The relationship between serum CA-125 level and recurrence in surgical stage 1 endometrial cancer patients.

Abstract

The majority of patients diagnosed with early stage endometrial cancer have a favorable prognosis; however, approximately 10-15% experience a recurrence. Therefore, the aim of the present study was to evaluate whether post-operative carbohydrate antigen 125 (CA-125) levels could be used to predict recurrence and recurrence-free survival (RFS) in patients with surgical stage I endometrial cancer. We enrolled a total of 518 patients with stage I endometrial cancer who underwent surgical treatment between January 2010 and March 2019. Serum CA-125 levels were measured prior to surgery, as well as 6-12 months after surgery. Subsequently, the correlations between the CA-125 levels, cancer recurrence, and RFS were analyzed. Although the pre-operative CA-125 level was not associated with the risk of cancer recurrence, the post-operative CA-125 level was found to be the only independent predictor of recurrence in both univariate and multivariate analyses. Additionally, we found that a post-operative CA-125 cut-off value of 13.75 U/mL yielded the best sensitivity and specificity for predicting cancer recurrence. Patients with a post-operative CA-125 level ≥ 13.75 U/mL, and those with a level < 13.75 U/mL, had a median time to recurrence and a 5-year RFS rate of 35.5 vs. 50.5 months and 84.7 vs. 94.4%, respectively. Additionally, post-operative CA-125 levels were not found to be correlated with pre-operative levels. In patients with stage I endometrial cancer, a post-operative CA-125 level ≥13.75 U/mL was found to be significantly correlated with a higher recurrence rate, as well as a shorter RFS. Therefore, obtaining a follow-up CA-125 level within 6-12 months after staging surgery may be a promising noninvasive biomarker for predicting recurrence.