30] Maiorano PF, Cormio G, Loizzi V, et al. Artificial intelligence in ovarian cancer: a systematic review and meta-analysis of predictive AI models in genomics, radiomics, and immunotherapy[J]. International Journal of Gynecological Cancer, 2026, 36(2S1):104224-104224.
[31] Xing Wenting, Bian Yun, Shao Chengwei. Artificial Intelligence-Assisted CT Diagnosis of Lymph Node Metastasis: Fusion Models, Multi-Cancer Applications, and Interpretability Challenges[J]. Journal of Naval Medical University, 2025, 46(12):1525-1531.
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