Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma

Objective

To evaluate whether a preoperative serum CA-125 level in patients with endometrial carcinoma can provide additional information in determining the stage of disease, and which cutoff value is optimal in this respect.

Study design

Retrospective chart review of 147 women with pathologically proven endometrial carcinoma who were treated between January 1999 and May 2009. The associations of preoperative CA-125 levels with the tumor stage, histologic type and grade, and the lymph node positivity were examined. To determine the values of cutoff point levels for serum tumor marker CA-125, the levels of 20 IU/ml and 35 IU/ml were compared.

Results

High CA-125 levels significantly correlated with advanced stage and lymph node metastases. The ROC curve determined that the best cutoff value was 20 U/ml. The sensitivity and specificity of a CA-125 cutoff level of 20 U/ml were 75% and 69.51%, respectively, with a positive predictive value of 80.6% and negative predictive value of 84.9%.

Conclusion

The current study suggests that measurement of preoperative CA-125 is a clinically useful test in endometrial carcinoma patients. CA-125 appears to be a significant independent predictor of the advanced stage of the disease as well as lymph node metastases. The results complement a growing body of literature that supports the relationship between CA-125 level and stage of disease but more studies are needed to establish the appropriate cutoff level for serum CA-125 in this respect.     

Is there a role for CA-125 in monitoring patients with early endometrial cancer?

Elevated CA-125 levels have been reported in some women with endometrial carcinoma. Current follow-up policy for these patients does not involve the use of tumor markers. CA-125 measurements were performed in 28 patients with a diagnosis of endometrial cancer, 14 clinically free of disease and 14 with known disease. Based on the sensitivity (0.64) and specificity (0.93) observed we constructed a model to estimate the predictive value of the assay as a marker in the follow-up of patients who have completed treatment. This model would involve a CA-125 assay every six months for five years in 100 patients with stage I and II disease. Despite the high statistical correlation between the clinical status of the patient and the CA-125 value observed in our study, the positive predictive value would be approximately 24% in such a follow-up protocol where a low prevalence of recurrent malignancy is expected.     

Receiver operator characteristics and diagnostic value of progesterone and CA-125 in the prediction of ectopic and abortive intrauterine gestations

OBJECTIVE: The study was designed to investigate the predictive value of progesterone and CA-125 in the diagnosis of ectopic pregnancy (EP) and inevitable miscarriage. METHODS: Forty women with EP, 20 with intrauterine (IU) abortive gestation and 20 regular pregnant women (controls) were studied. IU abortive and EP were confirmed and treated by surgery. Serum progesterone and CA-125 levels were measured at the time of presentation and 24h after surgery. RESULTS: Women with EP had significantly lower progesterone concentrations, compared to both women with IU abortive pregnancy and controls. Women with IU abortion had significantly higher CA-125 levels, compared to the other two groups. When using a progesterone concentration of less than 10.75 ng/ml as a cut-point for the diagnosis of EP, sensitivity, specificity, positive and negative predictive values were 85%. When using CA-125 concentration of more than 41.9 U/ml as a threshold for the diagnosis of IU abortive pregnancy, sensitivity was 80%, specificity 87%, the positive predictive value was 66% and the negative predictive value 93%. CONCLUSION: The measurement of progesterone and CA-125 levels is useful in discriminating ectopic and intrauterine abortive from normal gestations.     

Primary peritoneal carcinoma presenting as adenocarcinoma on a Pap smear. A case report

BACKGROUND: Primary peritoneal carcinoma is an uncommon malignancy that usually presents with gastrointestinal symptoms from abdominal carcinomatosis. CASE: A postmenopausal woman presented with vaginal bleeding and adenocarcinoma cells on a Pap smear. Colposcopy, endocervical and endometrial curettage, mammography, colonoscopy and pelvic ultrasound were all normal. Computed tomography revealed a large omental cake and ascites, and the CA-125 level was elevated, 2,907 IU/mL. Exploratory laparotomy revealed a primary peritoneal carcinoma with abdominal carcinomatosis. CONCLUSION: Primary peritoneal carcinoma should be considered in the differential diagnosis of adenocarcinoma cells arising on a Pap smear in the absence of cervical and endometrial cancer.     

