CA-125 seviyeleri, Endometrial seröz karsinomun uterus dışı yayılımının dışlanmasında ne kadar spesifiktir?

Öz

Amaç: Uterin papiller seröz karsinom hastalarında preoperatif serum CA-125 düzeylerini hastalığın yayılımını predikte etmek için araştırmak. Materyal ve metod: Uterin papiller seröz karsinom /mix seröz karsinom ve endometrioid karsinom için opere edilen hastalarda; preoperatif CA-125 seviyelerinin yanı sıra yaş, bildirilen tümör boyutu, lenf nodu tutulumu, lenfovasküler boşluk invazyonu, myometriyal invazyon derinliği ve evre gibi verileri topladık. Bulgular: Yirmi altı Uterin papiller seröz karsinom /mix seröz karsinom olgusu ve kırk beş endometrioid karsinom olgusu analizimize dahil edildi. Uterin papiller seröz karsinom /mix seröz karsinom ve endometrioid karsinom hastalarının ortalama yaşları sırasıyla 63.9 ve 58 idi. Seröz kanser grubunu CA-125 açısından incelediğimizde; CA-125 ile yaş (≤60 vs >60), tümör boyutu (≤40 vs >40mm), myometriyal invazyon derinliği, nod metastazı veya lenfovasküler boşluk invazyonu arasında hiçbir ilişki yoktu. Öte yandan, ortalama CA-125 seviyeleri, FIGO (Uluslararası Jinekoloji ve Obstetrik Federasyonu) Evre III/IV (medyan=54 U/ml) olan hastalarda FIGO evre I/II'ye (medyan=11 U/mL) anlamlı olarak yüksekti (p=0,002). Uterus dışına yayılan tümörler için ortalama CA-125 düzeyi 281,2 U/ml ve uterusta sınırlı tümörler için 14,3 U/ml idi (p=0,002). Ekstrauterin yayılmayı tahmin etmek için optimum eşik değeri 28.5 U/mL idi (duyarlılık%75, özgüllük%89). Preoperatif CA-125 düzeyi, ekstrauterin tutulum ve ileri evre ile ilişkilendirildi. Sonuç: Preoperatif CA-125 düzeyi, ekstrauterin tutulum ve ileri evre için iyi bir prediktördür. Cerrahi prosedürlerin planlanmasında, 28,5 U/mL'den daha düşük CA-125 değerine sahip Uterin papiller seröz karsinom vakalarına daha az agresif bir tedavi yöntemi öneriyoruz.

Anahtar Kelimeler

• CA125,
• Endometrium kanseri
• Uterin papiller seröz karsinom

How specific are CA-125 levels in ruling out extra-uterine extension of endometrial serous papillary cancer?

Öz

Abstract Aim: To investigate the CA-125 levels in uterine serous carcinoma (UPSC) patients to predict the extent of disease. Materials and Method: Medical records of patients operated for UPSC/mix serous carcinoma, endometrioid carcinoma; their preoperative CA-125 levels, as well as parameters including age, tumor size, lymph node involvement, lymphovascular space invasion (LVSI), depth of myometrial invasion (MI) and stage were documented. Results: Twenty-six UPSC/mix serous carcinoma cases and forty-five endometrioid carcinoma cases were included. When we analyzed the serous cancer group in terms of CA-125; there was no association between CA-125 and age (≤60 vs >60), tumor size (≤40 vs >40mm), MI, lymph node metastasis or LVSI. The mean CA-125 levels were significantly higher among patients with stage III/IV (median=54 U/ml), compared to stage I/II (median=11 U/mL). The mean CA-125 value for tumors spread beyond the uterus were 281.2 U/ml, and 14.3 U/ml for the tumors confined within the uterus (p=0.002). The optimum threshold value to predict extrauterine spread was 28.5 U/mL. CA-125 level was related to extrauterine involvement and advanced stage. Conclusion: CA-125 level is a useful test for extrauterine involvement and advanced stage. We suggest a less aggressive treatment modality with CA-125 <28.5U/mL may be considered for patients with a pre-operative CA 125 level of <28.5 and who cannot bear extensive surgery burden. Patients with a pre-operative CA 125 level of >28.5 and who need to receive comprehensive surgical staging, in settings where this is not feasible, should be referred to a gynecological oncologist in an experienced center.

Anahtar Kelimeler

• CA125
• Endometrial cancer
• Uterine papillary carcinoma

Kaynakça

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