Improved preoperative risk stratification with CA-125 in low-grade endometrial cancer: a multicenter prospective cohort study
- Author:
Casper REIJNEN
1
;
Nicole CM VISSER
;
Jenneke C KASIUS
;
Dorry BOLL
;
Peggy M GEOMINI
;
Huy NGO
;
Dennis VAN HAMONT
;
Brenda M PIJLMAN
;
Maria Caroline VOS
;
Johan BULTEN
;
Marc PLM SNIJDERS
;
Leon FAG MASSUGER
;
Johanna MA PIJNENBORG
Author Information
- Publication Type:Multicenter Study
- Keywords: CA-125 Antigen; Endometrial Neoplasms; Low-grade Carcinoma; Biomarkers; Risk Stratification
- MeSH: Biomarkers; CA-125 Antigen; Cohort Studies; Diagnosis; Disease-Free Survival; Endometrial Neoplasms; Female; Gynecology; Humans; Obesity; Obstetrics; Prevalence; Prospective Studies
- From:Journal of Gynecologic Oncology 2019;30(5):e70-
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVES: The global obesity epidemic has great impact on the prevalence of low-grade endometrial carcinoma. The preoperative tumor serum marker cancer antigen 125 (CA-125) might contribute to improved identification of high-risk patients within this group. The study aimed to investigate the prognostic value of CA-125 in relation to established preoperative prognosticators, with a focus on identifying patients with poor outcome in low-grade endometrial carcinoma (EC) patients. METHODS: Prospective multicenter cohort study including all consecutive patients surgically treated for endometrial carcinoma in nine collaborating hospitals from September 2011 until December 2013. All preoperative histopathological diagnoses were reviewed in a blinded manner. Associations between CA-125 and clinicopathological features were determined. Univariable and multivariable analysis by Cox regression were used. Separate analyses were performed for preoperatively designated low-grade and high-grade endometrial carcinoma patients. RESULTS: A total of 333 patients were analyzed. CA-125 was associated with poor prognostic features including advanced International Federation of Gynecology and Obstetrics (FIGO) stage. In multivariable analysis, age, preoperative tumor and CA-125 were significantly associated with disease-free survival (DFS); preoperative grade, tumor type, FIGO and CA-125 were significantly associated with disease-specific survival (DSS). Low-grade EC patients with elevated CA-125 revealed a DFS of 80.6% and DSS of 87.1%, compared to 92.1% and 97.2% in low-grade EC patients with normal CA-125. CONCLUSION: Preoperative elevated CA-125 was associated with poor prognostic features and independently associated with DFS and DSS. Particularly patients with low-grade EC and elevated CA-125 represent a group with poor outcome and should be considered as high-risk endometrial carcinoma.