Can optimal primary cytoreduction be predicted in advanced stage epithelial ovarian cancer? Role of preoperative serum CA-125 level

The aim of this study was to determine the ability of preoperative serum CA-125 levels to predict optimal cytoreduction in patients with stage III epithelial ovarian cancer. A retrospective review was made of the records of 40 patients with FIGO stage III ovarian carcinoma who underwent primary cytoreductive surgery. A receiver operating characteristic (ROC) curve was used to determine the most useful CA-125 level in predicting optimal versus suboptimal tumour cytoreduction. Twenty-two (55%) patients were optimally cytoreduced (residual disease 500 U/ml. At this threshold, preoperative serum CA-125 level was able to predict optimal versus suboptimal cytoreduction with a sensitivity of 72%, specificity of 73%, positive predictive value of 68%, and negative predictive value of 76%. In the management of patients with advanced epithelial ovarian carcinoma, preoperative serum CA-125 level may help to predict optimal primary cytoreduction and to identify candidates for alternative approaches other than traditional primary cytoreductive surgery, such as neoadjuvant chemotherapy.     

A new prognostic model for FIGO stage 1 epithelial ovarian cancer

BACKGROUND: No consensus exists which patients with surgical stage 1 epithelial ovarian should receive postoperative chemotherapy. The purpose of this study was to evaluate the prognostic impact of preoperative CA-125 and to establish a prognostic index to identify patients in different risk categories. METHODS: Data of 600 surgically staged patients with FIGO stage 1 EOC treated in eleven gynecological cancer centers in Australia, the USA and Europe were analyzed. Eligible patients include those with invasive EOC where a preoperative CA-125 was obtained and standard surgical staging performed. Overall survival (OS) was chosen as study endpoint. Preoperative CA-125 values were compared with other prognostic factors, and univariate and multivariate Cox models were calculated. RESULTS: Two hundred and one patients (33.5%) had preoperative CA-125 < or =30 U/ml and CA-125 levels < or =30 U/ml were associated with lower grade, sub-stage 1A and mucinous histologic cell type. Patients with elevated CA-125 levels were more likely to receive chemotherapy. OS probability was 95% and 85% for patients with pretreatment CA-125 < or =30 U/ml and >30 U/ml, respectively (p 0.003). Multivariate analysis confirmed preoperative serum CA-125 >30 U/ml (OR 2.7) and age at diagnosis >70 years (OR 2.6) as the only independent predictors for overall survival. CONCLUSION: Pretreatment of CA-125 < or =30 U/ml dominates over histologic cell type, sub-stage and grade to identify a subgroup of FIGO stage 1 patients with a genuinely good prognosis with extremely good survival and who could possibly be spared with adjuvant chemotherapy.     

The significance of adnexal involvement in endometrial carcinoma.

OBJECTIVE: To evaluate the prognostic significance of and predictive factors for adnexal involvement (AI) in patients with endometrial carcinoma. METHODS: We retrospectively reviewed the pathological features and outcomes of endometrial carcinoma patients. The prognostic significance of AI was examined by univariate and multivariate analyses. Median follow-up was 30.7 months. RESULTS: Of the 382 cases reviewed, 40 (10.5%) had AI. Patients with AI had a worse 5-year disease-free (DFS) survival (73.1 vs 37.1%, P < 0.0001) than patients without AI. However, patients with AI had multiple adverse features, including high grade disease, lymphovascular invasion, and additional sites of extrauterine disease. After controlling for these factors on multivariate analysis, AI lost its prognostic significance (P = 0.56). The 12 AI patients without other extrauterine disease had a favorable outcome (5-year DFS of 70.9%). Factors predictive of AI on logistic regression were metastatic disease, positive peritoneal washings, cervical involvement, and unfavorable histology. CONCLUSION: Endometrial carcinoma patients with AI have relatively poor prognoses. However, AI per se has little, if any, independent prognostic significance. The poor outcomes seen in these patients appear to result from the preponderance of other adverse pathologic factors.     

Predictors of final histology in patients with endometrial cancer

OBJECTIVE: To assess the usefulness of preoperative tumor grade and intraoperative assessment of gross depth of myometrial invasion as "predictors" of final grade, final depth of myometrial invasion and surgical stage in patients with "low-risk" endometrial cancer. METHODS: We retrospectively compared preoperative histology and intraoperative gross depth of invasion with final pathologic evaluation on hysterectomy specimens. For patients traditionally considered intraoperatively to be "low-risk" for lymph node metastasis (grade 1 or 2 adenocarcinoma with less than 50% myometrial invasion), "predictors" combining preoperative histology and intraoperative gross depth of myometrial invasion were established; that is, a preoperative biopsy of grade 1 adenocarcinoma with an intraoperative gross depth of myometrial invasion of 30% was assigned the predictor IbG1 (Stage Ib, grade 1). These predictors were then compared to final grade and surgical stage. Sensitivity, specificity, and positive predictive value were then calculated. RESULTS: A total of 153 patients had both a preoperative biopsy and intraoperative assessment of gross depth of invasion. Twenty-four patients had the IaG1 predictor; eight had stage IaG1 on final pathologic evaluation (sensitivity, 0.50; specificity, 0.88; positive predictive value, 0.33). Eight patients had the IaG2 predictor; none had stage IaG2 on final pathologic evaluation (sensitivity, 0; specificity, 0.95; positive predictive value, 0). Eighty-nine patients had the IbG1 predictor; forty-six had stage IbG1 on final pathologic evaluation (sensitivity, 0.72; specificity, 0.52; positive predictive value, 0.52). Thirty-two patients had the IbG2 predictor; 11 had stage IbG2 on final pathologic evaluation (sensitivity, 0.46; specificity, 0.84; positive predictive value, 0.34). CONCLUSION: A clinically significant number of patients will have more advanced disease than predicted by preoperative or intraoperative prognostic factors. These predictors should not be relied on in the staging of endometrial cancer.     

Accuracy of frozen-section diagnosis at surgery in clinical stage I and II endometrial carcinoma.

OBJECTIVES: The purpose of our study was to determine if frozen section accurately identifies certain poor prognostic pathologic factors in endometrial carcinoma that are known to be associated with pelvic and paraaortic nodal metastasis, including deep myometrial invasion, poorly differentiated tumor, cervical invasion, adnexal involvement, and poor histologic type. STUDY DESIGN: The frozen-section pathologic results of 199 patients with clinical stage I and II endometrial cancer were retrospectively compared with permanent-section pathologic findings. RESULTS: The depth of myometrial invasion (superficial third vs deep two thirds) was accurately determined by frozen-section diagnosis at surgery in 181 of 199 cases (91.0%). The sensitivity of frozen-section diagnosis for deep myometrial invasion was 82.7%, and the specificity was 89.1%. The following tumor characteristics were accurately determined on frozen section at surgery: poorly differentiated tumor (95.0%), cervical invasion (94.0%), adnexal involvement (98.5%), and histologic type (94.0%). Frozen section underestimated deep myometrial invasion in 17.3% of patients with this characteristic and poorly differentiated tumor in 26.3% when compared with permanent-section diagnosis. In patients with unfavorable histologic types, papillary serous and adenosquamous carcinomas were the most commonly misdiagnosed histologic types by frozen section at surgery (70.6%). However, when the preoperative curettage pathologic findings were included, these inaccuracies in tumor grade and histologic type dropped to 15.8% and 35.3%, respectively. Only 13 of 199 patients (6.5%) were not correctly identified by frozen section at surgery as having poor prognostic pathologic features. CONCLUSION: Frozen section diagnosis at surgery is an important procedure that enables the surgeon to identify patients at high risk for pelvic and paraaortic nodal metastasis.     

Use of preoperative serum CA-125 levels for prediction of lymph node metastasis and prognosis in endometrial cancer

BACKGROUND: The purpose of this study was to evaluate the predictive value of preoperative serum CA-125 levels in the assessment of disease extent and clinical outcome of endometrial cancer. METHOD: This retrospective study evaluated 92 women with pathologically proven endometrial carcinoma scheduled for treatment that had preoperative serum CA-125 levels between January 1999 and February 2006. The association of preoperative serum CA-125 with a variety of histopathologic factors was evaluated. Statistical analysis was performed using chi2/Fisher's exact test and a logistic regression. Survival was studied with the Kaplan-Meier method and Cox regression models. RESULTS: Elevated serum CA-125 levels were significantly correlated with advanced-stage disease (p<0.001), lymph node metastases (p<0.001), increased depth of myometrial invasion (p=0.001), and positive peritoneal cytology (p=0.026). Multivariate analyses using logistic regression showed that lymph node metastases had the most significant effect on the elevation of preoperative serum CA-125 levels (p=0.004). Patients with a serum CA-125 < or =28.5 U/ml had a significantly better five-year disease-free survival than those with an elevated level in this study: 85.6% versus 60.0% (p=0.004). CONCLUSIONS: The preoperative serum CA-125 level appears to be a significant independent predictor of lymph node metastasis and prognosis after surgical intervention. Therefore, preoperative serum CA-125 may be a useful tool, in the clinical setting, for optimal individualized patient management.     

Significance of early changes in the serum CA-125 antigen level on overall survival in advanced ovarian cancer

OBJECTIVE: The relationship between survival and early changes in the serum level of the CA-125 antigen in patients with advanced ovarian cancer remains poorly defined. METHODS: To explore this issue, the serum CA-125 values from 101 patients with advanced ovarian cancer who participated in a Southwest Oncology Group trial (SWOG 8412), which compared the systemic delivery of cisplatin/cyclophosphamide vs. carboplatin/cyclophosphamide (both delivered every 28 days for 6 cycles) in suboptimal residual stage III and IV ovarian cancer, were evaluated. All patients in this analysis had CA-125 values available for at least 8 weeks following initiation of chemotherapy. Cox proportional hazards regression was used in multivariate analysis to determine the prognostic significance of the CA-125 concentration. RESULTS: While pretreatment CA-125 values did not correlate with survival, the concentration of this tumor marker 8 weeks after initiation of therapy was a powerful independent prognostic factor. The median survivals for patients (n = 51) with a CA-125 < 35 U/ml, vs. patients (n = 50) with a CA-125 > 35 U/ml, at this time point, were 26 months and 15 months, respectively (P = 0.0001). Further, women with serum CA-125 values <50% of their pretreatment concentration at 8 weeks experienced a median survival of 21 months, compared to only 10 months for individuals with tumor marker levels >50% of their baseline value (P = 0.0003). CONCLUSION: Reduction in the serum CA-125 concentration over the initial two cycles of platinum-based chemotherapy is a powerful independent predictor of survival for patients with suboptimal stage III or IV ovarian cancer. Patients without significant declines in CA-125 after two cycles of platinum-based chemotherapy have a particularly poor prognosis.     

Serum CA-125 is a good predictor of benign disease in patients with postmenopausal ovarian cysts

AIM: To determine whether serum CA-125 levels, in addition to tumor size and ultrasonographic findings can help in differentiating benign ovarian cysts from malignant disease. METHODS: All postmenopausal women who had undergone explorative laporatomy for a preoperative diagnosis of an adnexal cyst between January 1999 and February 2006 were included if serum CA-125 levels were below 50 IU/ml. RESULTS: Ninety-three patients with ovarian cysts and serum CA-125 levels lower than 50 IU/ml were included. Seventy-five (80%) of the patients (53 unilocular, 22 multilocular) had ovarian cysts < 13 cm. Of 18 patients with ovarian cysts > 13 cm, seven had unilocular and 11 had multilocular cysts. All the patients (n = 77) with a serum CA-125 level < 35 IU/ml had benign histopathology regardless of the tumor size or ultrasonic features. Among 16 patients with CA-125 levels between 35 and 50 IU/ml, two with unilocular cysts > 13 cm and nine with multilocular cysts (3 < 13 cm, 6 > 13 cm) had borderline histopathology. CONCLUSION: We concluded that when unilocular ovarian cyst size is < 13 cm and serum CA-125 levels are below 35 IU/ml in a postmenopausal woman, the possibility of a benign etiology is most likely.     

