Utility of Preoperative CA125 Assay in the Management Planning of Women Diagnosed with Uterine Cancer

Abstract

Objective. This study assesses the role of preoperative serum CA125 levels in the planning treatment options for women diagnosed with uterine cancer. Material and Method. Ninety five consecutive patients diagnosed with uterine cancer during a four-year period were identified. Age ranged from 35 to 89 years with a mean age of 69 years. The preoperative CA125 levels were dichotomised at 28 U/mL (using ROC analysis to identify the best discriminating threshold for 5-year survival). This level was then correlated with preoperative prognostic indicators: patient age, tumour grade, and histopathological tumour cell type. Survival data was plotted using Kaplan-Meier curves and analysed using the log-rank test. Univariate and multivariate analysis were performed to identify the predictors of overall survival. Results. The mean age of patients was 69 years (range: 35–89). On univariate analysis, the use of preoperative CA125 levels of greater or less than 28 U/mL correlated significantly with age (P = 0.01), the grade of disease (P = 0.02) and unfavourable tissue type (P = 0.03). This threshold CA125 level had a sensitivity of 75%, specificity of 76%, positive predictive value of 35% and negative predicative value of 96.25%, and a likelihood ratio of 3.12 for predicting nodal disease. Using a threshold of preoperative CA125 level of 28 U/mL (area under curve: 0.60) was also a significant predictor of 5-year survival (log-rank test, P = 0.01). Using Cox multivariate survival analysis to identify predictive preoperative factors overall, unfavourable cell type was the strongest predictor of survival (Chi square = 36.5, df = 4, and P = 0.001), followed by preoperative CA125 level (CA125 > 28 U/mL, P = 0.011) and unfavourable preoperative grade (P = 0.017). Amongst patients with a favourable histological tissue type (endometrioid), preoperative CA125 levels predicted overall survival (Chi square = 6.039, df = 2, P = 0.02); however unfavourable preoperative grade did not (P = 0.5). Overall, at five-year follow-up, while there were no deaths among the women with preoperative serum CA125 less than 12 U/mL, eleven of the twenty-three deaths (47.82%) in the study occurred in women with a preoperative CA125 more than 28 U/mL. Conclusions. A preoperative CA125 assay for women with uterine cancer is a relatively inexpensive, reproducible, and objective test which provides valuable information regarding the risk of metastatic disease and overall likelihood of long term survival. Patients with a low likelihood of metastatic/nodal disease (favourable tissue type and CA125 level < 28 U/mL) and significant comorbidities may benefit from avoiding an extended complete staging procedure. Alternatively, a high level of CA125 may prompt further imaging and multidisciplinary discussions to plan for individualised management and consideration for recruitment to clinical trials.

Predicting Lymph Node Metastasis in Endometrial Cancer Using Serum CA125 Combined with Immunohistochemical Markers PR and Ki67, and a Comparison with Other Prediction Models

“…We selected commonly used immunohistochemical markers ER, PR, Ki67 and p53 as candidate predictors and screened these markers in the prediction cohort. Because a growing number of reports suggest that serum CA125 level correlates with the prognosis of endometrial cancer [ 15 – 17 ], and this variable is also easily accessed in clinical work, serum CA125 level was included in the screening as well. Univariate and multivariate logistic regression analyses were performed to screen candidate predictors ( Table 4 ).…”

Tumor Markers in Serum and Ascites in the Diagnosis of Benign and Malignant Ascites

“…CA125, as a kind of macromolecular poly-glycoprotein, will increase evidently in the blood of patients when the cellular structures are damaged and changed in malignant tissues. Some researches (Bozkurt et al, 2013;Bilen et al, 2014;Povolotskaya et al, 2014) demonstrated that CA125 level had different-degree increase in ascites and serum of patients with cancers of lung, liver, stomach, uterus and prostate, etc. CA19-9, also known as gastrointestinal cancer associated antigen, can be used as a complementary diagnostic index for patients with malignant tumors such as pancreatic and colorectal cancers.…”

Tumour-associated antigens and their anti-cancer applications

“…Several reports have also found elevated levels of CA125 in both primary and recurrent endometrial cancer as well as lymphomas (Povolotskaya et al . ; Memar et al . ).…”