Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer

Author:

Lombaers Marike S.12,Cornel Karlijn M. C.13,Visser Nicole C. M.4ORCID,Bulten Johan5,Küsters-Vandevelde Heidi V. N.6,Amant Frédéric78,Boll Dorry9,Bronsert Peter10ORCID,Colas Eva11ORCID,Geomini Peggy M. A. J.12,Gil-Moreno Antonio1113ORCID,van Hamont Dennis14ORCID,Huvila Jutta15ORCID,Krakstad Camilla1617ORCID,Kraayenbrink Arjan A.18,Koskas Martin19,Mancebo Gemma20ORCID,Matías-Guiu Xavier21ORCID,Ngo Huy22,Pijlman Brenda M.23,Vos Maria Caroline24ORCID,Weinberger Vit25ORCID,Snijders Marc P. L. M.26,van Koeverden Sebastiaan W.27,Haldorsen Ingfrid S.1628ORCID,Reijnen Casper29,Pijnenborg Johanna M. A.12ORCID,

Affiliation:

1. Department of Obstetrics and Gynaecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands

2. Radboud Institute of Health Sciences, 6525 GA Nijmegen, The Netherlands

3. Department of Obstetrics and Gynecology, Division Gynecologic Oncology, University of Toronto, Toronto, ON M5G 1E2, Canada

4. Department of Pathology, Eurofins PAMM, 5623 EJ Eindhoven, The Netherlands

5. Department of Pathology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands

6. Department of Pathology, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands

7. Department of Oncology, KU Leuven, 3000 Leuven, Belgium

8. Center for Gynecologic Oncology Amsterdam, Netherlands Cancer Institute and Amsterdam University Medical Center, 1066 CX Amsterdam, The Netherlands

9. Department of Gynecology, Catharina Hospital, 5623 EJ Eindhoven, The Netherlands

10. Institute of Pathology, University Medical Center, 79104 Freiburg, Germany

11. Biomedical Research Group in Gynecology, Vall Hebron Institute of Research, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red Cáncer, 08193 Barcelona, Spain

12. Department of Obstetrics and Gynecology, Maxima Medical Centre, 5631 BM Veldhoven, The Netherlands

13. Department of Gynecology, Vall Hebron University Hospital, Centro de Investigación Biomédica en Red Cáncer, 08035 Barcelona, Spain

14. Department of Obstetrics and Gynecology, Amphia Hospital, Breda, 4818 CK Breda, The Netherlands

15. Department of Pathology, University of Turku, 20500 Turku, Finland

16. Department of Obstetrics and Gynecology, Haukeland University Hospital, 5021 Bergen, Norway

17. Centre for Cancer Biomarkers, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway

18. Department of Obstetrics and Gynaecology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands

19. Department of Obstetrics and Gynecology, Bichat-Claude Bernard Hospital, 75018 Paris, France

20. Department of Obstetrics and Gynecology, Hospital del Mar, Parc de Salut Mar, 08003 Barcelona, Spain

21. Department of Pathology and Molecular Genetics and Research Laboratory, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Centro de Investigación Biomédica en Red Cáncer, 25003 Lleida, Spain

22. Department of Obstetrics and Gynecology, Elkerliek Hospital, 5751 CB Helmond, The Netherlands

23. Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands

24. Department of Obstetrics and Gynecology, Elisabeth-TweeSteden Hospital, 5000 LC Tilburg, The Netherlands

25. Department of Gynecology and Obstetrics, University Hospital Brno, Faculty of Medicine, Masaryk University, 601 77 Brno, Czech Republic

26. Department of Obstetrics and Gynecology, Canisius-Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands

27. Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands

28. Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, 5021 Bergen, Norway

29. Department of Radiation Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands

Abstract

Patients with high-grade endometrial carcinoma (EC) have an increased risk of tumor spread and lymph node metastasis (LNM). Preoperative imaging and CA125 can be used in work-up. As data on cancer antigen 125 (CA125) in high-grade EC are limited, we aimed to study primarily the predictive value of CA125, and secondarily the contributive value of computed tomography (CT) for advanced stage and LNM. Patients with high-grade EC (n = 333) and available preoperative CA125 were included retrospectively. The association of CA125 and CT findings with LNM was analyzed by logistic regression. Elevated CA125 ((>35 U/mL), (35.2% (68/193)) was significantly associated with stage III-IV disease (60.3% (41/68)) compared with normal CA125 (20.8% (26/125), [p < 0.001]), and with reduced disease-specific—(DSS) (p < 0.001) and overall survival (OS) (p < 0.001). The overall accuracy of predicting LNM by CT resulted in an area under the curve (AUC) of 0.623 (p < 0.001) independent of CA125. Stratification by CA125 resulted in an AUC of 0.484 (normal), and 0.660 (elevated). In multivariate analysis elevated CA125, non-endometrioid histology, pathological deep myometrial invasion ≥50%, and cervical involvement were significant predictors of LNM, whereas suspected LNM on CT was not. This shows that elevated CA125 is a relevant independent predictor of advanced stage and outcome specifically in high-grade EC.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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