Correlation between preoperative serum CA 125 and surgicopathologic prognostic factors in endometrial cancer

Abstract

e16524 Background: Poor prognostic factors dictating the need for extended surgical staging among endometrial cancer patients can be accurately determined only after laparotomy. An adequate preoperative work-up is thus necessary to tailor surgical treatment individually. This prospective study was conducted to determine the correlation between preoperative serum CA125 and surgicopathologic prognostic factors in endometrial cancer. It also aimed to determine the CA125 cutoff value which best predicted the prognostic factors to which it was correlated. Methods: Endometrial cancer patients diagnosed from October 2006 to July 2008 who were eligible for primary surgical treatment were included. Serum CA125 determination was done by a chemiluminescent enzyme immunoassay prior to surgery. All patients underwent laparotomy, peritoneal fluid cytology, extrafascial/radical hysterectomy, bilateral salpingooophorectomy, bilateral pelvic lymph node dissection, and para-aortic lymph node sampling. Specimens were examined for tumor differentiation, lymphovascular space invasion, depth of myometrial invasion, cervical, adnexal, and vaginal involvement, pelvic and para-aortic lymph node metastases, and peritoneal fluid cytology. Pearson r correlation test was used to evaluate the correlation of serum CA125 with the prognostic factors. A receiver operating characteristic curve was used to determine the optimal cutoff value of preoperative CA125. Results: Ninety patients with endometrioid endometrial adenocarcinoma were included. Preoperative serum CA125 was significantly correlated with deep myometrial invasion (p = 0.02), adnexal metastasis (p = 0.01), pelvic (p < 0.01), and para-aortic node involvement (p<0.01). It was also significantly correlated with extrauterine disease (p = 0.01). A cutoff value of 55U/mL can predict extrauterine spread with 53.85% sensitivity, 84.38% specificity and 75.56% accuracy. Conclusions: Preoperative serum CA125 has a significant correlation with deep myometrial invasion, adnexal metastasis, pelvic and para-aortic lymph node involvement, and extrauterine disease at a cutoff value of 55U/mL. It is recommended that serum CA125 determination be part of the preoperative work-up of endometrial cancer patients. No significant financial relationships to disclose.