Preoperatif CA-125 düzeyinin endometrioid endometrium kanserinde lenf nodu tutulumunu öngörmedeki değeri
Abstract
Amaç: endometrioid tip endometrium kanserinde preoperatif serum CA-125 düzeyinin, lenf nodu pozitifliğini öngörmedeki değerinin araştırılması
Gereç ve yöntem: Mart 2007 – Eylül 2020 arasında tersiyer iki merkezde endometrium kanseri tanısı alıp primer cerrahi tedavisi yapılan 513 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen hastaların kliniko-patolojik özellikleri değerlendirildi. Lenf nodu metastazı (LNM) açısından hastalar LNM (-) ve LNM (+) olmak üzere iki gruba ayrıldı. Bu iki grup univaryan ve multivaryan analizlerle karşılaştırıldı.
Sonuçlar: hastaların median yaşı 58 (28-84 yaş), median CA-125 değeri 14 IU/ml (2-600 IU/ml) olarak hesaplandı. Univaryan analizde CA 125≥ 35 IU/ml (p<0,001), Grade III tümör (p<0,001), tümör çapı≥ 35mm (p<0,001), myometrial invazyon≥ %50 (p<0,001), serviks uteri tutulumu (p<0,001), adneksiyal metastaz (p<0,001), uterin serozal tutulum (p<0,001), pozitif sitoloji (p<0,001) ve LVSI (p<0,001) artmış LNM riski ile ilişkili bulundu. Multivaryan analizde CA-125 (GOO=3,005 GA=1,337-6,756 p=0,008), tümör çapı≥ 35mm (GOO=3,174 GA=1,157-8,706 p=0,025) ve LVSI (GOO=11,045 GA=4,147-29,416 p<0,001) LNM için bağımsız risk faktörü olarak saptandı. Lenf nodu metastazı tahmini için optimal preoperatif CA-125 eşik değeri 58 yaş ve üstü hastalarda 35 IU/mL olarak belirlenirken, 58 yaş altında 24 IU/mL olarak saptandı. Alt grup analizinde klinik olarak uterusa sınırlı hastalığı olan toplam 498 hastada multivaryan analizde CA-125 düzeyi (GOO= 4,203, GA=1,738-10,159, p=0,001), tümör çapı≥35mm (GOO=3,452 GA=1,144-10,414 p=0,028) ve LVSI (GOO=11,243, GA=3,996-31,635, p<0,001) LNM için bağımsız risk faktörü olarak saptandı.
Tartışma: Endometrioid endometrium kanserinde tüm evrelerde ve alt grup olarak klinik uterusa sınırlı hastalıkta preoperatif serum CA125≥35 IU/ml, LVSI, tümör çapının ≥35mm olması, LNM öngörülmesinde bağımsız risk faktörü olarak saptandı.
Keywords
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References
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- 4. Pinar Cilesiz Goksedef B, Gorgen H, Baran SY, Api M, Cetin A. Preoperative serum CA 125 level as a predictor for metastasis and survival in endometrioid endometrial cancer. J Obstet Gynaecol Can. Ağustos 2011;33(8):844- 50.
- 5. Jiang T, Huang L, Zhang S. Preoperative serum CA125: a useful marker for surgical management of endometrial cancer. BMC Cancer. 12 Mayıs 2015;15:396.
- 6. Lin H, Wu C, Ou Y, Huang S, Fu H. Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi-institutional cohort study. Intl J Gynecology & Obste. Haziran 2024;165(3):1244-56.
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- 9. Lombaers MS, Cornel KMC, Visser NCM, Bulten J, Küsters-Vandevelde HVN, Amant F, vd. Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer. Cancers. 04 Mayıs 2023;15(9):2605.
- 10. Hsieh CH, ChangChien CC, Lin H, Huang EY, Huang CC, Lan KC, vd. Can a Preoperative CA 125 Level Be a Criterion for Full Pelvic Lymphadenectomy in Surgical Staging of Endometrial Cancer? Gynecologic Oncology. 01 Temmuz 2002;86(1):28-33.
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- 18. Panici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, vd. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. JNCI: Journal of the National Cancer Institute. 2008;100(23):1707-16.
