Usefulness of preoperative CA 125 level in decision making of lymphadenectomy in endometrial cancer patients

Choi, Youn Seok; Koh, Suk Bong; Ahn, Ji Young; Yi, Chong Mi; Shin, Im Hee; Lee, Tae Sung

Abstract

OBJECTIVE
The purpose of this study was to evaluate whether the preoperative serum level of CA 125 in patients with endometrial cancer could provide an additional information on determining the extent of surgical staging and which cutoff value might be optimal in this respect.
METHODS
CA 125 levels were measured in 42 patients with endometrial carcinoma who underwent surgery at our institution between March 2000 and December 2004. Operative and postoperative pathologic findings were then correlated with preoperative CA 125 values. Statistical analysis was performed using Mann-Whitney U test, Kruskal-Wallis test, chi-square test and logistic regression model to evaluate the association of preoperative CA 125 levels with various factors. Receiver operating characteristic (ROC) curve was used to determine which cutoff value of the preoperative CA 125 was optimal.
RESULTS
Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, extrauterine disease, and lymph node metastasis (P<0.05). The ROC curve showed that the best cutoff values to expect extrauterine disease and lymph node metastasis were 30 U/mL and 50 U/mL, respectively. Using the above cutoff value, the sensitivity and specificity for screening extrauterine disease were found to be 80% and 73%, and for lymph node metastasis to be 100% and 87%, respectively.
CONCLUSION
Our data provide evidence that extrauterine disease can be strongly predicted at a preoperative CA 125 level of >30 U/mL whereas lymph node metastasis can be predicted at the CA 125 level of >50 U/mL.