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Objective: This prospective study was conducted to determine the correlation between preoperative serum CA 125 and the presence of surgicopathologic prognostic factors in endometrial cancer. It also aimed to determine the CA 125 value which best predicted the prognostic factors to which it was significantly correlated.
Methods: Patients with endometrioid endometrial cancer eligible for primary surgery were included. CA 125 determination using a chemiluminescent enzyme immunoassay (CLEIA) was done before surgery. Patients underwent laparotomy, peritoneal fluid cytology, extrafascial/radical hysterectomy, bilateral salpingooophorectomy, bilateral pelvic lymph node dissection and para-aortic lymph node sampling. Specimens were examined for tumor differentiation, lymphovascular space invasion, myometrial invasion, cervical, adnexal and vaginal involvement, pelvic and para-aortic lymph node metastases and for the presence of tumor cells in the peritoneal fluid. Correlation between CA 125 and the prognostic factors was analyzed using Pearson r correlation test. A receiver operating characteristic curve (ROC) was constructed to determine the CA 125 cutoff value.
Results: Ninety patients were included in the analysis. Preoperative serum CA 125 was significantly correlated with deep myometrial invasion (σ = 0.24, p = 0.02), adnexal metastasis (σ = 0.26, p = 0.01) and pelvic (σ = 0.31, p < 0.01) and para-aortic lymph node involvement (σ = 0.43, p < 0.01). It was also significantly correlated with the presence of extrauterine disease (σ = 0.26, p = 0.01). A value of 55 U/mL can predict extrauterine spread with sensitivity of 53.85%, specificity of 84.38% and accuracy of 75.56%. Using this cutoff, the odds of a positive test is 3.44 and the odd of a negative test is 0.54.
Conclusion: Preoperative serum CA 125 has a statistically significant correlation with deep myometrial invasion, adnexal metastasis, pelvic and para-aortic lymph node involvement and extrauterine disease, at a cutoff value of 55 U/mL. CA 125 determination should be routinely performed as part of the preoperative work-up for patients with endometrioid endometrial cancer.