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CA-125 seviyeleri, Endometrial seröz karsinomun uterus dışı yayılımının dışlanmasında ne kadar spesifiktir?

Year 2022, Volume: 19 Issue: 2, 1255 - 1259, 01.07.2022
https://doi.org/10.38136/jgon.873417

Abstract

Amaç: Uterin papiller seröz karsinom hastalarında preoperatif serum CA-125 düzeylerini hastalığın yayılımını predikte etmek için araştırmak.
Materyal ve metod: Uterin papiller seröz karsinom /mix seröz karsinom ve endometrioid karsinom için opere edilen hastalarda; preoperatif CA-125 seviyelerinin yanı sıra yaş, bildirilen tümör boyutu, lenf nodu tutulumu, lenfovasküler boşluk invazyonu, myometriyal invazyon derinliği ve evre gibi verileri topladık.
Bulgular: Yirmi altı Uterin papiller seröz karsinom /mix seröz karsinom olgusu ve kırk beş endometrioid karsinom olgusu analizimize dahil edildi. Uterin papiller seröz karsinom /mix seröz karsinom ve endometrioid karsinom hastalarının ortalama yaşları sırasıyla 63.9 ve 58 idi. Seröz kanser grubunu CA-125 açısından incelediğimizde; CA-125 ile yaş (≤60 vs >60), tümör boyutu (≤40 vs >40mm), myometriyal invazyon derinliği, nod metastazı veya lenfovasküler boşluk invazyonu arasında hiçbir ilişki yoktu. Öte yandan, ortalama CA-125 seviyeleri, FIGO (Uluslararası Jinekoloji ve Obstetrik Federasyonu) Evre III/IV (medyan=54 U/ml) olan hastalarda FIGO evre I/II'ye (medyan=11 U/mL) anlamlı olarak yüksekti (p=0,002). Uterus dışına yayılan tümörler için ortalama CA-125 düzeyi 281,2 U/ml ve uterusta sınırlı tümörler için 14,3 U/ml idi (p=0,002). Ekstrauterin yayılmayı tahmin etmek için optimum eşik değeri 28.5 U/mL idi (duyarlılık%75, özgüllük%89). Preoperatif CA-125 düzeyi, ekstrauterin tutulum ve ileri evre ile ilişkilendirildi.
Sonuç: Preoperatif CA-125 düzeyi, ekstrauterin tutulum ve ileri evre için iyi bir prediktördür. Cerrahi prosedürlerin planlanmasında, 28,5 U/mL'den daha düşük CA-125 değerine sahip Uterin papiller seröz karsinom vakalarına daha az agresif bir tedavi yöntemi öneriyoruz.

References

  • Wang Y, Yu M, Yang JX, Cao DY, Shen K, Lang JH. Clinicopathological and survival analysis of uterine papillary serous carcinoma: a single institutional review of 106 cases. Cancer Manag Res 2018;10:4915-28.
  • Hendrickson M, Ross J, Eifel P, Martinez A, Kempson R. Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma. Am J Surg Pathol 1982;6(2):93-108.
  • Slomovitz BM, Burke TW, Eifel PJ, Ramondetta LM, Silva EG, Jhingran A, et al. Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases. Gynecol Oncol 2003;91(3):463-9.
  • Niloff JM, Klug TL, Schaetzl E, Zurawski VR Jr, Knapp RC, Bast RC Jr. Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix. Am J Obstet Gynecol 1984;148(8):1057-8.
  • Olawaiye AB, Rauh-Hain JA, Withiam-Leitch M, Rueda B, Goodman A, del Carmen MG. Utility of pre-operative serum CA-125 in the management of uterine papillary serous carcinoma. Gynecol Oncol 2008;110(3):293-8.
  • Goff BA. Surgical treatment of unusual endometrial cancer. In: American Society of Clinical Oncology Educational Book. 40th annual meeting of the American Society of Clinical Oncology; 2004 June 5-8, New Orleans, LA. 2004. p. 298-302.
  • Creasman WT, Kohler MF, Odicino F, Maisonneuve P, Boyle P. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol 2004; 95(3):593–6.
  • Lachance JA, Everett EN, Greer B, Mandel L, Swisher E, Tamimi H, et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2006;101(3):470-5.
  • İyibozkurt AC, Doğan M, Baştu E, Sözen H, Vatansever D, Topuz S, et al. Efficacy of endocervical curettage and CA-125 measurement in endometrial serous carcinoma: A case series and literature review. Turk J Obstet Gynecol 2015;12(3):164-7.
  • Üreyen I, Karalok A, Akdağ Cırık D, Taşçı T, Türkmen O, Kimyon Cömert G, et al. A comparison of clinico-pathologic characteristics of patients with serous and clear cell carcinoma of the uterus. Turk J Obstet Gynecol 2016;13(3):137-43.
  • Hui P, Kelly M, O'Malley DM, Tavassoli F, Schwartz PE. Minimal uterine serous carcinoma: a clinicopathological study of 40 cases. Mod Pathol 2005;18(1):75-82.
  • Havrilesky LJ, Secord AA, Bae-Jump V, Ayeni T, Calingaert B, Clarke-Pearson DL, et al. Outcomes in surgical stage I uterine papillary serous carcinoma. Gynecol Oncol 2007;105(3):677-82.
  • Duk JM, Aalders JG, Fleuren GJ, de Bruijn HW. CA 125: a useful marker in endometrial carcinoma. Am J Obstet Gynecol 1986;155(5):1097-102.
  • Patsner B, Mann WJ, Cohen H, Loesch M. Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma. Am J Obstet Gynecol 1988;158(2):399–402.
  • Koper NP, Massuger LF, Thomas CM, Kiemeney LA, Verbeek AL. Serum CA 125 measurements to identify patients with endometrial cancer who require lymphadenectomy. Anticancer Res 1998;18(3B):1897-902.
  • Cherchi PL, Dessole S, Ruiu GA, Ambrosini G, Farina M, Capobianco G, et al. The value of serum CA 125 and association CA 125/CA 19-9 in endometrial carcinoma. Eur J Gynaecol Oncol 1999;20(4):315-7.
  • Yildiz A, Yetimalar H, Kasap B, Aydin C, Tatar S, Soylu F, et al. Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 2012;164(2):191-5.
  • Alagoz T, Buller RE, Berman M, Anderson B, Manetta A, DiSaia P. What is a normal CA125 level?. Gynecol Oncol 1994;53(1):93-7.
  • Powell JL, Hill KA, Shiro BC, Diehl SJ, Gajewski WH. Preoperative serum CA-125 levels in treating endometrial cancer. J Reprod Med 2005;50(8):585-90.
  • Sebastianelli A, Renaud MC, Grégoire J, Roy M, Plante M. Preoperative CA 125 tumour marker in endometrial cancer: correlation with advanced stage disease. J Obstet Gynaecol Can 2010;32(9):856-60.
  • Goksedef BP, 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 2011;33(8):844-50.
  • Sood AK, Buller RE, Burger RA, Dawson JD, Sorosky JI, Berman M. Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome. Obstet Gynecol 1997;90(3):441-7.
  • Povolotskaya N, Das N, Dhar K, Brinkmann D, Gardner F, Woolas R. Utility of preoperative CA125 assay in the management planning of women diagnosed with uterine cancer. Surg Res Pract 2014;2014:497478.
  • Visser NCM, Reijnen C, Massuger LFAG, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: A systematic review and meta-analysis. Obstet Gynecol 2017;130(4):803-13.

How specific are CA-125 levels in ruling out extra-uterine extension of endometrial serous papillary cancer?

