Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer?
OBJECTIVE
The aim of the present study was to evaluate whether a preoperative serum level of CA 125 in patients with endometrial cancer can provide additional information in determining the extent of lymphadenectomy required in the surgical staging and which cutoff value is optimal in this respect.


METHODS
CA 125 was measured in 124 patients diagnosed with endometrial carcinoma who underwent surgery at our institution between January 1995 and May 2000. Statistic analysis was performed using the Mann-Whitney U test and Kruskal-Wallis test to evaluate the association of preoperative CA 125 levels with various factors. The chi(2)/Fisher's exact test and a logistic regression model were employed to examine the effects of clinicopathological factors on serum CA 125 levels. Furthermore, a receiver operating characteristic curve was used to determine which cutoff value of the preoperative CA 125 was the optimal one.


RESULTS
Univariate analyses showed that elevated CA 125 levels were significantly correlated with an advanced stage, larger tumor size, increasing depth of the myometrial invasion, cervical invasion, positive cytology, and lymph node metastases (P < 0.05). Multivariate analyses using a logistic regression model showed lymph node metastases had the most significant effect on the elevation of CA 125 levels. The ROC curve determined that the best cutoff value was 40 U/ml; the sensitivity and specificity for screening lymph node metastases were found to be 77.8 and 81.0%, respectively.


CONCLUSIONS
Our data provide evidence indicating that a preoperative CA 125 level greater than 40 U/ml can be considered a criterion for full pelvic lymphadenectomy in the surgical staging of endometrial cancer.
Hsieh
Chin-Hsiung
CH
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan.
ChangChien
Chan-Chao
CC
Lin
Hao
H
Huang
Eng-Yen
EY
Huang
Chao-Cheng
CC
Lan
Kuo-Chung
KC
Chang
Shiuh-Young
SY
D000704:Analysis of Variance; D018394:CA-125 Antigen / Q000097:blood*; D002277:Carcinoma / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care
D018394:CA-125 Antigen