VALUE OF PREOPERATIVE CA-125 LEVEL IN THE MANAGEMENT OF UTERINE-CANCER AND PREDICTION OF CLINICAL OUTCOME

Objective: To enhance cost-effective management of uterine cancer by p redicting the likelihood of extrauterine disease and survival on the b asis of preoperative parameters. Methods: A retrospective review of pr eoperative CA 125 levels from 210 women with endometrial carcinoma was performed. The relationship of preoperative CA 125 levels to various preoperative and postoperative histopathologic factors was investigate d. Results: Elevated CG 125 (greater than 35 U/mL) correlated (P < .05 ) with higher stage, higher grade, increased depth of myometrial invas ion, positive cytology, pelvic or para-aortic lymph node metastases, a nd reduced actuarial survival (P < . 001). Multivariate analysis of pr eoperative factors showed that an elevated CA 125 level was the most i mportant predictor for poor survival (P < .001). Moreover, a preoperat ive CA 125 level greater than 65 U/mL was the most significant predict or of extrauterine disease and carried a 6.5-fold higher risk (95% con fidence interval 2.5, 17.1). A logistic model to predict extrauterine disease was developed. The model has a sensitivity of 62%, specificity of 91%, positive predictive value of 69%, and negative predictive val ue of 88%. Conclusion: A CA 125 level should be included as part of th e preoperative workup for all patients with uterine cancer. Patients w ith a preoperative CA 125 level less than or equal to 20 U/mL should b e considered as candidates for vaginal hysterectomy unless unfavorable histology or a high-grade (grade II or III) tumor is present. In our series, this approach would have eliminated 24% of the abdominal stagi ng procedures, with a risk of less than 3% for extrauterine disease, w hile lowering treatment-related morbidity and cutting costs in the tre atment of this common female cancer. (C) 1997 by the American College of Obstetricians and Gynecologists).