SERUM CA 125 MEASUREMENTS TO IDENTIFY PATIENTS WITH ENDOMETRIAL CANCER WHO REQUIRE LYMPHADENECTOMY

Background: Most studies evaluating the role of serum CA 125 measureme nts in endometrial cancer report a positive correlation with prognosti c factors. The present study investigates the role of serum CA 125 mea surements as a preoperative aid in the decision whether lymphadenectom y or sampling should be part of the surgical procedure. Patients and M ethods: We retrospectively studied clinical data of 98 patients with e ndometrial cancer (FIGO stage I to III), who had serum samples availab le for analysis of IMx CA 125. Clinical information was included in th e analysis in the order in which it became available to the clinician. Patients were grouped retrospectively on the basis of histopathologic ally determined factors. Those with grade 3 tumors, and/or myometrial invasion greater than or equal to 1/2, and/or cervical involvement, an d/or parametrial or adnexal tissue involvement, and/or bloodvessel inv asion, were retrospectively assigned to require lymphadenectomy or sam pling (N = 60). All other patients were classified as not requiring su ch a procedure (N = 38). Results: Serum IMx CA 125 concentrations corr elated with all factors included in the surgical FIGO classification. The sensitivity to identify patients who would have required a lymphad enectomy or sampling on the basis of precurettage serum CA 125 measure ments ranged between 17% (10/60) with a cut-off of 35 U/ml, and 53% (3 2/60) with a 15 U/ml cut-off Corresponding specificity to exclude pati ents for lymphadenectomy or sampling ranged from 95% (36/38) to 76% (2 9/38), respectively. After curettage, information regarding histologic al grade became available. Using only this information, 17 out of 60 p atients who would have required a lymphadenectomy or sampling could be identified because of their grade 3 tumor. The combination of serum C A 125 and histological grade could identify between 37% (22/60) and 65 % (39/60) of the patients who required a lymphadenectomy or sampling, cut-offs again ranging from 35 to 15 U/ml. Conclusions: CA 125 serum l evels may provide additional information in the preoperative assessmen t of endometrial cancel patients. More studies are needed to establish the appropriate cut-off level for serum CA 125 in this respect.