CA-125 AUC as a new prognostic factor for patients with ovarian cancer

OBJECTIVE: The aim of the present study was to investigate the usefulness of the CA-125 area under the curve (AUC) as a new kinetic parameter for predicting overall survival in patients with ovarian cancer. In addition, the relationship of CA-125 AUC with other prognostic factors of ovarian cancer was evaluated. METHODS: Ninety-two patients that underwent primary line chemotherapy within 4 months after submission to cytoreductive surgery were included. For each patient, CA-125 AUC was calculated and a statistical analysis was conducted to compare CA-125 AUC behavior among patients according to several covariates. RESULTS: The mean age at diagnostic time was found to be 55.5 (16.1-82.4) years with a mean survival of 39.2 (3.5-100.1; SE = 2.6) months. Across FIGO stage I, II, III, and IV patients had a mean CA-125 AUC of 18.2, 24.6, 147.8, and 574.6 IU/ml*days, respectively (P < 0.05). At the evaluation date, living patients had a mean CA-125 AUC of 40.1 in contrast to 234.1 IU/ml*days (P < 0.05) for deceased ones. Patients with a complete response to primary chemotherapy had a mean CA-125 AUC of 48.8, while patients with a partial response had a mean of 251.7 IU/ml*days, and patients with no response or disease progression had a mean of 316.5 IU/ml*days (P < 0.05). The best CA-125 AUC performance is in predicting patient complete response to chemotherapy with a cut-off of 100 IU/ml*days and an accuracy of 82%. CONCLUSIONS: Despite CA-125 AUC high correlation with the FIGO stage, residual disease, and patient final outcome, the main interest of CA-125 AUC calculation is to evaluate the treatment efficacy and to foresee a full chemotherapy response. Further studies should be carried out before extrapolating these results to other data sets.     

Factors associated with cytoreducibility among women with ovarian carcinoma

OBJECTIVES: The aim of the current study is to investigate the clinical and molecular factors associated with cytoreduction among women with advanced stage epithelial ovarian carcinoma EOC. METHODS: Seventy-two women with FIGO stage III and IV EOC or primary peritoneal carcinoma (PPC) underwent similar attempt at surgical cytoreduction, mostly by the same surgeon. The histologic material of these patients was reviewed and the histologic subtype and grade were assigned. Immunohistochemical tests were performed for expression of molecular regulators of apoptosis (p53, p21, Bcl(2), Bcl(x), Bax) and chemoresistance (PGP, MRP, LRP, GST). The following factors were assessed for their association with complete (no residual tumor) and optimal (residual tumor < 1 cm) cytoreduction: type of carcinoma (EOC versus PPC), stage, CA-125 values, ascites, histology, tumor grade, and p53, p21, Bcl(2), Bcl(x), Bax, PGP, MRP, LRP, GST expression using the odds ratio and associated 95% confidence intervals. Significant univariate odds ratios were assessed jointly in a multivariate logistic regression model. Receiver operating characteristic curve analysis was performed to determine the CA-125 level with the maximal cytoreduction prognostic power. RESULTS: Twenty-three (31.9%) women had no residual tumor, 35 (48.6%) had 1 cm. Factors with significant univariate associations with complete cytoreduction included stage, CA-125 level, ascites, histology, and p53. p53 expression was the only factor which remained significant in the multivariate analysis (odds ratio 7.2, 95% CI 1.5, 34.9). A preoperative CA-125 value of 相似文献   

Postoperative radiotherapy in stage I endometrial adenocarcinoma

OBJECTIVE: To evaluate postoperative whole pelvic radiation for high-risk patients with Stage I endometrial adenocarcinoma. METHODS: One hunderd and twenty-two patients with irregular premenopausal or postmenopausal haemorrhage were included into the study. Fractional curettage was performed in all cases. When the pathohistological report confirmed endometrial adenocarcinoma, abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Low-risk patients include women with Stage IA tumours and Stage IB grade 1 or 2 histology. High-risk group include patients with Stage IB grade 3 tumours and Stage IC carcinomas. High-risk patients received whole pelvic radiotherapy between two and four weeks after surgery. RESULTS: Eighty-two patients (67.21%) were low-risk and forty patients (32.79%) were high-risk. In the low-risk group of patients, CA-125 was negative in ten cases and positive in 72 patients with a mean value of 30.12 +/- 12.42 U/ml serum. In the high-risk group of the patients, CA-125 was negative in two cases and positive in 38 patients with a mean value of 60, 48 +/- 20, 14 U/ml serum. Locoregional recurrences were diagnosed in four patients (4.87%) in the surgery group and in two patients (5.00%) assigned to radiotherapy. The incidence of distant metastases was 2.43% in the surgery group and 2.50% in the radiotherapy group. Overall survival at five years was 90.25% in the low-risk group and 87.50% in the high-risk group of patients. CONCLUSION: Five-year overall survival, locoregional and distant metastasis were similar in the low-risk and high-risk groups of patients. That emphasizes the value of whole pelvic radiation in patients with unfavourable prognostic factors in Stage I endometrial cancer.     

