Preoperative serum CA125: a useful marker for surgical management of endometrial cancer
Jiang et al. BMC Cancer
Preoperative serum CA125: a useful marker for surgical management of endometrial cancer
Tao Jiang 0
Ling Huang 0
Shulan Zhang 0
0 Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University , No.36, Sanhao Street, Heping District, Shenyang, Liaoning Province 110004 , China
Background: Surgery plays an important role in the management of endometrial cancer at all stages, particularly early clinical stage. There are still many unanswered questions regarding optimal surgical management of endometrial cancer, particularly regarding which patients should undergo lymphadenectomy. The aim of this study was to evaluate the role of preoperative cancer antigen 125 (CA125) serum levels for surgical management in endometrial cancer patients. Methods: A total of 995 patients with endometrial cancer, according to inclusion criteria of a preoperative serum level of CA125, were selected. The association between clinicopathological factors and CA125 were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the role of preoperative serum CA125 in predicting lymph node metastasis, adnexal involement, cervical stromal invasion in all patients, especially patients with clinical stage I. Survival analyses were also performed according to the four groups of preoperative CA125 serum levels. Results: Elevated CA125 level was significantly associated with all clinicopathological parameters, including age and menopause, but not histology type. ROC curve analysis results showed the CA125 serum level of 25 U/mL was the best cutoff to predict the lymph node metastasis. It was with 78% of sensitivity, 78% of specificity, 77.6% of false positive rate, 2.3% of false negative rate in all patients. In patients with clinical stage I, it was with 71.7% of sensitivity, 77.6% of specificity, 83.3% of false positive rate, 2.2% of false negative rate. The best cutoff to evaluate adnexal involement in patients with clinical stage I was 30U/ml, with 81% sensitivity, and 78.4% specificity. Survival analysis revealed CA125, FIGO stage, histology grade, and positive peritoneal cytology as independent prognostic factors of endometrial cancer. Conclusion: Preoperative serum CA125 is an important predictor for patients with endometrial cancer and it should be taken into consideration when surgical management is determined, especially if a lymphadenectomy should be undertaken in patients with clinical stage I.
CA125; Endometrial cancer; Surgical management
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Background
Endometrial cancer is the fourth most frequent cancer
in women and the most common gynecological cancer
in developed countries. Each year, endometrial cancer
develops in approximately 142,000 women worldwide,
with an estimated 42,000 deaths from this cancer [1]. The
standard treatment of endometrial carcinoma is surgery,
including hysterectomy, bilateral salpingo-oophorectomy,
pelvic and periaortic lymphadenectomy. Although the
uterine cancer staging system changed from a clinical to
a surgical system in 1988, and was revised in 2009 by the
International Federation of Gynecology and Obstetrics
(FIGO), routine usage of pelvic and periaortic
lymphadenectomy in the surgical management is still controversial.
The disadvantage of systematic lymphadenectomy is a
13-22% risk of lower limb lymphedema after surgery
[2,3], along with lymph cyst formation, increased
anesthesia and operating time, and the need for a
specialized surgical oncologist. Omitting
lymphadenectomy in grade 1 or 2 tumors with less than 50%
myometrial invasion, the incidence of undiagnosed lymph
node metastasis is acceptable for patients with
endometrial cancer. However, the most significant hurdle
to adopt this system for identifying low-risk disease at
the time of surgery is the reliability of frozen section.
Accordingly, in the United States, the Gynecologic
Oncology Group (GOG) generally requires complete
pelvic and periaortic lymphadenectomy in protocols
involving clinically early-stage endometrial cancer [4].
The elevation of cancer antigen 125 (CA125) were first
described in patients with recurrent and advanced
endometrial cancer by Niloff [5] in 1984. Since then, many
studies have confirmed that serum CA125
concentrations in patients with endometrial cancer are associated
with deep myometrial invasion, extrauterine spread,
positive peritoneal cytology, lymph node metastasis,
recurrence, advanced stages, and reduced survival [6-12].
However, many of these studies had limitations, such as
a small number of patients, and the appropriate
reference cutoff values of serum CA125 was inconsistent
between these studies, which limited its clinical utility.
Thus, we designed the current study to evaluate the
preoperative serum levels of CA125 in patients with
endometrial cancer in relation to clinicopathological
parameters, and whether these serum levels could
provide additional information in determining the extent
of surgical management. In part (...truncated)