Use of preoperative serum CA-125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer

Background. The purpose of this study was to evaluate the predictive value of preoperative serum CA-125 levels in the assessment of disease extent and clinical outcome of endometrial cancer. Method. This retrospective study evaluated 92 women with pathologically proven endometrial carcinoma scheduled for treatment that had preoperative serum CA-125 levels between January 1999 and February 2006. The association of preoperative serum CA-125 with a variety of histopathologic factors was evaluated. Statistical analysis was performed using chi(2)/Fisher's exact test and a logistic regression. Survival was studied with the Kaplan-Meier method and Cox regression models. Results. Elevated serum CA-125 levels were significantly correlated with advanced-stage disease (P <0.001), lymph node metastases (p <0.001), increased depth of myometrial invasion (p=0.001), and positive peritoneal cytology (p=0.026). Multivariate analyses using logistic regression showed that lymph node metastases had the most significant effect on the elevation of preoperative serum CA-125 levels (p =0.004). Patients with a serum CA-125 <= 28.5 U/ml had a significantly better five-year disease-free survival than those with an elevated level in this study: 85.6% versus 60.0% (p =0.004). Conclusions. The preoperative serum CA-125 level appears to be a significant independent predictor of lymph node metastasis and prognosis after surgical intervention. Therefore, preoperative serum CA-125 may be a useful tool, in the clinical setting, for optimal individualized patient management.