子宫内膜增生过长和子宫内膜样腺癌中VEGF 和TSP-1表达与血管新生研究

目的探讨子宫内膜增生过长及子宫内膜样腺癌中血管内皮生长因子(VEGF)和血小板反应素1(TSP-1)表达与血管新生的关系以及对子宫内膜样腺癌的发生、发展中的作用.方法采用免疫组织化学方法分别检测子宫内膜正常(12例)、增生过长(13例)、不典型增生(18例)及子宫内膜样腺癌(50例)中微血管密度(MVD)、VEGF及TSP-1表达情况.结果子宫内膜不典型增生和内膜样腺癌中MVD明显大于内膜正常及增生过长者(P＜0.05),子宫内膜样腺癌IA期与不典型增生二者的MVD差异无显著性(P＞0.05),而与正常内膜和增生过长者差异有显著性(P＜0.05);VEGF表达与上述不同内膜病变中MVD呈正相关(r=0.843,P=0.000 1),而TSP-1表达仅在子宫内膜样腺癌中分别与MVD和VEGF呈负相关趋势(r=-0.233,P=0.1041;r=-0.235,P=0.100 3);在子宫内膜样腺癌中TSP-1间质高表达且具有异质性.结论子宫内膜不典型增生和子宫内膜样腺癌中VEGF对血管新生起正向调节作用;TSP-1在部分腺癌患者中表达增强,但其负向调节作用较弱,可能会使血管新生开关平衡失调,与子宫内膜样腺癌发生及发展有关.     

VEGF和CD31在子宫内膜样腺癌中的表达及其临床意义

目的:检测血管内皮生长因子(VEGF)和CD31在不同子宫内膜组织中的表达情况。方法:采用免疫组化方法检测VEGF、CD31在52例子宫内膜样腺癌组织、22例子宫内膜不典型增生组织及21例正常子宫内膜组织中的表达,对结果进行量化分析。结果:(1)VEGF在正常子宫内膜组织、不典型增生组织及子宫内膜样腺癌中表达的阳性率分别为23.8%、31.8%、65.4%;CD31在正常子宫内膜组织、不典型增生组织及子宫内膜样腺癌组织中标记的微血管密度(microvessel density,MVD)分别为23.6±11.7、31.5±17.7、51.9±21.1。VEGF的阳性表达及CD31-MVD(CD31标记的MVD)在子宫内膜样腺癌组织中明显高于不典型增生及正常子宫内膜组织(P0.05)。(2)VEGF在子宫内膜样腺癌中的表达,与淋巴结转移有关(P0.05)。CD31-MVD与肿瘤分期、浸润肌层深度、组织学类型有关(P0.05)。(3)在子宫内膜样腺癌组织,VEGF表达与CD31-MVD无明显相关性(r=0.095,P=0.504)。结论:VEGF表达、CD31-MVD在子宫内膜样腺癌组织中增高,可能促进子宫内膜样腺癌的发生发展及转移浸润。     

Twist与E-cadherin在子宫内膜样腺癌中的表达及意义

目的:检测转录因子(Twist)及上皮钙黏蛋白(E-cadherin)在子宫内膜样腺癌中的表达水平,探讨两者在子宫内膜样腺癌的发生发展中的作用.方法:利用免疫组化方法检测36例子宫内膜样腺癌及20例正常子宫内膜组织中Twist及E-cadherin的表达情况,分析两者与子宫内膜样腺癌临床病理参数的关系.结果:Twist在子宫内膜样腺癌组织中的阳性表达率(91.7％)显著高于正常子宫内膜组织(35.0％),其差异有统计学意义(U=3.856,P=0.000);而E-cadherin在正常子宫内膜中的阳性表达率(100.0％)明显高于在子宫内膜样腺癌组织(44.4％),差异有统计学意义(U=3.725,P=0.000).Twist在子宫内膜样腺癌组织中的表达与组织学分级(x2=8.806,P=0.012)及肌层浸润程度(U=2.31,P=0.021)有关.E-cadherin的表达与子宫内膜样腺癌组织学分级(x2=7.069,P=0.029)、肌层浸润深度(U=2.086,P=0.037)、临床FIGO分期(U =2.569,P=0.010)及有无淋巴结转移(U=2.263,P=0.024)有关.Twist表达与E-cadherin表达呈负相关(r=-0.446,P=0.006).结论:Twist在子宫内膜样腺癌的表达增高,而E-cadherin的表达降低.两者在子宫内膜样腺癌发生发展过程中起着一定的作用,两者之间存在着一定的联系.     

