The Prognostic Significance of Preoperative Cancer Antigen-125 Levels in Uterine Papillary Serous Carcinomas

INTRODUCTION: This study aimed to determine the relationship between preoperative cancer antigen(CA)-125 levels and clinicopathologic prognostic factors as well as appropriate cut-off levels for pure uterine papillary serous carcinoma.
METHODS: Study data were collected from the documents and electronic medical records of patients who were diagnosed with pure uterine papillary serous carcinoma between 2005 and 2020 in our institution. The association between clinicopathological variables and CA-125 were analyzed. The accuracy of the preoperative serum CA-125 value in predicting metastasis sites was evaluated by the receiving operating characteristic curve analysis and the most appropriate cut-off values available were selected.
RESULTS: Seventy-eight patients met the study criteria. Median value of preoperative serum CA-125 level was higher in patients with omental (P <0.001), ovarian (P <0.001), cervical involvement (P = 0.017) and deep myometrial invasion (≥50%) (P = 0.001). According to the receiving operating characteristic curve, the optimal cut-off value of preoperative CA-125 level for predicting omental involvement was 35.5 U/mL (sensitivity: 93.8%, specificity: 79.3%), cervical involvement was 15.0 U/mL (sensivity: 86.8%, specificity: 44.7%) and ovarian involvement was 32.5 U/mL (sensivity: 77.3%, specificity: 72.2%).
DISCUSSION AND CONCLUSION: An elevated level of preoperative serum CA-125 is a marker for omental, ovarian, cervical involvement and deep myometrial invasion. The value for cervical involvement may be a guide that radical hysterectomy should be considered in the foreground in patients undergoing surgery. There is a need for future studies to evaluate the role of CA-125 in predicting recurrence and survival in uterine papillary serous carcinoma.

Uterin Papiller Seröz Karsinomlarda Preoperatif Kanser Antijen-125 Düzeylerinin Prognostik Önemi

GÝRÝÞ ve AMAÇ: Bu çalýþmada, pür uterin papiller seröz karsinomda preoperatif kanser antijeni(CA)-125 düzeylerinin çeþitli klinikopatolojik deðiþkenlerle iliþkisinin ve metastaz bölgesini öngörmede optimal cut-off deðerlerinin belirlenmesi amaçlanmýþtýr
YÖNTEM ve GEREÇLER: Çalýþma verileri, kurumumuzda 2005-2020 yýllarý arasýnda pür uterin papiller seröz karsinom tanýsý alan hastalarýn belgelerinden ve elektronik týbbi kayýtlarýndan toplandý. Klinikopatolojik deðiþkenler ile CA-125 arasýndaki iliþki analiz edildi. Preoperatif serum CA-125 deðerinin metastaz bölgelerini tahmin etmedeki doðruluðu, ROC(receiving operating characteristic) eðrisi analizi ile deðerlendirildi ve mevcut en uygun cut-off deðerleri seçildi.
BULGULAR: Yetmiþ sekiz hasta çalýþma kriterlerini karþýladý. Ameliyat öncesi serum CA-125 düzeyi ortanca deðeri omental (P<0,001), over (P<0,001), servikal tutulum (P=0,017) ve derin miyometriyal invazyon (≥%50) (P = 0,001) olan hastalarda daha yüksekti. ROC eðrisine göre, omental tutulumu öngörmek için preoperatif CA-125 seviyesinin optimal cut-off deðeri 35.5 U/mL (duyarlýlýk: %93,8, özgüllük: %79,3), servikal tutulum için 15.0 U/mL ( duyarlýlýk: %86,8, özgüllük: %44,7) ve over tutulumu için 32,5 U/mL (duyarlýlýk: %77,3, özgüllük: %72,2) idi.
TARTIÞMA ve SONUÇ: Preoperatif serum CA-125'in yüksek seviyesi omental, over, servikal tutulum ve derin myometrial invazyon için bir belirteçtir. Servikal tutulum için cut-off deðeri, cerrahi uygulanacak hastalarda radikal histerektominin ön planda düþünülmesi gerektiðine dair bir rehber olabilir. Uterus papiller seröz karsinomunda CA-125'in nüks ve saðkalýmý öngörmedeki rolünü deðerlendirecek ileri çalýþmalara ihtiyaç vardýr.