Serum Levels of CA125 and HE4 as a Tool for Predicting Regional Lymph Node Metastatic Involvement in Endometrial...

Background: Endometrial carcinoma is the most common gynaecological malignant tumour in developed countries. At present, no routinely used serum biomarker is available for the prediction of lymph node metastasis (LNM). This study thus evaluates the potential of tumour markers CA125 and HE4 as LNM predictors in endometrial carcinoma patients. Objectives: The aim of this study was to evaluate the potential use of CA125 and HE4 and to assess the viability of a model developed using the parameters of serum tumour marker levels for LNM risk stratification. Methods: A retrospective, single-institution study of 220 patients with biopsy-proven endometrial carcinoma was conducted from May 2020 to December 2023. Preoperative serum levels of HE4 and CA125 were determined. All patients underwent surgical lymph node staging. The study evaluated the sensitivity and specificity of tumour markers and of the developed LNM risk prediction model. Results: No LNM was observed in 167 of the 220 patients (75.9%), micrometastatic lymph node involvement was observed in 13 patients (5.9%), and macrometastatic involvement was observed in 24 patients (10.9%). Median CA125 and HE4 levels were significantly higher in patients with LNM than in those without. With a CA125 cut-off value of 35 IU/mL, a sensitivity of 70% and a specificity of 92% were obtained, while an HE4 cut-off value of 103 pmol/L yielded a sensitivity of 78% and a specificity of 80%. A prediction model combining CA125, HE4, and the extent of uterine invasion, as detected by ultrasound, yielded a sensitivity of 84% and a specificity of 98% in predicting LNM. Conclusions: CA125 and HE4, along with the prediction model, facilitate endometrial carcinoma patient subdivision into low- and high-risk LNM groups. As this method is technically simple, non-invasive, and inexpensive, it could be of undeniable benefit in the risk stratification of patients with multiple comorbidities, which limit the duration and extent of surgery.