The prognostic value of preoperative serum CA125 in endometrioid endometrial cancer with cervical stromal and parametrial invasion

Background:Although endometrial cancer is not ranked among the ten most common types in Iran, it is the 12th most prevalent in women and in cancers of the genital tract it is the third after breast and ovarian cancer.The mortality rate was reported 0.6 in 100,000 persons.Several studies have evaluated the correlation of preoperative CA125 in endometrial cancer with several surgicopathologic and prognostic variables , disease recurrence and need for lymphadenectomy. Recent data suggest adjuvant extrafascial hysterectomy after neoadjuvant therapy in spite of the initial radical hysterectomy for locally advanced disease. Therefore it would be helpful to use the preoperative assessment including serum CA125 to predict the extent of the disease and plan a less complicated therapy. Objective: To evaluate the cut-off value of CA125 in the parametrial and cervical stroma invasion in endometrioid endometrial cancer. Methods: A sample of 128 endometrial cancers, surgically staged from 2012 to 2018 in Imam Hosein Hospital was evaluated. According to exclusion criteria, 82 cases were analyzed finally. Receiver Operating Characteristic (ROC) Curve was used to determine the cut-off value of preoperative CA125 for parametrial and cervical stroma involvement. Results: A high preoperative CA125 level was significantly associated with advanced disease stage, cervical stroma invasion, pelvic lymph node metastases and higher grade (p< 0/05) ;the test showed marginally significant correlation for parametrial invasion, maybe be due to sample size limitation (p=.058). However the correlation between CA125 and myometrial /lymphovascular invasions were not statistically significant (P= 0.112, 0.168 respectively). The suitable cut–off for preoperative CA125 in parametrial invasion was 45.5 u/ml (100% sensitivity, 89% specificity, 33.3% Positive Predictive Value, 100% Negative Predictive Value) and for cervical stroma invasion, it was 41.9 u/ml (87.5% sensitivity, 87.8% specificity, 43.75% Positive Predictive Value and 98.48% Negative Predictive Value).Conclusion: Primary radical surgery may not be the first treatment approach in cervical/parametrial involvement. Neoadjuvant (chemo)radiotherapy and adjuvant extrafascial hysterectomy could be an alternative approach with fewer complications. Using preoperative CA125 along with physical examination and imaging modalities would be helpful in this regard. More investigations are needed to assess an agreed cut-off value for preoperative CA125 and endometrial cancer extension.