Elsevier

Obstetrics & Gynecology

Volume 90, Issue 3, September 1997, Pages 441-447
Obstetrics & Gynecology

Original Articles
Value of Preoperative CA 125 Level in the Management of Uterine Cancer and Prediction of Clinical Outcome

https://doi.org/10.1016/S0029-7844(97)00286-XGet rights and content

Abstract

Objective: To enhance cost-effective management of uterine cancer by predicting the likelihood of extrauterine disease and survival on the basis of preoperative parameters.

Methods: A retrospective review of preoperative CA 125 levels from 210 women with endometrial carcinoma was performed. The relationship of preoperative CA 125 levels to various preoperative and postoperative histopathologic factors was investigated.

Results: Elevated CA 125 (greater than 35 U/mL) correlated (P < .05) with higher stage, higher grade, increased depth of myometrial invasion, positive cytology, pelvic or para-aortic lymph node metastases, and reduced actuarial survival (P < .001). Multivariate analysis of preoperative factors showed that an elevated CA 125 level was the most important predictor for poor survival (P < .001). Moreover, a preoperative CA 125 level greater than 65 U/mL was the most significant predictor of extrauterine disease and carried a 6.5-fold higher risk (95% confidence interval 2.5, 17.1). A logistic model to predict extrauterine disease was developed. The model has a sensitivity of 62%, specificity of 91%, positive predictive value of 69%, and negative predictive value of 88%.

Conclusion: A CA 125 level should be included as part of the preoperative workup for all patients with uterine cancer. Patients with a preoperative CA 125 level less than or equal to 20 U/mL should be considered as candidates for vaginal hysterectomy unless unfavorable histology or a high-grade (grade II or III) tumor is present. In our series, this approach would have eliminated 24% of the abdominal staging procedures, with a risk of less than 3% for extrauterine disease, while lowering treatment-related morbidity and cutting costs in the treatment of this common female cancer.

Section snippets

Materials and Methods

Preoperative CA 125 levels were available from 210 patients with endometrial cancer who were treated at four centers between January 1985 and December 1993: 174 from the University of Iowa Hospitals and Clinics, and 36 from the University of California at Irvine and affiliated hospitals (Long Beach Memorial Hospital, City of Hope National Medical Center, and University of California at Irvine). All patients at these institutions with endometrial cancer diagnosed during the study period were

Results

The average age of the study patients was 62.7 years, with a range of 27 to 93 years. Characteristics of these patients and their cancers are listed in Table 1. The mean period of follow-up was 3.0 years (range 0–8.5 years). Eighty-six patients underwent a simple hysterectomy for treatment, whereas 124 also underwent bilateral pelvic lymph node dissection with or without para-aortic lymph node sampling. Sixty-seven percent of tumors were classified as adenocarcinoma, 11.4% as papillary serous,

Discussion

Uterine cancer is the most common gynecologic malignancy in women in the United States. Most patients present with early-stage disease; however, about 25% of patients present with stage III or higher disease and will require adjuvant therapy. The most common method of diagnosis for uterine cancer is an office endometrial biopsy or D&C. Thus, before treatment, only a few factors are available on which to base treatment decisions. These factors are patient’s age, histology, and grade of tumor. It

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This project was supported in part by the American Cancer Society Clinical Oncology Fellowship Award (number 95-39-1) to Anil K. Sood, MD.

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