Serum CA-125 in preoperative patients at high risk for endometriosis

OBJECTIVE: To investigate the factors contributing to the elevated level of CA-125 in endometriosis and to study whether CA-125 assay is useful to identify women who require preoperative bowel preparation. METHODS: A total of 685 women undergoing surgery for endometriosis between July 1988 and June 1999 were studied. Preoperative serum CA-125 levels were compared between various pelvic conditions using F statistics. Multiple regression was employed to determine significant correlates of elevated serum CA-125, and the receiver operating characteristic curve was applied to assess the utility of serum CA-125 in preoperative preparation. Based on the two-sample Student t test, the sample size required to detect a difference in mean serum CA-125 levels of one-half of one standard deviation with a power of 90% when the sample size ratio of the two groups was 1:50 was 675 with a significance level of 5%. RESULTS: The mean serum CA-125 levels (IU/mL) for American Society of Reproductive Medicine stages I, II, III, and IV endometriosis were 18.8 +/- 0.9, 40.3 +/- 2.8, 77.1 +/- 3.5, and 182.4 +/- 14.0, respectively. CA-125 levels were significantly increased with advanced stages (P <.001, F test). Furthermore, serum CA-125 levels were significantly higher in patients with more extensive adhesions to the peritoneum, omentum, ovary, fallopian tube, colon, and cul-de-sac, or with ruptured endometrioma (P <.001, F test). We then classified patients with at least one of the three factors including dense omentum adhesion, ruptured endometrioma, and complete cul-de-sac obliteration as the high-risk group that required preoperative bowel preparation, and the others as the low-risk group. Receiver operating characteristic curve analyses set a cutoff point of 65 IU/mL, which gave a sensitivity of 76%, a specificity of 71%, a positive predictive value of 76%, and a negative predictive value of 93.2%. CONCLUSION: Our results suggest that preoperative CA-125 assay is useful to decide which women should receive preoperative bowel preparation. Endometriosis patients with preoperative CA-125 levels higher than 65 IU/mL are at high risk for severe pelvic adhesions that warrant thorough preoperative bowel preparation.     

The ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in stage III epithelial ovarian carcinoma

PURPOSE: The aim of this study was to determine the ability of preoperative serum CA-125 to predict optimal primary tumor cytoreduction in patients with Stage III epithelial ovarian carcinoma. METHODS: We performed a retrospective chart review of 100 consecutive patients with Stage III ovarian carcinoma who had a serum CA-125 drawn prior to primary cytoreductive surgery. We used a receiver operating characteristic curve to determine the CA-125 level with the maximal prognostic power in predicting optimal versus suboptimal cytoreduction. RESULTS: The median CA-125 level for the 100 patients was 819 U/ml (range 5.6-26,200 U/ml). Optimal cytoreduction (diameter of largest residual tumor nodule < or =1 cm) was obtained in 45 cases (45%). The probability of performing optimal cytoreduction decreased with increasing CA-125 levels. A preoperative CA-125 level of 500 U/ml was identified as the value with the most predictive power. Optimal cytoreduction was achieved in 33 of the 45 cases (73%) with a CA-125 less than 500 U/ml compared to only 12 of the 55 cases (22%) with a CA-125 greater than 500 U/ml. Using a threshold level of 500 U/ml, the preoperative serum CA-125 level was able to predict optimal versus suboptimal cytoreduction with a sensitivity of 78%, specificity of 73%, positive predictive value of 78%, and negative predictive value of 73%. CONCLUSION: The probability of performing optimal cytoreduction in patients with Stage III ovarian carcinoma and a preoperative CA-125 greater than 500 U/ml was approximately one in five. These patients may be candidates for initial laparoscopic evaluation to obtain a confirmatory tissue diagnosis and to determine resectability.     

Pretreatment serum levels of CA-125, carcinoembryonic antigen, tissue polypeptide antigen, and placental alkaline phosphatase in patients with ovarian carcinoma: influence of histological type, grade of differentiation, and clinical stage of disease

Pretreatment serum levels of the tumor-associated antigens CA-125, tissue polypeptide antigen (TPA), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PLAP) were analyzed in 142 patients with epithelial ovarian carcinoma, and related to clinical and histopathological parameters. In a linear multiple regression model CA-125 serum levels were profoundly influenced by the type of tumor, i.e., mucinous or nonmucinous. Clinical stage also had significant impact, whereas grade of differentiation did not, when the other two factors were taken into account. CEA levels were also dependent mainly on histological type. Mucinous tumor cases had high levels. Only clinical stage or tumor burden had a significant impact on TPA levels. PLAP levels were significantly influenced by histological type of tumor and by grade of differentiation but not by clinical stage. The dependence of CA-125 levels upon clinical stage was evident only in nonmucinous tumors. Furthermore, size of the primary tumor was not important for the CA-125 value, in contrast to FIGO stage. Thus CA-125 is primarily a sensitive indicator of disseminated disease in ovarian carcinoma patients. On the basis of the CA-125 level it was possible to predict the extent of disease with an overall accuracy of 55%. If TPA and CEA levels were also considered, the predictive accuracy was 63%.     

Endometrial and endocervical curettage findings at the time of cervical conization

The medical records and histopathology of 250 patients who underwent cervical conization between January 1979 and December 1982 were reviewed. Two hundred thirty (92%) had endometrial curettage at the time of cervical conization. Abnormal findings were present in 7 (3%) of the 230 curettings. Limiting the performance of endometrial curettage at the time of conization to patients meeting specific criteria would have reduced the number of combined procedures by 75% without jeopardizing our ability to detect significant pathology. Endocervical curettage was performed on 221 (88%) of the 250 patients undergoing conization. The endocervical curettings were not a good predictor of the involvement of the cone margins with neoplasia. Only 7 (20%) of 35 patients with involved endocervical margins had a positive endocervical curettage. While the cone margins predicted residual carcinoma in the hysterectomy specimen with a sensitivity of 1.0, the sensitivity of the endocervical curettings for predicting residual carcinoma was 0.5. Although endocervical curettings can detect an invasive cancer not detected in the cone specimen, a negative endocervical curettage does not rule out invasive cancer above the excision line.     

Preoperative serum YKL-40 is a marker for detection and prognosis of endometrial cancer

OBJECTIVE: YKL-40 is a secreted glycoprotein of the chitinase family that has been previously described as a diagnostic and prognostic marker for a number of cancers, including epithelial ovarian cancer. In this study, we examined the frequency of serum elevation as well as the diagnostic and prognostic significance of this serum marker in endometrial cancer. MATERIALS AND METHODS: Preoperative serum levels of YKL-40 and CA125 were evaluated by enzyme-linked immunosorbent assay (ELISA) for all endometrial cancer patient samples (34) available in the Memorial Sloan-Kettering Cancer Center Gynecology Service Tissue Bank between the years 1987 and 2002, and compared to a cohort of normal individuals. A YKL-40 value of 61 ng/mL has previously been determined to represent the upper limit of normal. YKL-40 values were correlated with clinical characteristics, including patient age, tumor grade, histology, clinical stage, and clinical outcome (progression-free survival [PFS] and overall survival [OS]). RESULTS: YKL-40 was elevated (>61 ng/mL) in 26 (76%) of 34 endometrial cancer patients compared with elevations of CA125 in 21 (62%) of 34 patients (P=0.09). Twenty-eight (82%) of all 34 patients had elevations of either CA125 or YKL-40 or both; 16 (89%) of 18 advanced-stage endometrial cancer patients had elevation of at least one of these two markers. Median preoperative YKL-40 value was 137 ng/mL (range, 22-1738 ng/mL) for endometrial cancer patients compared with 28 ng/mL (range, 15-72 ng/mL) for normal healthy subjects (P<0.0001). There was no statistically significant association of YKL-40 with patient age, tumor grade, histology, or stage. Elevation of YKL-40 (>80 ng/mL) was correlated with poor clinical outcome in univariate analysis, but was not demonstrated in multivariate analysis. At 5 years' follow-up, the PFS rate was 80% for patients with YKL-40<80 ng/mL compared with 43% for patients with YKL-40>80 ng/mL (P=0.004). The 5-year OS rate for patients with YKL-40<80 ng/mL was 79% compared with 48% for patients with YKL-40>80 ng/mL (P=0.047). CONCLUSION: Preoperative serum YKL-40 is frequently elevated and may represent a novel marker for the detection of endometrial cancer and the identification of high-risk subsets of patients with worse clinical outcome. Further investigation of this promising endometrial cancer marker in larger studies is warranted.