title: Preoperative serum CA-125 levels in treating endometrial cancer.
abstract: OBJECTIVE
  To evaluate preoperative levels of CA-125 for the prediction of advanced stages of uterine cancer.
  
  
  METHODS
  Retrospective chart review of 141 women with endometrial cancer who were treated by a single gynecologic oncologist at a community teaching hospital in North Carolina between November 1994 and September 2002.
  
  
  RESULTS
  Ninety-three of 106 patients (87.7%) with surgical stage I or II endometrial cancer had normal preoperative CA-125 levels. Ten of 11 (91%) women with stage IV endometrial cancer had elevated preoperative CA-125 levels. High CA-125 levels and positive lymph vascular space invasion correlated most strongly with advanced stage (p < 0.01). Similar trends in correlation of CA-125 levels were seen with the highest grade and the deepest myometrial invasion. The sensitivity and specificity of a CA-125 cutoff level of 35 U/mL were 63% and 88%, respectively, with a positive predictive value of 61% and negative predictive value of 89%.
  
  
  CONCLUSIONS
  Measurement of preoperative CA-125 is a clinically useful test in endometrial cancer patients. CA-125 appears to be a significant independent predictor of the extrauterine spread of disease and is a better predictor of disease than depth of invasion or grade. This evidence complements a growing body of literature that supports the strong relationship between CA-125 level and stage of disease. A CA-125 level should be included as part of the preoperative workup for all patients with endometrial cancer.
authors.affiliation: Department of Obstetrics and Gynecology, New Hanover Regional Medical Center, USA. john.powell@coastalahec.org
authors.forename: John L
authors.initials: JL
authors.lastname: Powell
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Hill
authors.forename: Brian C
authors.initials: BC
authors.lastname: Shiro
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Diehl
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gajewski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D016889:Endometrial Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D016015:Logistic Models; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen