PREOPERATIVE EVALUATION OF MACROPHAGE-COLONY-STIMULATING FACTOR LEVELS IN PATIENTS WITH ENDOMETRIAL CANCER

OBJECTIVE: Our purpose was to examine the relationship between preoper ative serum levels of macrophage colony-stimulating factor, alone and in combination with CA 125, and the presence of prognostic clinicopath ologic factors and subclinical metastases in women with endometrial ca ncer. STUDY DESIGN: Ninety-two women who underwent primary exploration for endometrial adenocarcinoma had preoperative serum samples evaluat ed for macrophage colony-stimulating factor and CA 125 levels. Multiva riate analysis was used to determine the associations of surgicopathol ogic findings with macrophage colony-stimulating factor and CA 125 lev els. Logistic regression analysis was used to identify factors associa ted with the risk of extrauterine disease. The association of macropha ge colony-stimulating factor and CA 125 levels with stage, grade, and depth of myometrial invasion and histologic characteristics were analy zed with Fisher's two-tailed exact test. RESULTS: Elevated levels of m acrophage colony-stimulating factor were not associated with depth of myometrial invasion, histologic grade, or histologic cell type; howeve r, advanced stage (p = 0.02) and the presence of lymph node metastases (p = 0.04) were associated with elevated levels. Sensitivity and spec ificity of macrophage colony-stimulating factor for predicting extraut erine disease were 42% and 89%, respectively if either an elevated mac rophage colony-stimulating factor or an elevated CA 125 level was used to predict extrauterine disease, the sensitivity was increased to 67% but the specificity was decreased to 78%. Macrophage colony-stimulati ng factor elevations predicted lymph node metastases with a sensitivit y of 50% and a specificity of 86%. A multivariate regression model sho wed CA 125 to be the most significant predictor of extrauterine diseas e; macrophage colony-stimulating factor also contributed prognostic in formation (p = 0.02). The sensitivity and specificity of the multivari ate model for predicting extrauterine disease were 75% and 73%, respec tively. CONCLUSION: Macrophage colony-stimulating factor and CA 125 ar e neither sensitive nor specific enough to be used as predictors of th e presence or absence of extrauterine disease in patients with endomet rial cancer.