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Abstract
Objectives This study aims to estimate the serum CA-125 concentration as a predictor of nodal and distant metastases in preoperative stage I Endometrial Cancer (EC).
Methods Medical record review was conducted on preoperative imaging-based stage I EC patients who underwent lymphadenectomy between January 2014 and December 2017 in a reference cancer center in Barretos, Brazil. Preoperative CA-125 levels were evaluated to quantify the predictive ability of nodal or distant metastases by Mann-Whitney test and receiver operating characteristic (ROC) curve.
Results A total of 146 EC cases were included: 104(71.2%) stage IA and 42(28.8%) stage IB with mean age of 61.75(8.5) years and body mass index (BMI) of 31.6(6.2) kg/m². Sentinel lymph node mapping was performed in 96(65.75%) patients; while 86(58.9%), 84(57.53%) and 56(38.36%) underwent left, right pelvic and retroperitoneal systematic lymphadenectomy, respectively. Low-risk EC, comprising endometrioid G1 and G2, was present in 82(56.2%) and high-risk disease (endometrioid G3, serous, clear cell, and carcinosarcoma) in 64(43.8%). After oncological surgery, nodal and/or distant metastases were found in 18(12.33%) cases. CA-125 levels were higher in low-risk women with pathological evidence of dissemination, compared to non-metastatic disease [24.86(20.4–56.5) vs. 11.4(7.05–17.80)U/mL, p<0.001], with a sensitivity of 85.71% and specificity of 83.56%, at a concentration threshold of 19.55U/mL (AUC=0.86, p=0.002). CA-125 values did not attain statistical difference in high-risk patients for prediction of metastasis (p=0.51).
Conclusions CA125 levels are elevated in low-risk EC patients with nodal and/or distant metastases. Further studies are warranted to substantiate these findings and possibly favor CA-125 as a parameter for an individualized surgical approach.