血管内皮生长因子与雌孕激素受体在子宫内膜腺癌中的表达及意义

目的:探讨子宫内膜腺癌组织中血管内皮生长因子(VEGF)表达与雌激素受体(ER)α及β、孕激素受体(PR)的表达及其与临床病理特征的关系。方法:采用免疫组化(SP)方法检测93例子宫内膜腺癌(内膜腺癌组)和31例正常子宫内膜(正常内膜组)VEGF、ERα、ERβ及PR的表达。结果:1内膜腺癌组VEGF阳性表达率(58.1%)明显高于正常内膜组(32.3%),而ERα的阳性表达率(59.1%)明显低于正常内膜组(80.6%),差异均有统计学意义(P0.05)。ERβ、PR的阳性表达率差异无统计学意义(P0.05)。2在子宫内膜腺癌组织中,VEGF的阳性表达在病理分期和有无淋巴结转移中比较,差异有统计学意义(P0.05);ERα的阳性表达率在病理分期、组织学分级、肌层浸润深度中比较,差异有统计学意义(P0.05);PR的阳性表达率在病理分期和组织学分级中比较,差异有统计学意义(P0.05);ERβ的阳性表达率在临床病理特征中的比较,差异均无统计学意义(P0.05)。3VEGF与ERα的表达呈负相关(r=-0.273,P=0.046)。结论:VEGF及ERα的表达与子宫内膜腺癌的发生发展及预后有关,VEGF及ERα的检测可能有助于评估子宫内膜腺癌的生物学行为和预后。     

G蛋白偶联受体30和磷酸化AKT在子宫内膜腺癌中表达及意义

目的:探讨G蛋白偶联受体30(GPR30)和磷酸化AKT(P-AKT)在子宫内膜腺癌发生发展中的作用及相互关系。方法:用免疫组化SP法检测10例增生期子宫内膜,49例子宫内膜增殖症,55例子宫内膜腺癌组织中GPR30和P-AKT的表达。结果:GPR30蛋白在子宫内膜腺癌、子宫内膜增殖症的阳性表达率(81.8%、67.3%)均明显高于增生期子宫内膜中的阳性表达率(20.0%);子宫内膜增殖症中GPR30蛋白在单纯型增生子宫内膜(SH)、复杂型增生子宫内膜(CH)和不典型增生子宫内膜(AH)的阳性表达率分别为30.0%(3/10),70.0%(14/20)和84.2%(16/19),AH和SH的差异有统计学意义(P=0.012)。P-AKT在子宫内膜腺癌、子宫内膜增殖症的阳性表达率(78.2%、71.4%)均显著高于增生期子宫内膜中的阳性表达率(20.0%);子宫内膜增殖症中P-AKT蛋白在SH、CH、AH的阳性表达率分别为40.0%(4/10),65.0%(13/20)和94.7%(18/19),AH与SH的差异有统计学意义(P=0.005)。子宫内膜腺癌GPR30、P-AKT蛋白阳性表达率与组织分化程度、FIGO分期及患者是否绝经有关,在中、低分化组(P=0.023;P=0.009)、FIGOⅡ～Ⅲ期(P=0.039;P=0.017)及绝经后(P=0.046;P=0.031)较高。肌层浸润较深的子宫内膜腺癌P-AKT蛋白表达水平高于肌层浸润较浅者(P=0.042)。子宫内膜腺癌组织中GPR30与P-AKT蛋白表达呈正相关(P<0.001)。结论:GPR30和P-AKT活化与子宫内膜癌的发生发展有关。     