Year 2022, Volume: 19 Issue: 2, 1255 - 1259, 01.07.2022
https://doi.org/10.38136/jgon.873417

Abstract

Abstract
Aim: To investigate the CA-125 levels in uterine serous carcinoma (UPSC) patients to predict the extent of disease.
Materials and Method: Medical records of patients operated for UPSC/mix serous carcinoma, endometrioid carcinoma; their preoperative CA-125 levels, as well as parameters including age, tumor size, lymph node involvement, lymphovascular space invasion (LVSI), depth of myometrial invasion (MI) and stage were documented.
Results: Twenty-six UPSC/mix serous carcinoma cases and forty-five endometrioid carcinoma cases were included. When we analyzed the serous cancer group in terms of CA-125; there was no association between CA-125 and age (≤60 vs >60), tumor size (≤40 vs >40mm), MI, lymph node metastasis or LVSI. The mean CA-125 levels were significantly higher among patients with stage III/IV (median=54 U/ml), compared to stage I/II (median=11 U/mL). The mean CA-125 value for tumors spread beyond the uterus were 281.2 U/ml, and 14.3 U/ml for the tumors confined within the uterus (p=0.002). The optimum threshold value to predict extrauterine spread was 28.5 U/mL. CA-125 level was related to extrauterine involvement and advanced stage.
Conclusion: CA-125 level is a useful test for extrauterine involvement and advanced stage. We suggest a less aggressive treatment modality with CA-125 <28.5U/mL may be considered for patients with a pre-operative CA 125 level of <28.5 and who cannot bear extensive surgery burden. Patients with a pre-operative CA 125 level of >28.5 and who need to receive comprehensive surgical staging, in settings where this is not feasible, should be referred to a gynecological oncologist in an experienced center.

