The role of preoperative serum CA-125 levels in predicting lymph node metastasis in patients undergoing treatment for endometrial cancer

Year 2024, Volume: 7 Issue: 1, 114 - 119, 15.01.2024

Savaş Özdemir , Fatih Şahin , Ozan Doğan , Alp Koray Kinter , Özgür Akbayir

https://doi.org/10.32322/jhsm.1403151

Abstract

Aims: Endometrial cancer stands as the most prevalent gynecological malignancy in developed nations, often detected at an early stage, and generally carries a positive prognosis. The stage of the disease is important for survival, but many factors such as tumor grade, histopathology, myometrial invasion, age, and spread are also effective. Our objective was to assess the significance of preoperative Cancer antigen 125 (CA-125) concentrations in the prediction of lymph node metastasis in patients with endometrial cancer and to identify a suitable threshold value.
Methods: This retrospective analysis was carried out on 286 female patients diagnosed with endometrial cancer at a specialized gynecologic oncology facility from 2012 to 2022. We examined clinical-pathological and demographic attributes, including preoperative serum CA-125 concentrations, surgical interventions conducted for each patient, post-treatment physical assessments, imaging findings, and cytological outcomes. CA-125 was measured using electrochemiluminescence immunoassay.
Results: Statistically significant differences were observed in CA-125 levels among patients in terms of grade, invasion depth, lymph node involvement, cervical involvement, and stage (respectively, p<0.001, p=0.042, p<0.001, p<0.001, p<0.001). The FIGO advanced stage ratio was 30.6 times higher for serum CA-125 concentrations above the cutoff of 21 IU/ml (95% CI: 10.7-87.6) (p<0.001). Lymph node involvement was 29.7 times more likely for serum CA-125 values above the cutoff of 35 IU/ml (95% CI: 25.3-74.8) (p<0.001).
Conclusion: Early identification of high-risk endometrial cancer patients is vital for prognosis and guiding adjuvant therapy. CA-125, a tumor marker, has been found useful in assessing myometrial invasion depth, lymph node involvement, stage differentiation, and tumor grade.

Keywords

CA-125, endometrial cancer, metastasis, lymph node, predictive marker

Ethical Statement

Prof.DR.CEMİL TAŞCIOĞLU ŞEHİR HASTANESİ KLİNİK ARAŞTIRMALAR ETİK KURULU 23.10.23 NO:232

Supporting Institution

NONE

Project Number

232

Thanks

NONE

References

• Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33.
• Makker V, MacKay H, Ray-Coquard I, et al. Endometrial cancer. Nature Rev Dis Primers. 2021;7(1):88.
• Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387(10023):1094-1108.
• Shawn LyBarger K, Miller HA, Frieboes HB. CA125 as a predictor of endometrial cancer lymphovascular space invasion and lymph node metastasis for risk stratification in the preoperative setting. Sci Rep. 2022;12(1):19783.
• Yilmaz Baran Ş, Alemdaroğlu S, Doğan Durdağ G, et al. What is the predictive value of preoperative CA 125 level on the survival rate of type 1 endometrial cancer? Turk J Med Sci. 2021;51(1):335-341.
• Yin BWT, Lloyd KO. Molecular cloning of the CA125 ovarian cancer antigen: identification as a new mucin, MUC16. J Biol Chem. 2001;276(29):27371-27375.
• Sahin F, Aktürk E, Günkaya OS, et al. Borderline ovarian tumors: twenty years of experience at a tertiary center. Anatolian Curr Med J. 2023;5(3):196-200.
• Muhammad S, Azwan RJ, Rita RS, Susanti R, Yusrawati. The role of Interleukin 6 (IL6), Cancer Antigen-125 (CA-125), and Human Epididymis Protein 4 (HE4) to predict tumor resectability in the advanced epithelial ovarian cancer patients. PLoS One. 2023;18(10):e0292282.
• Şahin F, Aydın E, Öcal EUB, Özdemir S, Kasapoğlu AM, Akbayır Ö. Evaluation of colposcopy and LEEP results performed in gynecology and gynecological oncology surgery services. Eur J Gynaecological Oncol. 2024. doi:10.22514/ejgo.2023.071
• Duk JM, Aalders JG, Fleuren GJ, de Bruijn HW. CA 125: a useful marker in endometrial carcinoma. Am J Obstet Gynecol. 1986;155(5):1097-1102.
• Reijnen C, Visser NC, Kasius JC, et al. Improved preoperative risk stratification with CA-125 in low-grade endometrial cancer: a multicenter prospective cohort study. J Gynecol Oncol. 2019;30(5):e70.
• Köse O, Ünal O, Köse E, Gök K, Bostancı MS, Özden S. Covid -19 pandemisi öncesi ve pandemi döneminde endometrium kanseri vakalarının karşılaştırılması bir eğitim araştırma hastanesi örneği. Sakarya Tıp Derg. 2022;12(3):438-443.
• Nithin KU, Sridhar MG, Srilatha K, Habebullah S. CA 125 is a better marker to differentiate endometrial cancer and abnormal uterine bleeding. Afr Health Sci. 2018;18(4):972-978.
• Markman M. The role of CA-125 in the management of ovarian cancer. Oncologist. 1997;2(1):6-9.
• Nicklin J, Janda M, Gebski V, Jobling T, Land R. The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer. Int J Cancer. 2012;131(4):885-890.
• Fu P, Sun H, Zhou T, Cui P, Wang S, Liu R. Postoperative adjuvant treatment in women with stage I endometrial cancer: a retrospective study. Int J Clin Pract. 2023;2023:4007616. doi: 10.1155/2023/4007616
• Zhou X, Wang H, Wang X. Preoperative CA125 and fibrinogen in patients with endometrial cancer: a risk model for predicting lymphovascular space invasion. J Gynecol Oncol. 2017;28(2):e11.
• Zamani N, Gilani MM, Mirmohammadkhani M, et al. The utility of CA125 and HE4 in patients suffering from endometrial cancer. Int J Women’s Health Reprod Sci. 2020;8(1):95-100.
• Alcazar JL, Dominguez-Piriz J, Juez L, Caparros M, Jurado M. Intraoperative gross examination and intraoperative frozen section in patients with endometrial cancer for detecting deep myometrial invasion: a systematic review and meta-analysis. Int J Gynecol Cancer. 2016;26(2):407-415.
• Kurt B, Küçükyıldız İ, Yanık A. The predictive role of CA- 125 value in early stage endometrioid endometrial cancer. Cumhuriyet Med J. 2023;45(2):31-37.
• Ünsal M, Kimyon Comert G, Karalok A, Basaran D, Turkmen O. The preoperative serum CA125 can predict the lymph node metastasis in endometrioid-type endometrial cancer. Ginekologia Polska. 2018;89(11):599-606.
• Schmidt M, Segev Y, Sadeh R, Suzan E, Feferkorn I, Kaldawy A. Cancer antigen 125 levels are significantly associated with prognostic parameters in uterine papillary serous carcinoma. Int J Gynecologic Cancer. 2018;28(7):1311-1317.
• Küçükyıldız İ, Yanık A. The predictive role of CA-125 value in early stage endometrioid endometrial cancer. Cumhuriyet Med J. 2023;45(2):31-37.
• Bağcı M, Gülhan İM, Saygılı U, Demir N. The diagnostic accuracy of magnetic resonance imaging in the prediction of myometrial invasion and correlation between serum Ca - 125 level and myometrial invasion in endometrial cancer. J Clin Obstet Gynecol. 2005;15(6):296-303.
• Atguden Z, Yildiz A, Aksut H, et al. The value of preoperative CA 125 levels in prediction of myometrial invasion in patients with early-stage endometrioid- type endometrial cancer. Asian Pac J Cancer Prev. 2016;17(2):497-501.
• Hsieh CH, Chang Chien CC, Lin H. Can a preoperative CA-125 level he a criterion for full pelviclymphadenectomy in surgical staging of endometrial cancer? Gynecol Oncol. 2002;86(1):28-33.
• Jiang T, Huang L, Zhang S. Preoperative serum CA125: a useful marker for surgical treatment of endometrial cancer. BMC Cancer. 2015;15(1):1-8
• Mitric C, Bernardini MQ. Endometrial cancer: transitioning from histology to genomics. Curr Oncol. 2022;29(2):741-757.