S100A14在子宫内膜癌中的表达及其意义

目的:探讨S100A14在子宫内膜样腺癌中的表达及其临床意义。方法:采用免疫组化法检测子宫内膜癌组织、不典型增生子宫内膜组织、单纯性增生子宫内膜组织及正常子宫内膜组织中S100A14的表达情况。结果:84例子宫内膜癌患者中,高、中分化与低分化癌组织中S100A14表达具有统计学差异(P=0.020,P=0.034);行淋巴结清扫的74例子宫内膜癌患者中,淋巴结阴性与淋巴结阳性癌组织中S100A14表达有统计学差异(P=0.044)。子宫内膜癌组织中S100A14的表达与正常内膜组织比较,差异有统计学意义(P=0.034),单纯性增生、不典型增生子宫内膜组织中S100A14的表达与正常内膜组织比较,无统计学差异。结论:S100A14的表达下调与子宫内膜样腺癌的恶性程度及肿瘤转移程度相关。     

IGFBP-7在子宫内膜腺癌中的表达及其意义

目的:研究胰岛素样生长因子结合蛋白7(IGFBP-7)在子宫内膜腺癌组织的表达,并分析其与子宫内膜样腺癌临床病理参数之间的关系。方法:选取2011年1月~2012年12月郑州大学第一附属医院病理科存档的手术切除石蜡包埋子宫内膜组织标本共123例,其中子宫内膜样腺癌61例,子宫内膜非典型增生22例,子宫内膜简单性增生10例,正常子宫内膜组织30例。免疫组化SP法检测IGFBP-7的表达,实时荧光定量RT-PCR法检测IGFBP-7 mRNA的表达。分析IGFBP-7的阳性表达率与子宫内膜样腺癌临床病理参数之间的关系。结果:(1)免疫组化法检测显示,子宫内膜样腺癌组织中的IGFBP-7阳性表达率显著高于子宫内膜非典型增生和子宫内膜简单性增生(P0.05);IGFBP-7的表达与子宫内膜癌的病理分级、超重、合并高血压、合并糖尿病有关(P0.05);(2)RT-PCR检测结果显示,子宫内膜样腺癌中IGFBP7 mRNA表达量显著高于子宫内膜非典型增生、简单性增生和正常子宫内膜组织(P0.01)。结论:IGFBP-7基因可能参与了子宫内膜腺癌的发生发展过程。     

COX-2和VEGF在子宫内膜腺癌中表达及其与肌层侵袭和淋巴转移的关系

目的 探讨COX-2和VEGF在子宫内膜腺癌中表达与肌层侵袭和淋巴转移的关系.方法 收集上海交通大学附属第六人民医院2006年9月至2008年7月手术切除子宫内膜腺癌标本60例,根据有无深肌层浸润和(或)淋巴转移将子宫内膜腺癌分为两组,应用荧光定量PCR、蛋白印迹法测定腺癌组织中COX-2、VEGF的表达水平,以正常子宫内膜组织作为对照组.结果 (1)子宫内膜腺癌组织COX-2与VEGF mRNA表达呈正相关(r=0.7137,P=0.0001);(2)对照组中COX-2和VEGF mRNA表达(4.78±1.07、3.37±0.70)均高于低危组(3.84±0.91、2.55±1.02).差异有统计学意义(P<0.05);(3)低危组中COX-2和VEGF蛋白表达(0.13±0.10、0.68±0.16)均低于高危组(0.20±0.12、0.83±0.14),差异有统计学意义(P<0.05).结论子宫内膜腺癌组织中COX-2可能上调VEGF的表达水平,促进新生血管和淋巴管生成,从而促进肌层浸润和淋巴转移,为临床预防、治疗及预后判断提供参考.     

