Preoperative Evaluation Of Serum CA-125 Levels Maybe A More Significantly Prognostic Factor In Low To Intermediate-risk Endometrial Carcinoma: A Multi-institutional Study

Abstract

To evaluate the prognostic role of preoperative serum CA-125 levels in different ESMO-ESGO-ESTRO risk classification in early-stage endometrial carcinoma (EC) from long-term data of a multi-institutional analysis. The material for the current study was derived from a total of 1108 patients with early-stage EC from a multi-institutional analysis in China between 2000 and 2016. The eligibility criteria included the primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy, stage I and II disease (FIGO 2009 staging) with complete clinicopathologic and follow-up information, serum CA-125 levels were evaluated preoperatively. Risk classification according to ESMO-ESGO-ESTRO Consensus. Time to any event was measured from the day RT started. Overall survival (OS), cancer-specific survival (CSS), disease free survival (DFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were calculated using the Kaplan–Meier method, Cox proportional hazards regression model was used for multivariate analysis. The cut-off values of CA-125 were obtained using receiver operating characteristic curves (ROC). Statistical analyses were performed with statistical analysis software. A total of 447 patients were enrolled. The median follow-up time was 49 months. The median age was 56 years. Stage Ia/b disease represented 90.6% of the cohort, low to intermediate-risk group62.9%. Patients mainly received VBT alone (65.8%, n = 294). The 5-year OS, DFS, CSS, LRFS, and DMFS rates for all patients were 95.2%, 89.5%, 97.1%, 92.8%, and 90.7% respectively. Subgroup analysis revealed that age>60, preoperative serum CA-125>35U/ml, and grade were found to be significant prognostic factors for CSS in low to intermediate-risk group(p = 0.032, 0.002, and 0.031). The best cut-off values for preoperative serum CA-125 of low to intermediate-risk and high-intermediate to high-risk diseases were 20.35U/mL (AUC = 0.825, p = 0.013) and 17.21 U/mL(AUC = 0.681, p = 0.042), respectively. Preoperative serum CA-125 had no significant prognostic effect on OS and DFS. Preoperative evaluation of serum CA-125 level maybe a more significantly prognostic factor for CSS in low to intermediate-risk EC than high-intermediate to high-risk diseases, but it may not be useful for predicting OS and DFS.