The value of preoperative CA-125 level in predicting lymph node involvement in endometrioid endometrial cancer.

Abstract

Aim: to investigate the value of preoperative serum CA-125 level in predicting lymph node positivity in endometrioid type endometrial cancer. Materials and methods: 513 patients who were diagnosed with endometrial cancer and underwent primary surgical treatment in two tertiary centers between March 2007 and September 2020 were included in the study. The clinico-pathological features of the patients included in the study were evaluated. In terms of lymph node metastasis (LNM), the patients were divided into two groups as LNM (-) and LNM (+). These two groups were compared with univariate and multivariate analyses. Results: the median age of the patients was 58 years (28-84 years), and the median CA-125 value was calculated as 14 IU/ml (2-600 IU/ml). In univariate analysis, CA 125≥ 35 IU/ml (p<0.001), Grade III tumor (p<0.001), tumor diameter≥ 35 mm (p<0.001), myometrial invasion≥ 50% (p<0.001), cervix uteri involvement (p<0.001), adnexal metastasis (p<0.001), uterine serosal involvement (p<0.001), positive cytology (p<0.001) and LVSI (p<0.001) were found to be associated with increased risk of LNM. In multivariate analysis, CA-125 (GOR=3.005 CI=1.337-6.756 p=0.008), tumor diameter≥35 mm (GOR=3.174 CI=1.157-8.706 p=0.025) and LVSI (GOR=11.045 CI=4.147-29.416 p<0.001) were found to be independent risk factors for LNM. The optimal preoperative CA-125 threshold value for the prediction of lymph node metastasis was determined as 35 IU/mL in patients aged 58 years and older, while it was determined as 24 IU/mL in patients aged under 58 years. In the subgroup analysis, in a total of 498 patients with clinically limited disease to the uterus, multivariate analysis revealed that CA-125 level (GOR=4.203, CI=1.738-10.159, p=0.001), tumor diameter≥35 mm (GOR=3.452 CI=1.144-10.414 p=0.028) and LVSI (GOR=11.243, CI=3.996-31.635, p<0.001) were independent risk factors for LNM. Discussion: in endometrioid endometrial cancer, preoperative serum CA125≥35 IU/ml, LVSI, tumor diameter ≥35 mm were found to be independent risk factors for predicting LNM in all stages and in the subgroup of clinically uterus-limited disease.

Keywords

• CA-125
• endometrioid
• lymph node
• metastasis

Preoperatif CA-125 düzeyinin endometrioid endometrium kanserinde lenf nodu tutulumunu öngörmedeki değeri

Abstract

Amaç: endometrioid tip endometrium kanserinde preoperatif serum CA-125 düzeyinin, lenf nodu pozitifliğini öngörmedeki değerinin araştırılması Gereç ve yöntem: Mart 2007 – Eylül 2020 arasında tersiyer iki merkezde endometrium kanseri tanısı alıp primer cerrahi tedavisi yapılan 513 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen hastaların kliniko-patolojik özellikleri değerlendirildi. Lenf nodu metastazı (LNM) açısından hastalar LNM (-) ve LNM (+) olmak üzere iki gruba ayrıldı. Bu iki grup univaryan ve multivaryan analizlerle karşılaştırıldı. Sonuçlar: hastaların median yaşı 58 (28-84 yaş), median CA-125 değeri 14 IU/ml (2-600 IU/ml) olarak hesaplandı. Univaryan analizde CA 125≥ 35 IU/ml (p<0,001), Grade III tümör (p<0,001), tümör çapı≥ 35mm (p<0,001), myometrial invazyon≥ %50 (p<0,001), serviks uteri tutulumu (p<0,001), adneksiyal metastaz (p<0,001), uterin serozal tutulum (p<0,001), pozitif sitoloji (p<0,001) ve LVSI (p<0,001) artmış LNM riski ile ilişkili bulundu. Multivaryan analizde CA-125 (GOO=3,005 GA=1,337-6,756 p=0,008), tümör çapı≥ 35mm (GOO=3,174 GA=1,157-8,706 p=0,025) ve LVSI (GOO=11,045 GA=4,147-29,416 p<0,001) LNM için bağımsız risk faktörü olarak saptandı. Lenf nodu metastazı tahmini için optimal preoperatif CA-125 eşik değeri 58 yaş ve üstü hastalarda 35 IU/mL olarak belirlenirken, 58 yaş altında 24 IU/mL olarak saptandı. Alt grup analizinde klinik olarak uterusa sınırlı hastalığı olan toplam 498 hastada multivaryan analizde CA-125 düzeyi (GOO= 4,203, GA=1,738-10,159, p=0,001), tümör çapı≥35mm (GOO=3,452 GA=1,144-10,414 p=0,028) ve LVSI (GOO=11,243, GA=3,996-31,635, p<0,001) LNM için bağımsız risk faktörü olarak saptandı. Tartışma: Endometrioid endometrium kanserinde tüm evrelerde ve alt grup olarak klinik uterusa sınırlı hastalıkta preoperatif serum CA125≥35 IU/ml, LVSI, tümör çapının ≥35mm olması, LNM öngörülmesinde bağımsız risk faktörü olarak saptandı.

Keywords

• CA-125
• endometrioid
• lenf nodu
• metastaz

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