微管相关蛋白LC3和组织蛋白酶D在子宫内膜样腺癌中的表达及意义

目的:探讨微管相关蛋白LC3、组织蛋白酶D在子宫内膜样腺癌组织中的表达及与临床病理参数之间的关系。方法:用免疫组织化学法检测12例正常增生期子宫内膜、12例子宫内膜增殖症以及51例子宫内膜样腺癌组织中LC3和组织蛋白酶D的表达并分析。结果:LC3在子宫内膜样腺癌组织的表达强度显著低于正常增生期内膜和子宫内膜增殖症(P＜0．001,P＜0．001) LC3在子宫内膜样腺癌中的表达强度与组织学分级以及手术病理分期呈明显的负相关(r=-0．390,P＜0．001;r=-0．312,P＜0．05)。组织蛋白酶D在子宫内膜样腺癌组织中的表达显著低于正常增生期内膜(P＜0．05)。结论:自噬活性相关的LC3、组织蛋白酶D在子宫内膜样腺癌中的表达下降,自噬活性的改变可能参与了子宫内膜样腺癌的发生和演进过程。     

G蛋白偶联雌激素受体在子宫内膜腺癌组织表达及其意义

目的探讨G蛋白偶联雌激素受体(GPER)在子宫内膜腺癌组织中发生发展的作用。方法选取2005年3月至2008年4月郑州大学第一附属医院病理科手术及活检标本的存档蜡块,采用免疫组织化学SP法检测55例子宫内膜腺癌、49例子宫内膜增殖症及10例正常增生期子宫内膜组织中GPER蛋白的表达,分析其与子宫内膜腺癌患者临床病理特征的关系。结果正常增生期子宫内膜组织、子宫内膜增殖症组织和子宫内膜腺癌组织中GPER蛋白的阳性表达率分别为20.0%、67.3%和81.8%,差异具有统计学意义(χ2=15.778,P<0.001)。子宫内膜增殖症中,简单型增生、复杂型增生及不典型增生内膜组织中GPER蛋白的阳性表达率分别为30.0%、70.0%和84.2%,差异具有统计学意义(χ2=8.864,P=0.012)。绝经后和未绝经子宫内膜腺癌组织中GPER的阳性表达率分别为89.7%和62.5%,差异具有统计学意义(χ2=3.977,P=0.046)。高分化和中、低分化子宫内膜腺癌组织中GPER的阳性表达率分别为71.4%和100%,差异具有统计学意义(χ2=5.196,P=0.023)。临床分期Ⅰ期和(Ⅱ+Ⅲ)期子宫内膜腺癌组织中GPER的阳性表达率分别为73.0%和100%,差异具有统计学意义(χ2=4.268,P=0.039)。有淋巴结转移和无淋巴结转移的子宫内膜腺癌组织中GPER的阳性表达率分别为66.7%和83.7%,差异无统计学意义(χ2=0.210,P=0.646)。在肌层浸润深度<1/2和≥1/2的子宫内膜腺癌组织中GPER的阳性表达率分别为75%和100%,差异无统计学意义(χ2=3.057,P=0.080)。结论 GPER与子宫内膜腺癌的发生、发展可能具有相关性。     

