J Gynecol Oncol.  2009 Sep;20(3):181-186. 10.3802/jgo.2009.20.3.181.

Premenopausal early-stage endometrial carcinoma patients with low CA-125 levels and low tumor grade may undergo ovary-saving surgery

Affiliations
  • 1Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea. drchang@ajou.ac.kr
  • 2Department of Pathology, Ajou University School of Medicine, Suwon, Korea.

Abstract


OBJECTIVE
The purpose of this study was to determine the possible predicting factors of coexisting adnexal malignancies, and to evaluate the safety of ovary-saving surgery for early-stage endometrial carcinoma in premenopausal patients. METHODS: A retrospective review of 107 patients with endometrial carcinoma who underwent surgical treatment at our institution was conducted. All patients were younger than 50 years of age and premenopausal status. Statistical analysis was performed. RESULTS: Of the 107 patients, 78 patients had stage I to II disease and both preoperative CA-125 levels were measured and tumor grades evaluated. On multivariate analysis, preoperative CA-125 levels (p=0.018) and preoperative tumor grade (p=0.029) were independent predicting factors of adnexal diseases. The risk of coexisting ovarian malignancy was 1.8% in patients with preoperative CA-125 levels less than or equal to 34.5 U/ml and preoperative tumor grade 1 or 2. The risk increases to 20% for low CA-125 and grade 3, 13.3% for high CA-125 and grade 1 or 2, and 100% for high CA-125 and grade 3. Between patients who underwent unilateral salpingo-oophorectomy and those who underwent bilateral salpingo-oophorectomy, there was no statistically significant difference in terms of BMI, preoperative CA-125 levels, FIGO stage, histology, tumor grade, lymphadenectomy, and adjuvant treatment. CONCLUSION: Ovary-saving surgery for premenopausal, early-stage endometrial cancer patients may be considered as a treatment option in those with low preoperative CA-125 and low tumor grade.

Keyword

Premenopausal women; Endometrial carcinoma; Ovary-saving surgery

MeSH Terms

Adnexal Diseases
Endometrial Neoplasms
Female
Humans
Lymph Node Excision
Multivariate Analysis
Retrospective Studies

Figure

  • Fig. 1 ROC curve of preoperative CA-125 level for coexisting adnexal disease (AUC, 0.935; SE, 0.033; p<0.001; 95% CI, 0.871-0.999).

  • Fig. 2 Coexisting adnexal disease for the cohorts of 78 premenopausal women less than 50 years of age with endometrial carcinoma and who have available data of preoperative CA-125 and tumor grade.


Reference

1. Schmeler KM, Soliman PT, Sun CC, Slomovitz BM, Gershenson DM, Lu KH. Endometrial cancer in young, normal-weight women. Gynecol Oncol. 2005. 99:388–392.
2. Homesley HD. Management of endometrial cancer. Am J Obstet Gynecol. 1996. 174:529–534.
3. Soliman PT, Slomovitz BM, Broaddus RR, Sun CC, Oh JC, Eifel PJ, et al. Synchronous primary cancers of the endometrium and ovary: a single institution review of 84 cases. Gynecol Oncol. 2004. 94:456–462.
4. Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol. 2005. 106:693–699.
5. Lee TS, Jung JY, Kim JW, Park NH, Song YS, Kang SB, et al. Feasibility of ovarian preservation in patients with early stage endometrial carcinoma. Gynecol Oncol. 2007. 104:52–57.
6. Zaino R, Whitney C, Brady MF, DeGeest K, Burger RA, Buller RE. A gynecologic oncology group study. Simultaneously detected endometrial and ovarian carcinomas: a prospective clinicopathologic study of 74 cases. Gynecol Oncol. 2001. 83:355–362.
7. Sheu BC, Lin HH, Chen CK, Chao KH, Shun CT, Huang SC. Synchronous primary carcinomas of the endometrium and ovary. Int J Gynaecol Obstet. 1995. 51:141–146.
8. Falkenberry SS, Steinhoff MM, Gordinier M, Rappoport S, Gajewski W, Granai CO. Synchronous endometrioid tumors of the ovary and endometrium: a clinicopathologic study of 22 cases. J Reprod Med. 1996. 41:713–718.
9. DiSaia PJ, Creasman WT, Boronow RC, Blessing JA. Risk factors and recurrent patterns in Stage I endometrial cancer. Am J Obstet Gynecol. 1985. 151:1009–1015.
10. Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991. 40:55–65.
11. Takeshima N, Hirai Y, Yano K, Tanaka N, Yamauchi K, Hasumi K. Ovarian metastasis in endometrial carcinoma. Gynecol Oncol. 1998. 70:183–187.
12. Connell PP, Rotmensch J, Waggoner S, Mundt AJ. The significance of adnexal involvement in endometrial carcinoma. Gynecol Oncol. 1999. 74:74–79.
13. Soliman PT, Oh JC, Schmeler KM, Sun CC, Slomovitz BM, Gershenson DM, et al. Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol. 2005. 105:575–580.
14. Lee TS, Kim JW, Kim TJ, Cho CH, Ryu SY, Ryu HS, et al. Ovarian preservation during the surgical treatment of early stage endometrial cancer: a nation-wide study conducted by the Korean Gynecologic Oncololgy Group. Gynecol Oncol. 2009. 115:26–31.
15. Ulbright TM, Roth LM. Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases. Hum Pathol. 1985. 16:28–34.
16. Niloff JM, Klug TL, Schaetzl E, Zurawski VR Jr, Knapp RC, Bast RC Jr. Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix. Am J Obstet Gynecol. 1984. 148:1057–1058.
17. Duk JM, Aalders JG, Fleuren GJ, de Bruijn HW. CA-125: a useful marker in endometrial carcinoma. Am J Obstet Gynecol. 1986. 155:1097–1102.
18. Rose PG, Sommers RM, Reale FR, Hunter RE, Fournier L, Nelson BE. Serial serum CA-125 measurements for evaluation of recurrence in patients with endometrial carcinoma. Obstet Gynecol. 1994. 84:12–16.
19. Patsner B, Mann WJ, Cohen H, Loesch M. Predictive value of preoperative serum CA-125 levels in clinically localized and advanced endometrial carcinoma. Am J Obstet Gynecol. 1988. 158:399–402.
20. Fanning J, Piver MS. Serial CA-125 levels during chemotherapy for metastatic or recurrent endometrial cancer. Obstet Gynecol. 1991. 77:278–280.
21. Sood AK, Buller RE, Burger RA, Dawson JD, Sorosky JI, Berman M. Value of preoperative CA-125 level in the management of uterine cancer and prediction of clinical outcome. Obstet Gynecol. 1997. 90:441–447.
22. Koper NP, Massuger LF, Thomas CM, Kiemeney LA, Verbeek AL. Serum CA-125 measurements to identify patients with endometrial cancer who require lymphadenectomy. Anticancer Res. 1998. 18:1897–1902.
23. Granberg S, Wikland M, Friberg LG. Tumor marker CA-125 level and ovarian volume at different cycle day periods and in postmenopause. Int J Gynaecol Obstet. 1990. 33:149–152.
24. Zurawski VR Jr, Sjovall K, Schoenfeld DA, Broderick SF, Hall P, Bast RC Jr, et al. Prospective evaluation of serum CA-125 levels in a normal population, phase I: the specificities of single and serial determinations in testing for ovarian cancer. Gynecol Oncol. 1990. 36:299–305.
25. Alagoz T, Buller RE, Berman M, Anderson B, Manetta A, DiSaia P. What is a normal CA125 level? Gynecol Oncol. 1994. 53:93–97.
26. Kurihara T, Mizunuma H, Obara M, Andoh K, Ibuki Y, Nishimura T. Determination of a normal level of serum CA125 in postmenopausal women as a tool for preoperative evaluation and postoperative surveillance of endometrial carcinoma. Gynecol Oncol. 1998. 69:192–196.
27. Dotters DJ. Preoperative CA-125 in endometrial cancer: is it useful? Am J Obstet Gynecol. 2000. 182:1328–1334.
28. Wright JD, Buck AM, Shah M, Burke WM, Schiff PB, Herzog TJ. Safety of ovarian preservation in premenopausal women with endometrial cancer. J Clin Oncol. 2009. 27:1214–1219.
29. Richter CE, Qian B, Martel M, Yu H, Azodi M, Rutherford TJ, et al. Ovarian preservation and staging in reproductive-age endometrial cancer patients. Gynecol Oncol. 2009. 114:99–104.
Full Text Links
  • JGO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr