2f6d0fe530799a39dcd8b8435d795001 pmc_10177432.pdf 472d0e4bf07767133c0a5d966c0509a0fb08535b pmc_10177432.pdf 53dbf1eea5ec86b1a0dc9ec74470a311c19a3681fff2843750b35f9faea019e3 pmc_10177432.pdf Title: Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer Subject: 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. Keywords: endometrial cancer; advanced stage; outcome; high-grade; CA125 Author: Marike S. Lombaers, Karlijn M. C. Cornel, Nicole C. M. Visser, Johan Bulten, Heidi V. N. Küsters-Vandevelde, Frédéric Amant, Dorry Boll, Peter Bronsert, Eva Colas, Peggy M. A. J. Geomini, Antonio Gil-Moreno, Dennis van Hamont, Jutta Huvila, Camilla Krakstad, Arjan A. Kraayenbrink, Martin Koskas, Gemma Mancebo, Xavier Matías-Guiu, Huy Ngo, Brenda M. Pijlman, Maria Caroline Vos, Vit Weinberger, Marc P. L. M. Snijders, Sebastiaan W. van Koeverden, ENITEC-Consortium, Ingfrid S. Haldorsen, Casper Reijnen and Johanna M. A. Pijnenborg Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Fri May 5 11:19:46 2023 CEST ModDate: Fri May 5 11:34:51 2023 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 851302 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- YSPQJI+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 TVRZUI+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 WLQLTQ+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 GVKZEG+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 JVWUWA+VnURWPalladioL Type 1 Custom yes yes no 28 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 47 0 TNBSFT+CMSY10 Type 1 Builtin yes yes no 69 0 WBVKDJ+URWPalladioL-BoldItal Type 1 Custom yes yes no 79 0 OKLLFK+Calibri CID TrueType Identity-H yes yes yes 101 0 OKLHFJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 107 0 OKLHFK+PalatinoLinotype CID TrueType Identity-H yes yes yes 110 0 OKLHFL+PalatinoLinotype TrueType WinAnsi yes yes no 116 0 OKLHFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 119 0 OKLICK+PalatinoLinotype TrueType MacRoman yes yes no 122 0 OKLHFJ+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 136 0 OKLHFL+PalatinoLinotype TrueType WinAnsi yes yes no 139 0 OKLHFN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 142 0 OKLICK+PalatinoLinotype TrueType MacRoman yes yes no 145 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-02-02 02:35:02 CET RepresentationInformation: pmc_10177432.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-10-07 02:18:19 CEST Size: 851302 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 334 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Patient Cohort Destination: subsection.2.1 Item: Title: Data Collection Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Children: Item: Title: Study Cohort Destination: subsection.3.1 Item: Title: CA125 in Relation to Extra-Uterine Disease and LNM Destination: subsection.3.2 Item: Title: Imaging in Relation to Extra-Uterine Disease and LNM Destination: subsection.3.3 Item: Title: CA125 and CT Results in Relation to LNM Destination: subsection.3.4 Item: Title: CA125 in Relation to Outcome Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Children: Item: Title: Summary of Main Results Destination: subsection.4.1 Item: Title: Results in the Context of Published Literature Destination: subsection.4.2 Item: Title: Strengths and Weaknesses Destination: subsection.4.3 Item: Title: Implications for Practice and Future Research Destination: subsection.4.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.A. Info: Title: Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer Author: Marike S. Lombaers, Karlijn M. C. Cornel, Nicole C. M. Visser, Johan Bulten, Heidi V. N. Küsters-Vandevelde, Frédéric Amant, Dorry Boll, Peter Bronsert, Eva Colas, Peggy M. A. J. Geomini, Antonio Gil-Moreno, Dennis van Hamont, Jutta Huvila, Camilla Krakstad, Arjan A. Kraayenbrink, Martin Koskas, Gemma Mancebo, Xavier Matías-Guiu, Huy Ngo, Brenda M. Pijlman, Maria Caroline Vos, Vit Weinberger, Marc P. L. M. Snijders, Sebastiaan W. van Koeverden, ENITEC-Consortium, Ingfrid S. Haldorsen, Casper Reijnen and Johanna M. A. Pijnenborg Subject: 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. 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