Use of preoperative serum CA-125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer

Abstract

Background: The purpose of this study was to evaluate the predictive value of preoperative serum CA-125 levels in the assessment of disease extent and clinical outcome of endometrial cancer.

Method: This retrospective study evaluated 92 women with pathologically proven endometrial carcinoma scheduled for treatment that had preoperative serum CA-125 levels between January 1999 and February 2006. The association of preoperative serum CA-125 with a variety of histopathologic factors was evaluated. Statistical analysis was performed using chi2/Fisher's exact test and a logistic regression. Survival was studied with the Kaplan-Meier method and Cox regression models.

Results: Elevated serum CA-125 levels were significantly correlated with advanced-stage disease (p<0.001), lymph node metastases (p<0.001), increased depth of myometrial invasion (p=0.001), and positive peritoneal cytology (p=0.026). Multivariate analyses using logistic regression showed that lymph node metastases had the most significant effect on the elevation of preoperative serum CA-125 levels (p=0.004). Patients with a serum CA-125 < or =28.5 U/ml had a significantly better five-year disease-free survival than those with an elevated level in this study: 85.6% versus 60.0% (p=0.004).

Conclusions: The preoperative serum CA-125 level appears to be a significant independent predictor of lymph node metastasis and prognosis after surgical intervention. Therefore, preoperative serum CA-125 may be a useful tool, in the clinical setting, for optimal individualized patient management.