基质金属蛋白酶及其组织抑制因子在子宫内膜癌中的表达及其意义

目的　研究基质金属蛋白酶 (matrixmetalloproteinases,MMPs) 2、9及其组织抑制因子(tissueinhibitorofmetalloproteinases ,TIMPs) 1、2在子宫内膜癌中的表达 ,探讨其与子宫内膜癌浸润转移的关系。方法　应用链霉菌抗生物素蛋白 过氧化物酶免疫组织化学方法和明胶酶谱法对 37例内膜癌及 7例绝经期妇女子宫内膜组织中MMP 2、MMP 9、TIMP 1、TIMP 2蛋白及其活性进行检测。结果　MMP 2、MMP 9及TIMP 1、TIMP 2蛋白主要分布在内膜癌细胞、血管内皮细胞及绝经期子宫内膜腺上皮细胞中 ,在间质细胞中也有少量表达。内膜癌细胞中 ,MMP 2、MMP 9及TIMP 1蛋白的表达 ,病理分级为G3内膜癌的强阳性率分别为 73%、2 0 %及 6 7% ,高于G2 (13%、0及 2 7% )、G1 者 (均为 0 ,P<0 0 5 ) ;深肌层浸润内膜癌的强阳性率分别为 6 3%、16 %及 6 8% ,高于浅肌层浸润的 8%、0及 0 (P<0 0 1) ;有淋巴结转移者的强阳性率分别为 4例中 4例、4例中 3例及 4例中 4例 ,高于无淋巴结转移者的 2 5 %、0及 2 5 % (P <0 0 5 ) ;手术病理分期为Ⅲ～Ⅳ期者强阳性率分别为 5例中 5例、5例中 3例及 5例中 5例 ,高于Ⅰ～Ⅱ期者的 30 %、0及 30 % (P <0 0 5 ) ;TIMP 2蛋白在不同病理分级、肌层浸润、淋巴结转移和手术病理分期的内膜癌细     

Interferon regulatory factor-1 expression in human uterine endometrial carcinoma

OBJECTIVES: The objective was to investigate the expression of interferon regulatory factors 1 (IRF-1) in human uterine endometrial carcinoma. METHODS: Formalin-fixed, paraffin-embedded, archival tissue specimens from 76 human endometrial carcinomas and stained with polyclonal anti-IRF-1 antibody, using immunohistochemistry, localization, and immunostaining, were evaluated quantitatively using the H score together with 30 normal endometrium and 16 postmenopausal endometrium. RESULTS: The expression of IRF-1 was highest in normal endometrium, and decreased with the grade of endometrioid adenocarcinoma from grade 1 to grade 3. Postmenopausal endometrium was virtually unstained. CONCLUSIONS: Expression of IRF-1 is altered in human endometrioid adenocarcinoma compared with normal endometrium and postmenopausal endometrium. The loss of IRF-1 expression does not contradict with the tumor-suppressor function. The intensity of IRF-1 expression in each grade of endometrioid adenocarcinoma could be useful prognostic and therapeutic indicators.     

Cytosol vascular endothelial growth factor in endometrial carcinoma: correlation with disease-free survival

OBJECTIVE: The aim of this study was to evaluate whether vascular endothelial growth factor (VEGF) could be a marker for disease-free survival in endometrial carcinoma patients. METHODS: Fifty-three patients with endometrial carcinoma undergoing surgery were enrolled. Clinical and pathologic items were recorded. Cytosol VEGF was quantified by enzyme immunoassay. The microvessel density (MVD) of the excised tumors was immunohistochemically assessed. The relationship among MVD, cytosol VEGF concentration of the tumor tissues, and clinicopathologic parameters was analyzed. The risk factors influencing clinical outcome were tested. RESULTS: Higher cytosol VEGF concentrations and MVD values were noted in tumors with advanced stage (more than stage I) (917 versus 125 pg/mg, P = 0.03; 94.1 +/- 37.8 versus 60.8 +/- 38.9, P = 0.008), lymphovascular emboli (917 versus 102 pg/mg, P = 0.001; 94.4 +/- 33.2 versus 62.4 +/- 40.7, P = 0.009), and lymph node metastasis (1032 versus 95 pg/mg, P < 0.001; 116.5 +/- 30.8 versus 56.7 +/- 33.3, P < 0.001). The cytosol VEGF and MVD showed a positive linear correlation (VEGF versus MVD, r = 0.41, P = 0.003). Grade 3 tumor and overexpressed cytosol VEGF (> 800 pg/mg) are independent risk factors for recurrence. There was a trend that patients with grade 1 or 2 tumors and normal-expressed VEGF had the highest probability of disease-free survival, and patients with grade 3 tumors and overexpressed cytosol VEGF had the poorest probability of disease-free survival. CONCLUSIONS: Cytosol VEGF had a good correlation with the disease progression and metastasis in endometrial carcinoma, and it might also be an independent prognostic factor for disease-free survival of endometrial carcinoma patients.     

