PREOPERATIVE CA-125 LEVELS PREDICT POOR PROGNOSTIC PATHOLOGICAL FEATURES IN EARLY-STAGE, FIGO GRADE-1 AND GRADE-2 ENDOMETRIAL ADENOCARCINOMA

Preoperative CA-125 levels were studied in patients with favorable his tology and early clinical stage endometrial adenocarcinoma to determin e its ability to predict the presence of poor pathologic prognostic fe atures on final pathology. One hundred and one patients with clinical stage I (N = 65) or II (N = 19) or diagnosed by endometrial curettage (EMC) only (N-17) with grade 1 or 2 endometrial adenocarcinoma without gross cervical involvement underwent preoperative CA-125 levels. Fina l pathology was reviewed for five poor prognostic pathologic features: FIGO grade 3 histology, unfavorable histologic type (sarcoma, clear c ell, or papillary serous), invasion into the outer third of the myomet rium, extension to the cervix, and extra-uterine metastases. Fifteen p atients (14.9%) had CA-125 levels greater than 30 IU ml-1. Of these 15 patients, 12 had one or more of the five poor prognostic pathologic f eatures (positive predictive value 80.0%, specificity 95.8%, P < 0.000 1). However, since 30 of the 101 patients were found to have one or mo re of these poor prognostic pathologic features the sensitivity was on ly 40.0%. When clinical stage I patients were analyzed separately thre e patients (4.6%) had CA-125 levels greater than 30 IU ml-1 (positive predictive value 100%, specificity of 100%, sensitivity of 21.4%, P = 0.008). For patients with clinical stage II carcinoma, CA-125 was not predictive of pathologic findings except as a negative predictor of di sease in a subgroup of patients whose endocervical curettage (ECC) dem onstrated carcinoma unattached to endocervical tissue. In patients dia gnosed by EMC only, an elevated CA-125 level was associated with poor prognostic pathologic features (P = 0.001). An elevated preoperative C A-125 reliably predicts advanced disease even in patients with apparen tly favorable histology and clinical stage, however the sensitivity of this method remains low.