A systematic review of the use of biomarkers in ovarian cancer diagnosis and management

Abstract

Introduction: Ovarian cancer is considered one of the gynaecological cancers, which has a high mortality rate and poor diagnosis. Despite ovarian cancer awareness, survival and cure rates have remained unchanged since early detection remains challenging. It is due to a combination of reasons, including a lack of a proper screening tool and ambiguous symptoms and signs that might "masquerade" as nonmalignant conditions. The purpose of this study is to explore the ability of biomarkers in ovarian cancer diagnosis early. Method: The study was systematically examined by a PRISMA search approach to focus on the biomarkers CA-125, HE4 and KLKs and selected 14 papers. After screening each study title and abstract for verify of search terms, papers were included. Inclusion and exclusion criteria were applied to the PRISMA publications. Results: The 14 studies included in this systematic review revealed contradictory information on the biomarkers CA-125, HE4, and KLKs, with broad range values of specificity and sensitivity and a lack of distinction between different stages of ovarian cancer. Some studies asserted ovarian cancer patients had considerably higher HE4 and CA-125 levels than healthy controls or those with the benign condition. Similarly, epithelial ovarian cancers raise serum HE4 levels higher than non-epithelial ovarian malignancies. As a result of the increased CA-125 levels, studies have indicated that older women over 50 are more likely to develop non-ovarian malignancies. More recent papers have suggested the possibility of combining biomarkers testing for ovarian cancer diagnosis. When Kim et al investigated this in 2019, more reliable diagnostic values were identified, with an AUC of the combination of CA-125 + HE4 in the premenopausal patient group of 0.847 and an AUC of CA-125 + HE4 in the post-menopausal patient group of 0.927. Limitations were found that most of the chosen studies had relatively small study populations, resulting in limiting representation of age, symptoms, and women status of pre/post-menopausal who might have a varied expression of the biomarkers studied. Conclusion: The results showed that each biomarker had a different diagnostic performance based on the pathologic type of ovarian cancer and the complication of benign gynaecological cancer. It is suggested that biomarkers be employed to test for ovarian cancer on a routine basis to improve the accuracy of the marker used to identify the related risks during pelvic exams to manage the disease effectively.