References

  • Wang Y, Yu M, Yang JX, Cao DY, Shen K, Lang JH. Clinicopathological and survival analysis of uterine papillary serous carcinoma: a single institutional review of 106 cases. Cancer Manag Res 2018;10:4915-28.
  • Hendrickson M, Ross J, Eifel P, Martinez A, Kempson R. Uterine papillary serous carcinoma: a highly malignant form of endometrial adenocarcinoma. Am J Surg Pathol 1982;6(2):93-108.
  • Slomovitz BM, Burke TW, Eifel PJ, Ramondetta LM, Silva EG, Jhingran A, et al. Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases. Gynecol Oncol 2003;91(3):463-9.
  • Niloff JM, Klug TL, Schaetzl E, Zurawski VR Jr, Knapp RC, Bast RC Jr. Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix. Am J Obstet Gynecol 1984;148(8):1057-8.
  • Olawaiye AB, Rauh-Hain JA, Withiam-Leitch M, Rueda B, Goodman A, del Carmen MG. Utility of pre-operative serum CA-125 in the management of uterine papillary serous carcinoma. Gynecol Oncol 2008;110(3):293-8.
  • Goff BA. Surgical treatment of unusual endometrial cancer. In: American Society of Clinical Oncology Educational Book. 40th annual meeting of the American Society of Clinical Oncology; 2004 June 5-8, New Orleans, LA. 2004. p. 298-302.
  • Creasman WT, Kohler MF, Odicino F, Maisonneuve P, Boyle P. Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium. Gynecol Oncol 2004; 95(3):593–6.
  • Lachance JA, Everett EN, Greer B, Mandel L, Swisher E, Tamimi H, et al. The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 2006;101(3):470-5.
  • İyibozkurt AC, Doğan M, Baştu E, Sözen H, Vatansever D, Topuz S, et al. Efficacy of endocervical curettage and CA-125 measurement in endometrial serous carcinoma: A case series and literature review. Turk J Obstet Gynecol 2015;12(3):164-7.
  • Üreyen I, Karalok A, Akdağ Cırık D, Taşçı T, Türkmen O, Kimyon Cömert G, et al. A comparison of clinico-pathologic characteristics of patients with serous and clear cell carcinoma of the uterus. Turk J Obstet Gynecol 2016;13(3):137-43.
  • Hui P, Kelly M, O'Malley DM, Tavassoli F, Schwartz PE. Minimal uterine serous carcinoma: a clinicopathological study of 40 cases. Mod Pathol 2005;18(1):75-82.
  • Havrilesky LJ, Secord AA, Bae-Jump V, Ayeni T, Calingaert B, Clarke-Pearson DL, et al. Outcomes in surgical stage I uterine papillary serous carcinoma. Gynecol Oncol 2007;105(3):677-82.
  • Duk JM, Aalders JG, Fleuren GJ, de Bruijn HW. CA 125: a useful marker in endometrial carcinoma. Am J Obstet Gynecol 1986;155(5):1097-102.
  • Patsner B, Mann WJ, Cohen H, Loesch M. Predictive value of preoperative serum CA 125 levels in clinically localized and advanced endometrial carcinoma. Am J Obstet Gynecol 1988;158(2):399–402.
  • Koper NP, Massuger LF, Thomas CM, Kiemeney LA, Verbeek AL. Serum CA 125 measurements to identify patients with endometrial cancer who require lymphadenectomy. Anticancer Res 1998;18(3B):1897-902.
  • Cherchi PL, Dessole S, Ruiu GA, Ambrosini G, Farina M, Capobianco G, et al. The value of serum CA 125 and association CA 125/CA 19-9 in endometrial carcinoma. Eur J Gynaecol Oncol 1999;20(4):315-7.
  • Yildiz A, Yetimalar H, Kasap B, Aydin C, Tatar S, Soylu F, et al. Preoperative serum CA 125 level in the prediction of the stage of disease in endometrial carcinoma. Eur J Obstet Gynecol Reprod Biol 2012;164(2):191-5.
  • Alagoz T, Buller RE, Berman M, Anderson B, Manetta A, DiSaia P. What is a normal CA125 level?. Gynecol Oncol 1994;53(1):93-7.
  • Powell JL, Hill KA, Shiro BC, Diehl SJ, Gajewski WH. Preoperative serum CA-125 levels in treating endometrial cancer. J Reprod Med 2005;50(8):585-90.
  • Sebastianelli A, Renaud MC, Grégoire J, Roy M, Plante M. Preoperative CA 125 tumour marker in endometrial cancer: correlation with advanced stage disease. J Obstet Gynaecol Can 2010;32(9):856-60.
  • Goksedef BP, 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 2011;33(8):844-50.
  • Sood AK, Buller RE, Burger RA, Dawson JD, Sorosky JI, Berman M. Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome. Obstet Gynecol 1997;90(3):441-7.
  • Povolotskaya N, Das N, Dhar K, Brinkmann D, Gardner F, Woolas R. Utility of preoperative CA125 assay in the management planning of women diagnosed with uterine cancer. Surg Res Pract 2014;2014:497478.
  • Visser NCM, Reijnen C, Massuger LFAG, Nagtegaal ID, Bulten J, Pijnenborg JMA. Accuracy of endometrial sampling in endometrial carcinoma: A systematic review and meta-analysis. Obstet Gynecol 2017;130(4):803-13.
There are 24 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Esra Keles 0000-0001-8099-8883

Serkan Akış 0000-0003-0620-1500

Şefik Özyürek 0000-0002-5373-3991

Uğur Kemal Öztürk 0000-0003-0720-2919

Yunus Emre Purut 0000-0001-5779-3847

Canan Kabaca 0000-0002-7069-279X

Murat Api 0000-0001-9442-2690

Publication Date July 1, 2022
Submission Date February 2, 2021
Acceptance Date January 21, 2022
Published in Issue Year 2022 Volume: 19 Issue: 2

Cite

Vancouver Keles E, Akış S, Özyürek Ş, Öztürk UK, Purut YE, Kabaca C, Api M. How specific are CA-125 levels in ruling out extra-uterine extension of endometrial serous papillary cancer?. JGON. 2022;19(2):1255-9.