title: Utility of pre-operative serum CA-125 in the management of uterine papillary serous carcinoma.
abstract: OBJECTIVE
  To evaluate the usefulness of pre-operative serum CA-125 in the management of women diagnosed with uterine papillary serous carcinoma (UPSC). We hypothesized that elevated pre-operative levels of serum CA-125 correlate with higher disease stage and poorer prognosis.
  
  
  METHODS
  Patients diagnosed with UPSC and managed in our institution were identified over a period of 10 years, 1995 to 2005. All required information were extracted from their records. The nonparametric test applied for comparison of data included Kruskal Wallis H-test and Man-Whitney U-test. The chi(2) test and Spearman correlation test were used to examine the association of serum CA-125 with different parameters. Receiver operator characteristic curves (ROC) were used to quantify marker performance. Recurrence and survival were analyzed using Kaplan-Meier method. Multivariate analyses were performed with a Cox proportional regression method.
  
  
  RESULTS
  A total of 41 patients met the study criteria. Mean pre-operative serum CA-125 levels were significantly higher in patients with stage IV (1150+/-1297 U/mL), compared with stage III (181+/-232 U/mL; P<0.001), stage II (22+/-9; P<0.001), and stage I (14+/-1; P<0.001). CA-125 correlated strongly with stage (r=0.68, P<0.001). On the ROC, a cut-off of 35 IU/mL provided the best sensitivity and specificity (78% vs. 100% respectively) for extra-uterine disease. Disease free survival (DFS) and overall survival (OS) were longer in patients with CA-125<35 U/mL compared with CA-125>or=35 U/mL [median DFS not reached during study vs. 21.2 months (P=0.009), and median OS not reached during study vs. 25 months, (P=0.0001) respectively]. Multivariate regression model showed CA-125 as the only variable associated with survival (P=0.05).
  
  
  CONCLUSIONS
  Pre-operative serum CA-125 levels correlate with stage of disease in patients with UPSC. This may be important for management planning, prognostication and counseling in these women.
authors.affiliation: Department of Obstetrics, Division of Gynecologic Oncology, Harvard Medical School, Vincent Obstetrics and Gynecology Service, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Olawaiye
authors.forename: Jose Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Matthew
authors.initials: M
authors.lastname: Withiam-Leitch
authors.forename: Bo
authors.initials: B
authors.lastname: Rueda
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.forename: Marcela G
authors.initials: MG
authors.lastname: del Carmen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood*; D002291:Carcinoma, Papillary / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D018284:Cystadenocarcinoma, Serous / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007430:Intraoperative Care / Q000379:methods; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy; D014594:Uterine Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*
chemical_list: D018394:CA-125 Antigen