Preoperative CA125 Significantly Improves Risk Stratification
in High-Grade Endometrial Cancer

LOMBAERS, Marike S, Karlijn M C CORNEL, Nicole C M VISSER, Johan BULTEN, Heidi V N KUESTERS-VANDEVELDE, Frederic AMANT, Dorry BOLL, Peter BRONSERT, Eva COLAS, Peggy M A J GEOMINI, Antonio GIL-MORENO, Dennis VAN HAMONT, Jutta HUVILA, Camilla A KRAKSTAD, Arjan A KRAAYENBRINK, Martin KOSKAS, Gemma MANCEBO, Xavier MATIAS-GUIU, Huy M NGO, Brenda M PIJLMAN, Maria Caroline VOS, Vít WEINBERGER, Marc P L M W SNIJDERS, Sebastiaan W S VAN KOEVERDEN, Ingfrid S HALDORSEN, Casper REIJNEN and Johanna M A PIJNENBORG. Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer. Cancers. BASEL: MDPI, 2023, vol. 15, No 9, p. 1-12. ISSN 2072-6694. Available from: https://dx.doi.org/10.3390/cancers15092605.

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TY  - JOUR
ID  - 2293066
AU  - Lombaers, Marike S - Cornel, Karlijn M C - Visser, Nicole C M - Bulten, Johan - Kuesters-Vandevelde, Heidi V N - Amant, Frederic - Boll, Dorry - Bronsert, Peter - Colas, Eva - Geomini, Peggy M A J - Gil-Moreno, Antonio - van Hamont, Dennis - Huvila, Jutta - Krakstad, Camilla A - Kraayenbrink, Arjan A - Koskas, Martin - Mancebo, Gemma - Matias-Guiu, Xavier - Ngo, Huy M - Pijlman, Brenda M - Vos, Maria Caroline - Weinberger, Vít - Snijders, Marc P L M W - van Koeverden, Sebastiaan W S - Haldorsen, Ingfrid S - Reijnen, Casper - Pijnenborg, Johanna M A
PY  - 2023
TI  - Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer
JF  - Cancers
VL  - 15
IS  - 9
SP  - 1-12
EP  - 1-12
PB  - MDPI
SN  - 20726694
KW  - endometrial cancer
KW  - advanced stage
KW  - outcome
KW  - high-grade
KW  - CA125
UR  - https://www.mdpi.com/2072-6694/15/9/2605
N2  - Simple Summary Patients with high-grade uterine cancer (UC) have a risk of around 20% of the cancer spreading to the lymph nodes, while this is only around 10% in patients with low-grade uterine cancer. CA125 is a marker that can be detected in blood and is associated with increased tumor spread. Studies on CA125 and its association with tumor spread within low-grade UC exist but are limited for high-grade UC. The primary aim of this retrospective study was to assess whether elevated CA125 is predictive for UC spread and survival. Secondarily, we studied the additional value of preoperative imaging by CT scan in relation to CA125 specifically in high-grade UC. We observed that elevated CA125 was related to advanced stage and LNM in high-grade UC and a worse prognosis. If CA125 was normal, the additional value of CT to predict lymph node spread was limited. Abstract Patients with high-grade endometrial carcinoma (EC) have an increased risk of tumor spread and lymph node metastasis (LNM). Preoperative imaging and CA125 can be used in work-up. As data on cancer antigen 125 (CA125) in high-grade EC are limited, we aimed to study primarily the predictive value of CA125, and secondarily the contributive value of computed tomography (CT) for advanced stage and LNM. Patients with high-grade EC (n = 333) and available preoperative CA125 were included retrospectively. The association of CA125 and CT findings with LNM was analyzed by logistic regression. Elevated CA125 ((>35 U/mL), (35.2% (68/193)) was significantly associated with stage III-IV disease (60.3% (41/68)) compared with normal CA125 (20.8% (26/125), [p < 0.001]), and with reduced disease-specific-(DSS) (p < 0.001) and overall survival (OS) (p < 0.001). The overall accuracy of predicting LNM by CT resulted in an area under the curve (AUC) of 0.623 (p < 0.001) independent of CA125. Stratification by CA125 resulted in an AUC of 0.484 (normal), and 0.660 (elevated). In multivariate analysis elevated CA125, non-endometrioid histology, pathological deep myometrial invasion >= 50%, and cervical involvement were significant predictors of LNM, whereas suspected LNM on CT was not. This shows that elevated CA125 is a relevant independent predictor of advanced stage and outcome specifically in high-grade EC.
ER  -

