Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer
Lombaers, Marike S. (Radboud Institute of Health Sciences (Holanda))
Cornel, Karlijn M. C. (Department of Obstetrics and Gynecology, University of Toronto)
Visser, Nicole C. M. (Department of Pathology, Eurofins PAMM (Països Baixos))
Bulten, Johan (Radboud University Medical Center (Holanda))
Küsters-Vandevelde, Heidi V. N. (Department of Pathology, Canisius-Wilhelmina Hospital (Països Baixos))
Amant, Frederic (The Netherlands Cancer Institute (Països Baixos))
Boll, Dorry (Department of Gynecology, Catharina Hospital (Països Baixos))
Bronsert, Peter (University Medical Center)
Colás Ortega, Eva (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Geomini, Peggy M. A. J. (Department of Obstetrics and Gynecology, Maxima Medical Centre (Països Baixos))
Gil-Moreno, Antonio 1965- (Hospital Universitari Vall d'Hebron. Institut de Recerca)
van Hamont, Dennis (Department of Obstetrics and Gynecology, Amphia Hospital (Països Baixos))
Huvila, Jutta (Department of Pathology, University of Turku (Països Baixos))
Krakstad, Camilla (Department of Clinical Science, University of Bergen)
Kraayenbrink, Arjan A. (Department of Obstetrics and Gynaecology, Rijnstate Hospital (Països Baixos))
Koskas, Martin (Department of Obstetrics and Gynecology, Bichat-Claude Bernard Hospital (França))
Mancebo, Gemma (Hospital del Mar (Barcelona, Catalunya))
Matías-Guiu, Xavier (Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova)
Ngo, Huy (Department of Obstetrics and Gynecology, Elkerliek Hospital (Països Baixos))
Pijlman, Brenda M. (Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 5223 GZ 's-Hertogenbosch (Països Baixos))
Vos, Maria Caroline (Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital (Països Baixos))
Weinberger, Vit (Department of Gynecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University (República Txeca))
Snijders, Marc P. L. M. (Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital (Països Baixos))
van Koeverden, Sebastiaan W. (Department of Radiology and Nuclear Medicine, Radboud University Medical Center (Països Baixos))
Haldorsen, Ingfrid S. (Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway)
Reijnen, Casper (Department of Radiation Oncology, Radboud University Medical Center (Països Baixos))
Pijnenborg, Johanna M. A. (Radboud Institute of Health Sciences (Països Baixos))
Universitat Autònoma de Barcelona

Data:	2023
Resum:	Patients with high-grade uterine cancer (UC) have a risk of around 20% of the cancer spreading to the lymph nodes, while this is only around 10% in patients with low-grade uterine cancer. CA125 is a marker that can be detected in blood and is associated with increased tumor spread. Studies on CA125 and its association with tumor spread within low-grade UC exist but are limited for high-grade UC. The primary aim of this retrospective study was to assess whether elevated CA125 is predictive for UC spread and survival. Secondarily, we studied the additional value of preoperative imaging by CT scan in relation to CA125 specifically in high-grade UC. We observed that elevated CA125 was related to advanced stage and LNM in high-grade UC and a worse prognosis. If CA125 was normal, the additional value of CT to predict lymph node spread was limited. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Endometrial cancer ; Advanced stage ; Outcome ; High-grade ; CA125
Publicat a:	Cancers, Vol. 15 (may 2023) , ISSN 2072-6694

DOI: 10.3390/cancers15092605
PMID: 37174070

12 p, 831.3 KB

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