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- 21. Moffatt J, Dwan K, Webster KE, Frost JA, Morrison J. Lymphadenectomy or sentinel node biopsy for the management of endometrial cancer: a network meta- analysis. Cochrane Central Editorial Service, editör. Cochrane Database of Systematic Reviews [Internet]. 12 Eylül 2023 [a.yer 19 Mayıs 2025];2023(9). Erişim adresi: http://doi.wiley.com/10.1002/14651858.CD015786
The value of preoperative CA-125 level in predicting lymph node involvement in endometrioid endometrial cancer.
Abstract
Aim: to investigate the value of preoperative serum CA-125 level in predicting lymph node positivity in endometrioid type endometrial cancer.
Materials and methods: 513 patients who were diagnosed with endometrial cancer and underwent primary surgical treatment in two tertiary centers between March 2007 and September 2020 were included in the study. The clinico-pathological features of the patients included in the study were evaluated. In terms of lymph node metastasis (LNM), the patients were divided into two groups as LNM (-) and LNM (+). These two groups were compared with univariate and multivariate analyses.
Results: the median age of the patients was 58 years (28-84 years), and the median CA-125 value was calculated as 14 IU/ml (2-600 IU/ml). In univariate analysis, CA 125≥ 35 IU/ml (p<0.001), Grade III tumor (p<0.001), tumor diameter≥ 35 mm (p<0.001), myometrial invasion≥ 50% (p<0.001), cervix uteri involvement (p<0.001), adnexal metastasis (p<0.001), uterine serosal involvement (p<0.001), positive cytology (p<0.001) and LVSI (p<0.001) were found to be associated with increased risk of LNM. In multivariate analysis, CA-125 (GOR=3.005 CI=1.337-6.756 p=0.008), tumor diameter≥35 mm (GOR=3.174 CI=1.157-8.706 p=0.025) and LVSI (GOR=11.045 CI=4.147-29.416 p<0.001) were found to be independent risk factors for LNM. The optimal preoperative CA-125 threshold value for the prediction of lymph node metastasis was determined as 35 IU/mL in patients aged 58 years and older, while it was determined as 24 IU/mL in patients aged under 58 years. In the subgroup analysis, in a total of 498 patients with clinically limited disease to the uterus, multivariate analysis revealed that CA-125 level (GOR=4.203, CI=1.738-10.159, p=0.001), tumor diameter≥35 mm (GOR=3.452 CI=1.144-10.414 p=0.028) and LVSI (GOR=11.243, CI=3.996-31.635, p<0.001) were independent risk factors for LNM.
Discussion: in endometrioid endometrial cancer, preoperative serum CA125≥35 IU/ml, LVSI, tumor diameter ≥35 mm were found to be independent risk factors for predicting LNM in all stages and in the subgroup of clinically uterus-limited disease.
Keywords
References
- 1. Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, vd. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. Ocak 2021;31(1):12-39.
- 2. Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, vd. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clinicians. Mayıs 2024;74(3):229-63.
- 3. Fanaki M, Pergialiotis V, Koutras A, Perros P, Vlachos DE, Daskalakis G, vd. Prognostic significance of lymph node ratio in patients with endometrial cancer: A systematic review and meta-analysis. Intl J Gynecology & Obste. 15 Şubat 2025;ijgo.70003.
- 4. Pinar Cilesiz Goksedef B, Gorgen H, Baran SY, Api M, Cetin A. Preoperative serum CA 125 level as a predictor for metastasis and survival in endometrioid endometrial cancer. J Obstet Gynaecol Can. Ağustos 2011;33(8):844- 50.
- 5. Jiang T, Huang L, Zhang S. Preoperative serum CA125: a useful marker for surgical management of endometrial cancer. BMC Cancer. 12 Mayıs 2015;15:396.
- 6. Lin H, Wu C, Ou Y, Huang S, Fu H. Integration of pretreatment tumor markers in a nomogram model for prognostic prediction of FIGO stage I endometrial cancer: A multi-institutional cohort study. Intl J Gynecology & Obste. Haziran 2024;165(3):1244-56.
