TY - JOUR
T1 - Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer
AU - Lombaers, Marike S.
AU - Cornel, Karlijn M. C.
AU - Visser, Nicole C. M.
AU - Bulten, Johan
AU - Küsters-Vandevelde, Heidi V. N.
AU - Amant, Frédéric
AU - Boll, Dorry
AU - Bronsert, Peter
AU - Colas, Eva
AU - Geomini, Peggy M. A. J.
AU - Gil-Moreno, Antonio
AU - van Hamont, Dennis
AU - Huvila, Jutta
AU - Krakstad, Camilla
AU - Kraayenbrink, Arjan A.
AU - Koskas, Martin
AU - Mancebo, Gemma
AU - Matías-Guiu, Xavier
AU - Ngo, Huy
AU - Pijlman, Brenda M.
AU - Vos, Maria Caroline
AU - Weinberger, Vit
AU - Snijders, Marc P. L. M.
AU - van Koeverden, Sebastiaan W.
AU - Haldorsen, Ingfrid S.
AU - ENITEC-consortium
AU - Reijnen, Casper
AU - Pijnenborg, Johanna M. A.
N1 - Publisher Copyright: © 2023 by the authors.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - 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.
AB - 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.
KW - CA125
KW - advanced stage
KW - endometrial cancer
KW - high-grade
KW - outcome
UR - http://www.scopus.com/inward/record.url?scp=85159615116&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/cancers15092605
DO - https://doi.org/10.3390/cancers15092605
M3 - Article
C2 - 37174070
SN - 2072-6694
VL - 15
JO - Cancers
JF - Cancers
IS - 9
M1 - 2605
ER -