Pg. Rose et al., PREOPERATIVE CA-125 LEVELS PREDICT POOR PROGNOSTIC PATHOLOGICAL FEATURES IN EARLY-STAGE, FIGO GRADE-1 AND GRADE-2 ENDOMETRIAL ADENOCARCINOMA, International journal of gynecological cancer, 3(4), 1993, pp. 259-263
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.