- 7. Lee J, Kong TW, Paek J, Chang SJ, Ryu HS. Predicting Model of Lymph Node Metastasis Using Preoperative Tumor Grade, Transvaginal Ultrasound, and Serum CA-125 Level in Patients With Endometrial Cancer. International Journal of Gynecological Cancer. Kasım 2016;26(9):1630-5.
- 8. Nicklin J, Janda M, Gebski V, Jobling T, Land R, Manolitsas T, vd. The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer. Intl Journal of Cancer. 15 Ağustos 2012;131(4):885-90.
- 9. Lombaers MS, Cornel KMC, Visser NCM, Bulten J, Küsters-Vandevelde HVN, Amant F, vd. Preoperative CA125 Significantly Improves Risk Stratification in High-Grade Endometrial Cancer. Cancers. 04 Mayıs 2023;15(9):2605.
- 10. Hsieh CH, ChangChien CC, Lin H, Huang EY, Huang CC, Lan KC, vd. Can a Preoperative CA 125 Level Be a Criterion for Full Pelvic Lymphadenectomy in Surgical Staging of Endometrial Cancer? Gynecologic Oncology. 01 Temmuz 2002;86(1):28-33.
- 11. Han SS, Lee SH, Kim DH, Kim JW, Park NH, Kang SB, vd. Evaluation of preoperative criteria used to predict lymph node metastasis in endometrial cancer. Acta Obstet Gynecol Scand. 2010;89(2):168-74.
- 12. Patsner B, Yim GW. Predictive value of preoperative serum CA-125 levels in patients with uterine cancer: The Asian experience 2000 to 2012. Obstet Gynecol Sci. 2013;56(5):281.
- 13. Son JH, Kong TW, Kim SH, Paek J, Chang SJ, Lee EJ, vd. Prediction of lymph node metastasis in patients with apparent early endometrial cancer. Obstet Gynecol Sci. 2015;58(5):385.
- 14. Shi XW, Wang DF, Zhang GN, Zhang J. [Postoperative lymph node metastasis status and related factors in patients with early-stage, low-risk endometrial cancer assessed by the Mayo criteria]. Zhonghua Yi Xue Za Zhi. 12 Mart 2024;104(10):736-41.
- 15. Guntupalli SR, Zighelboim I, Kizer NT, Zhang Q, Powell MA, Thaker PH, vd. Lymphovascular space invasion is an independent risk factor for nodal disease and poor outcomes in endometrioid endometrial cancer. Gynecologic Oncology. Ocak 2012;124(1):31-5.
- 16.KoskasM,BassotK,GraesslinO,AristizabalP,Barranger E, Clavel-Chapelon F, vd. Impact of lymphovascular space invasion on a nomogram for predicting lymph node metastasis in endometrial cancer. Gynecologic Oncology. Mayıs 2013;129(2):292-7.
- 17. Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: Is lymphadenectomy or radiotherapy necessary? American Journal of Obstetrics and Gynecology. Haziran 2000;182(6):1506- 19.
- 18. Panici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, vd. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. JNCI: Journal of the National Cancer Institute. 2008;100(23):1707-16.
- 19. Kitchener H, Swart A, Qian Q, Amos C, Parmar M. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England). 2008;373(9658):125- 36.
- 20. Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R, vd. Uterine neoplasms, version 1.2023, NCCN clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network. 2023;21(2):181-209.
- 21. Moffatt J, Dwan K, Webster KE, Frost JA, Morrison J. Lymphadenectomy or sentinel node biopsy for the management of endometrial cancer: a network meta- analysis. Cochrane Central Editorial Service, editör. Cochrane Database of Systematic Reviews [Internet]. 12 Eylül 2023 [a.yer 19 Mayıs 2025];2023(9). Erişim adresi: http://doi.wiley.com/10.1002/14651858.CD015786
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Gynecologic Oncology Surgery |
| Journal Section | Research Article |
| Authors | |
| Early Pub Date | June 2, 2025 |
| Publication Date | June 2, 2025 |
| Submission Date | April 4, 2025 |
| Acceptance Date | May 27, 2025 |
| Published in Issue | Year 2025 Volume: 25 Issue: 1 |