Basic information
Original name	Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer
Authors	LOMBAERS, Marike S (guarantor), Karlijn M C CORNEL, Nicole C M VISSER, Johan BULTEN, Heidi V N KUESTERS-VANDEVELDE, Frederic AMANT, Dorry BOLL, Peter BRONSERT, Eva COLAS, Peggy M A J GEOMINI, Antonio GIL-MORENO, Dennis VAN HAMONT, Jutta HUVILA, Camilla A KRAKSTAD, Arjan A KRAAYENBRINK, Martin KOSKAS, Gemma MANCEBO, Xavier MATIAS-GUIU, Huy M NGO, Brenda M PIJLMAN, Maria Caroline VOS, Vít WEINBERGER (203 Czech Republic, belonging to the institution), Marc P L M W SNIJDERS, Sebastiaan W S VAN KOEVERDEN, Ingfrid S HALDORSEN, Casper REIJNEN and Johanna M A PIJNENBORG.
Edition	Cancers, BASEL, MDPI, 2023, 2072-6694.

Other information
Original language	English
Type of outcome	Article in a journal
Field of Study	30214 Obstetrics and gynaecology
Country of publisher	Switzerland
Confidentiality degree	is not subject to a state or trade secret
WWW	URL
Impact factor	Impact factor: 5.200 in 2022
RIV identification code	RIV/00216224:14110/23:00131035
Organization unit	Faculty of Medicine
Doi	http://dx.doi.org/10.3390/cancers15092605
UT WoS	000986951900001
Keywords in English	endometrial cancer; advanced stage; outcome; high-grade; CA125
Tags	14110240, rivok
Tags	International impact, Reviewed
Changed by	Changed by: Mgr. Tereza Miškechová, učo 341652. Changed: 21/6/2023 14:03.

Abstract

Simple Summary Patients with high-grade uterine cancer (UC) have a risk of around 20% of the cancer spreading to the lymph nodes, while this is only around 10% in patients with low-grade uterine cancer. CA125 is a marker that can be detected in blood and is associated with increased tumor spread. Studies on CA125 and its association with tumor spread within low-grade UC exist but are limited for high-grade UC. The primary aim of this retrospective study was to assess whether elevated CA125 is predictive for UC spread and survival. Secondarily, we studied the additional value of preoperative imaging by CT scan in relation to CA125 specifically in high-grade UC. We observed that elevated CA125 was related to advanced stage and LNM in high-grade UC and a worse prognosis. If CA125 was normal, the additional value of CT to predict lymph node spread was limited. Abstract Patients with high-grade endometrial carcinoma (EC) have an increased risk of tumor spread and lymph node metastasis (LNM). Preoperative imaging and CA125 can be used in work-up. As data on cancer antigen 125 (CA125) in high-grade EC are limited, we aimed to study primarily the predictive value of CA125, and secondarily the contributive value of computed tomography (CT) for advanced stage and LNM. Patients with high-grade EC (n = 333) and available preoperative CA125 were included retrospectively. The association of CA125 and CT findings with LNM was analyzed by logistic regression. Elevated CA125 ((>35 U/mL), (35.2% (68/193)) was significantly associated with stage III-IV disease (60.3% (41/68)) compared with normal CA125 (20.8% (26/125), [p < 0.001]), and with reduced disease-specific-(DSS) (p < 0.001) and overall survival (OS) (p < 0.001). The overall accuracy of predicting LNM by CT resulted in an area under the curve (AUC) of 0.623 (p < 0.001) independent of CA125. Stratification by CA125 resulted in an AUC of 0.484 (normal), and 0.660 (elevated). In multivariate analysis elevated CA125, non-endometrioid histology, pathological deep myometrial invasion >= 50%, and cervical involvement were significant predictors of LNM, whereas suspected LNM on CT was not. This shows that elevated CA125 is a relevant independent predictor of advanced stage and outcome specifically in high-grade EC.

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Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer

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