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J Reprod Med. 2005 Aug;50(8):585-90

Preoperative serum CA-125 levels in treating endometrial cancer.

Powell JL,Hill KA,Shiro BC,Diehl SJ,Gajewski WH.

Department of Obstetrics and Gynecology, New Hanover Regional Medical Center, USA. john. Powell@coastalahec.org

Objectives:

To evaluate preoperative levels of CA-125 for the prediction of advanced stages of uterine cancer.

Study Design:

Retrospective chart review of 141 women with endometrial cancer who were treated by a single gynecologic oncologist at a community teaching hospital in North Carolina between November 1994 and September 2002.

Results:

Ninety-three of 106 patients (87.7%) with surgical stage I or II endometrial cancer had normal preoperative CA-125 levels. Ten of 11 (91%) women with stage IV endometrial cancer had elevated preoperative CA-125 levels. High CA-125 levels and positive lymph vascular space invasion correlated most strongly with advanced stage (p< 0.01). Similar trends in correlation of CA-125 levels were seen with the highest grade and the deepest myometrial invasion. The sensitivity and specificity of a CA-125 cutoff level of 35 U/mL were 63% and 88%, respectively, with a positive predictive value of 61% and negative predictive value of 89%.

Conclusion:

Measurement of preoperative CA-125 is a clinically useful test in endometrial cancer patients. CA-125 appears to be a significant independent predictor of the extrauterine spread of disease and is a better predictor of disease than depth of invasion or grade. This evidence complements a growing body of literature that supports the strong relationship between CA-125 level and stage of disease. A CA-125 level should be included as part of the preoperative workup for all patients with endometrial cancer.