Elevated human epididymis protein 4 levels in chronic kidney disease compromise the accuracy of the risk of ovarian malignancy algorithm
- 1Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon 25440, Republic of Korea
- 2Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
Abstract
The present study aimed to compare the diagnostic accuracy of the risk of ovarian malignancy algorithm (ROMA) for differentiating ovarian tumors in patients with and without chronic kidney disease (CKD), using postoperative histopathological findings as the reference standard among patients who underwent surgery after ROMA testing. The retrospective study included 1,122 patients, including 21 with CKD, who met the inclusion criteria and underwent surgery for ovarian tumors at Gangneung Asan Hospital between August 2015 and August 2025. In patients with CKD, human epididymis protein 4 (HE4) levels were elevated in both benign and malignant groups compared with normal levels, with progressively higher levels observed with increasing CKD severity. Among patients with benign ovarian tumors, median HE4 levels were higher in those with CKD than in those without CKD (210.00 vs. 41.10 pmol/l). Cancer antigen 125 (CA125) levels did not differ significantly according to CKD status. Because of the elevated HE4 levels, ROMA scores were significantly higher in patients with CKD, resulting in low specificity {0.200 [95% confidence interval (CI), 0.066-0.470]} and reduced overall accuracy [0.429 (95% CI, 0.240-0.640)]. Receiver operating characteristic curve analysis demonstrated superior predictive performance of ROMA in patients without CKD [area under the curve (AUC), 0.724; 95% CI, 0.680-0.768] compared with those with CKD (AUC, 0.467; 95% CI, 0.217-0.717). In conclusion, in patients with CKD and ovarian tumors, ROMA should be interpreted with caution, and CA125 and imaging findings should be considered alongside other clinical information when assessing the risk of ovarian malignancy.
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BibTeX
@article{ju2026elevated,
title = {{Elevated human epididymis protein 4 levels in chronic kidney disease compromise the accuracy of the risk of ovarian malignancy algorithm}},
author = {Da-Hye Ju and Se-Won Kim and Sang Wook Yi and Sang-Soo Lee and Woo-Seok Sohn and Young-Jae Lee},
journal = {Experimental and Therapeutic Medicine},
year = {2026},
month = oct,
doi = {10.3892/etm.2026.13338},
url = {https://europepmc.org/article/PMC/PMC13728489},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Elevated human epididymis protein 4 levels in chronic kidney disease compromise the accuracy of the risk of ovarian malignancy algorithm
AU - Da-Hye Ju
AU - Se-Won Kim
AU - Sang Wook Yi
AU - Sang-Soo Lee
AU - Woo-Seok Sohn
AU - Young-Jae Lee
PY - 2026
DA - 2026/10/19
JO - Experimental and Therapeutic Medicine
DO - 10.3892/etm.2026.13338
UR - https://europepmc.org/article/PMC/PMC13728489
AB - The present study aimed to compare the diagnostic accuracy of the risk of ovarian malignancy algorithm (ROMA) for differentiating ovarian tumors in patients with and without chronic kidney disease (CKD), using postoperative histopathological findings as the reference standard among patients who underwent surgery after ROMA testing. The retrospective study included 1,122 patients, including 21 with CKD, who met the inclusion criteria and underwent surgery for ovarian tumors at Gangneung Asan Hospital between August 2015 and August 2025. In patients with CKD, human epididymis protein 4 (HE4) levels were elevated in both benign and malignant groups compared with normal levels, with progressively higher levels observed with increasing CKD severity. Among patients with benign ovarian tumors, median HE4 levels were higher in those with CKD than in those without CKD (210.00 vs. 41.10 pmol/l). Cancer antigen 125 (CA125) levels did not differ significantly according to CKD status. Because of the elevated HE4 levels, ROMA scores were significantly higher in patients with CKD, resulting in low specificity {0.200 [95% confidence interval (CI), 0.066-0.470]} and reduced overall accuracy [0.429 (95% CI, 0.240-0.640)]. Receiver operating characteristic curve analysis demonstrated superior predictive performance of ROMA in patients without CKD [area under the curve (AUC), 0.724; 95% CI, 0.680-0.768] compared with those with CKD (AUC, 0.467; 95% CI, 0.217-0.717). In conclusion, in patients with CKD and ovarian tumors, ROMA should be interpreted with caution, and CA125 and imaging findings should be considered alongside other clinical information when assessing the risk of ovarian malignancy.
SN - 1792-0981
SN - 1792-1015
ER -