Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer

Abstract

Patients with high-grade endometrial carcinoma (EC) have an increased risk of tumor spread and lymph node metastasis (LNM). Preoperative imaging and CA125 can be used in work-up. As data on cancer antigen 125 (CA125) in high-grade EC are limited, we aimed to study primarily the predictive value of CA125, and secondarily the contributive value of computed tomography (CT) for advanced stage and LNM. Patients with high-grade EC (n = 333) and available preoperative CA125 were included retrospectively. The association of CA125 and CT findings with LNM was analyzed by logistic regression. Elevated CA125 ((>35 U/mL), (35.2% (68/193)) was significantly associated with stage III-IV disease (60.3% (41/68)) compared with normal CA125 (20.8% (26/125), [p < 0.001]), and with reduced disease-specific—(DSS) (p < 0.001) and overall survival (OS) (p < 0.001). The overall accuracy of predicting LNM by CT resulted in an area under the curve (AUC) of 0.623 (p < 0.001) independent of CA125. Stratification by CA125 resulted in an AUC of 0.484 (normal), and 0.660 (elevated). In multivariate analysis elevated CA125, non-endometrioid histology, pathological deep myometrial invasion ≥50%, and cervical involvement were significant predictors of LNM, whereas suspected LNM on CT was not. This shows that elevated CA125 is a relevant independent predictor of advanced stage and outcome specifically in high-grade EC.

Function of homocysteine and HE4 in endometrial carcinoma: verified by prospective experiment

“…The usefulness of small-molecule markers for EC diagnosis is worthy of exploration. Human epididymal protein 4 (HE4), carbohydrate antigen 125 (CA125) and carbohydrate antigen 199 (CA199) are widely used in the diagnosis of gynecological tumors ( 12 - 14 ). Despite this, the prognosis of EC has not been significantly improved ( 15 , 16 ).…”

Biomarkers of Tumor Metastasis and Invasiveness

“…In this field, attempts to identify biomarkers of lymph node invasion are continuously produced, which have led, for example, to recently highlighting the role played by CD47 in the progression of colorectal cancer [22]. In the case of highgrade endometrial cancer, Lombaers et al reported that the increased risk of lymph node metastasis observed in patients with stage III-IV disease was associated with elevated levels of cancer antigen 125 (CA125) and reduced overall survival, confirming its predictive value [23]. In patients with lung adenocarcinoma, Yu and colleagues revealed that the expression of one member of the mitogen-activated protein kinase family, MAPK15, was positively correlated with lymph node metastasis.…”