Preoperative serum CA 125 level as a predictor for metastasis and survival in endometrioid endometrial cancer

We wished to determine the relationship between preoperative serum CA 125 levels and the risk of metastatic disease, recurrent disease, and death in women with endometrial cancer.

We reviewed the records of women with endometrial adenocarcinoma of all stages who underwent primary surgery. We abstracted multiple data variables, including demographic characteristics, serum CA 125 levels, postoperative histopathology results, progression-free survival, and overall survival rates.

The records of 97 women with endometrial carcinoma were analyzed. With a serum CA 125 cut-off level of 35 kU/L, the likelihood of disease-related death could be predicted with 70% sensitivity and 83% specificity; disease progression could be predicted with 60% sensitivity and 84% specificity; and lymph node metastasis could be predicted with 75% sensitivity and 84% specificity. There was a significant relationship between a serum CA 125 level ≥ 35 kU/L and depth of myometrial invasion, cervical stromal invasion, stage, frequency of recurrence, and disease-related death. Having deep myometrial invasion, cervical stromal involvement, positive peritoneal cytology, lymph node metastasis, disease recurrence, and disease-related death were each associated with significantly higher mean CA 125 levels. In women with serum CA 125 levels < 35 kU/L, five-year progression-free survival rates (88%) and overall survival rates (92%) were significantly better than in women with levels ≥ 35 kU/L (57% and 70%, respectively; P = 0.001 for both).

Serum CA 125 levels and extension of disease are highly correlated in women with endometrioid endometrial cancer, and elevated CA 125 levels predict a higher risk of disease recurrence and death.