title: Preoperative CA-125 predicts extra-uterine disease and survival in uterine papillary serous carcinoma patients.
abstract: OBJECTIVE
  We determined the clinical utility of preoperative serum CA-125 as predictor of extra-uterine disease and as prognosticator for survival in patients with uterine papillary serous carcinoma (UPSC).
  
  
  METHODS
  Patients diagnosed with UPSC, identified between 1992 and 2009, and with preoperative CA-125 measurement were included. A receiver operator characteristic (ROC) curve was used to quantify marker performance. Overall and progression free survival were analyzed using the Kaplan-Meier method. Regression analyses were used to investigate the association of preoperative CA-125 levels and other clinicopathological variables with the presence of extra-uterine disease and the effects on survival.
  
  
  RESULTS
  Sixty-six patients met the study criteria. Using ROC, the CA-125 concentration of 45 U/mL as cutoff level provided the best sensitivity (75%) and specificity (74%) for extra-uterine disease, with a positive predictive value of 86%. Survival was significantly longer in patients with preoperative CA-125 ≤ 45 U/mL (p<0.001). Only preoperative CA-125 >45 U/mL remained significantly associated with extra-uterine disease (OR=6.30, 95% CI 1.93-20.62). Furthermore, advanced FIGO stage (HR=4.53, 95% CI 1.50-13.62) and preoperative CA-125 >45 U/mL (HR=3.12, 95% CI 1.13-8.73) were associated with decreased survival.
  
  
  CONCLUSIONS
  Preoperative elevated serum CA-125 is an independent predictor for the presence of extra-uterine disease and an independent risk factor for survival in UPSC patients.
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. T.Roelofsen@obgyn.umcn.nl
authors.forename: Thijs
authors.initials: T
authors.lastname: Roelofsen
authors.forename: Marjanka
authors.initials: M
authors.lastname: Mingels
authors.forename: Jan C M
authors.initials: JC
authors.lastname: Hendriks
authors.forename: Rahul A
authors.initials: RA
authors.lastname: Samlal
authors.forename: Marc P
authors.initials: MP
authors.lastname: Snijders
authors.forename: Anette L
authors.initials: AL
authors.lastname: Aalders
authors.forename: Johan
authors.initials: J
authors.lastname: Bulten
authors.forename: Maaike A P C
authors.initials: MA
authors.lastname: van Ham
authors.forename: Leon F A G
authors.initials: LF
authors.lastname: Massuger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D018284:Cystadenocarcinoma, Serous / Q000097:blood* / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000097:blood* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen