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

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.

Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

“…21 Some investigators proposed their own preoperative evaluation methods including CA 125 in order to predict lymph node metastasis and extrauterine disease. [22][23][24] It is well known that MRI has a high accuracy for assessment of the depth of myometrial invasion in endometrial cancer. Many studies show that the accuracy of T2-weighted images in the determination of myometrial invasion by endometrial cancer ranges from 68 to 82% and dynamic MRI increases the accuracy up to 91%.…”

Current status in the management of uterine corpus cancer in Korea

“…59,62 In two case-control Korean studies regarding this issue, it was concluded that ovarian-saving surgery in early-stage disease did not affect disease-free survival and overall survival with a mean of 39 months follow-up 63 and recurrence. 64 They suggested young patients with a low pre-operative CA-125 and low tumor grade are considered as candidates for ovarian-saving surgery. 64 In a nationwide survey under the influence of the Korean Gynecologic Oncology Group, Lee et al 48 analyzed outcomes of 175 women undergoing ovarian-saving surgery.…”

“…64 They suggested young patients with a low pre-operative CA-125 and low tumor grade are considered as candidates for ovarian-saving surgery. 64 In a nationwide survey under the influence of the Korean Gynecologic Oncology Group, Lee et al 48 analyzed outcomes of 175 women undergoing ovarian-saving surgery. During a median follow-up of 55 months, recurrence-free survival and overall survival were 94.3% and 93.3%, respectively.…”