Leukaemia inhibitory factor (LIF) is immunohistochemically expressed in normal, hyperplastic and malignant endometrial tissue

OBJECTIVE: Leukaemia inhibitory factor (LIF) is a pleiotrophic cytokine, which might play an important role in human reproduction and endocrine-responsive tumours. Therefore, the aim of this study was to determine the frequency and tissue distribution of LIF in normal, hyperplastic and malignant endometrium. STUDY DESIGN: Paraffin-fixed endometrial tissue was obtained from normal premenopausal women (n = 15), endometrial hyperplasia (n = 20), endometroid adenocarcinoma (n = 32) and endometrial polyps (n = 9). The LIF expression was demonstrated by immunohistochemical means and evaluated with a semi-quantitative immunoreactive score. The Mann-Whitney U-test was used for statistical evaluation. RESULTS: The lowest expression of LIF was observed in endometrial adenocarcinomas compared to all groups, while endometrial polyps expressed the highest LIF immunostaining. The expression in normal human glandular cells was significantly higher during the late secretory phase than in the proliferative phase. The highest expression of LIF was observed in endometrial polyps. Simple hyperplasia showed a significantly higher LIF expression than proliferative endometrium and adenocarcinoma. Adenomatous hyperplasia (AH) grade I-III had a significantly higher LIF expression than adenocarcinoma. The lowest expression of LIF was observed in adenocarcinoma, being statistically significant compared to all groups. CONCLUSION: LIF was immunohistochemically demonstrated in normal, hyperplastic and malignant endometrial tissue, suggesting a widespread but complex role for LIF in hyperplastic and malignant endometrial growth regulation. AH I-III also expressed LIF with statistically higher immunostaining than adenocarcinoma. Since AH III can be considered as a precursor of endometrial cancer, LIF could be a marker of cell transformation.     

Expression of fos and jun proto-oncogenes in benign versus malignant human uterine tissue

OBJECTIVE: The objective of this study was to evaluate expression of fos and jun proto-oncogenes in benign human uterine tissue compared with malignant uterine tissue. METHODS: Forty-two endometrial tissue specimens were obtained at the time of hysterectomy. Tissue samples from different phases of the menstrual cycle and from postmenopausal patients were stained using immunohistochemical methods to detect Fos and Jun proteins, estrogen and progesterone receptor status, and Ki67 (detects a nuclear antigen associated with proliferating cells). Tissue was examined microscopically for nuclear staining in endometrial epithelium and stroma. The endometrium was based on the patient's last menstrual period, pathologic dating, and proliferative versus nonproliferative status as determined by Ki67. Benign and malignant specimens were subjected to Northern blot analysis to evaluate levels of expression of c-fos, c-jun, and jun-B mRNA. The pattern of c-fos mRNA expression in malignant samples was further evaluated using in situ hybridization. RESULTS: In proliferative, secretory, postmenopausal, and progesterone-influenced, uterine specimens immunohistochemically stained and examined, the endometrial and stromal nuclei stained for both Fos and Jun in varying intensities. However, no pattern was found in the variation of intensity according to the phase of the endometrium. Similarly, in malignant and benign endometrial tissue examined by Northern blot and in situ hybridization analyses, expression of proto-oncogene mRNAs was readily detectable, but no statistical correlation between type of tissue examined, grade of adenocarcinoma, and stage of endometrial cancer was found in this study. CONCLUSIONS: In rodent models, control of uterine cell proliferation is related to change in expression of fos and jun proto-oncogenes. Our results indicate that hormonal control is likely to be different in human endometrium and probably involves genes other than the proto-oncogenes under study. Expression of Fos and Jun do not correlate with endometrial cancer stage and grade.     

Platelet-derived endothelial cell growth factor as a prognostic factor for radiotherapy outcome in patients with adenocarcinoma of the uterine cervix

OBJECTIVE: The aim of this study was to evaluate the platelet-derived endothelial cell growth factor (PD-ECGF) and VEGF expressions of tumor cells as prognostic factors for radiotherapy outcome in patients with adenocarcinoma of the uterine cervix. METHODS: In 47 formalin fixed, paraffin-embedded tissues from adenocarcinoma of the uterine cervix which had been treated with radiation (1970-1995), PD-ECGF and VEGF expressions were determined using immunohistochemistry, and the relationships between PD-ECGF or VEGF expressions and local control or survival were assessed. RESULTS: PD-ECGF and VEGF expressions were successfully detected in the cytoplasm and/or nucleus of adenocarcinoma cells of the uterine cervix. Of the 47 patients, 44.6 (21/47 cases) and 57.4% (27/47 cases) were positive for PD-ECGF and VEGF, respectively. There was no correlation between PD-ECGF or VEGF expressions and age, grade, or histologic subtypes. Stage and high expression of PD-ECGF showed a significant correlation to local control (P = 0.0025, P = 0.0057, respectively) and were significant independent prognostic factors for 5-year survival in multivariate analysis (P = 0.0039, P = 0.0032, respectively). CONCLUSION: This study demonstrated that PD-ECGF expression was a significant prognostic factor for radiotherapy outcome in patients with adenocarcinoma of the uterine cervix. Preradiation assessment of PD-ECGF expression may be helpful in selecting high-risk patients, providing them with opportunities to receive more sophisticated and individualized treatments.     

Preoperative CA-125 levels predict poor prognostic pathologic features in early stage, FIGO grade 1 and 2 endometrial adenocarcinoma

Preoperative CA-125 levels were studied in patients with favorable histology and early clinical stage endometrial adenocarcinoma to determine its ability to predict the presence of poor pathologic prognostic features on final pathology. One hundred and one patients with clinical stage I ( N = 65) or II ( N = 19) or diagnosed by endometrial curettage (EMC) only ( N -17) with grade 1 or 2 endometrial adenocarcinoma without gross cervical involvement underwent preoperative CA-125 levels. Final pathology was reviewed for five poor prognostic pathologic features: FIGO grade 3 histology, unfavorable histologic type (sarcoma, clear cell, or papillary serous), invasion into the outer third of the myometrium, extension to the cervix, and extra-uterine metastases. Fifteen patients (14.9%) had CA-125 levels greater than 30 IU ml⁻¹. Of these 15 patients, 12 had one or more of the five poor prognostic pathologic features (positive predictive value 80.0%, specificity 95.8%, P < 0.0001). However, since 30 of the 101 patients were found to have one or more of these poor prognostic pathologic features the sensitivity was only 40.0%. When clinical stage I patients were analyzed separately three patients (4.6%) had CA-125 levels greater than 30 IU ml ⁻¹ (positive predictive value 100%, specificity of 100%, sensitivity of 21.4%, P = 0.008). For patients with clinical stage II carcinoma, CA-125 was not predictive of pathologic findings except as a negative predictor of disease in a subgroup of patients whose endocervical curettage (ECC) demonstrated carcinoma unattached to endocervical tissue. In patients diagnosed by EMC only, an elevated CA-125 level was associated with poor prognostic pathologic features ( P = 0.001). An elevated preoperative CA-125 reliably predicts advanced disease even in patients with apparently favorable histology and clinical stage, however the sensitivity of this method remains low.