Preoperative Serum CA125 and Extrauterine Disease in Patients with Endometrial Cancer

Objective: To study whether the preoperative serum CA125 level was associated with clinicopathological variables in patients with endometrial cancer and whether the level could be used for predicting extrauterine disease. Methods: Records of 132 patients with endometrioid endometrial cancer treated surgically were reviewed and analysed to check for any correlation between preoperative CA125 levels and clinicopathological variables. Receiver operating characteristics (ROC) curves were constructed to determine the best cutoff values of CA125 indicative of extrauterine disease including lymph node metastases. Patient outcomes were reviewed and survival analyses were performed. Results: 15 patients (11%) had extrauterine disease, and 14 had lymph node metastases. Deep myometrial invasion and lymph node metastasis were found to be significantly associated with elevated preoperative CA125 levels. The ROC curves showed the best cutoff level to be 26.2 U/ml. Serum CA125 level above this value had a sensitivity of 93% and positive predictive value of 44% for extrauterine disease. Among those with preoperative CA125 levels below this value, only 1% had extrauterine disease. Despite the more common use of radiotherapy (78% vs 28%), patients with raised CA125 level had more recurrences (16% vs 2%) and poorer survival outcomes. Conclusion: Raised preoperative CA125 levels were associated with extrauterine disease in patients with endometrioid endometrial cancers. Using a cutoff of 26.2 U/ml, raised serum CA125 levels could identify the high-risk patients. Serum CA125 should be checked during preoperative assessment.