Evaluation of serum CA-125 levels for preoperative counseling in endometrioid endometrial cancer: A multi-center study

Objective: To evaluate the role of serum CA-125 levels for preoperative counseling in endometrioid endometrial cancer (EEC). Methods: We reviewed 413 patients with EEC from 6 tertiary medical centers between July 1996 and June 2008. All patients were divided into (1) 4 categories of preoperative serum CA-125 levels: < 18 U/mL (n = 203); 18-35 U/mL (n = 114); 36-70 U/mL (n = 53); > 70 U/mL (n = 43) or (2) 3 categories: low-risk (n = 240); intermediate-risk (n = 99); high-risk diseases (n = 74). Results: Receiver operative curves showed the best cut-off values of 16.2-40.8 U/mL for predicting prognostic factors with 53.4-84.2% of sensitivity, 43.9-81.7% of specificity, 48.8-82.1% of positive predictive value (PPV), 48.5-83.8% of negative predictive value (NPV) and 48.6-83.0% of accuracy. Especially, adnexal involvement was predicted with the highest accuracy (83.0%) at ≥ 40.8 U/mL. The best cut-off values for preoperative selection of intermediate- to high-risk, and high-risk diseases were 17.3 U/mL and 21.9 U/mL (62.4% and 68.9% of sensitivity; 54.6% and 64.3% of specificity; 57.9% and 64.2% of PPV; 59.2% and 67.4% of NPV, 58.5% and 65.8% of accuracy). Furthermore, > 70 U/mL of preoperative serum CA-125 levels was a prognostic factor for poor progression-free and overall survivals. Conclusions: Serum CA-125 levels may not be useful for predicting most of prognostic factors, and may not contribute to preoperative selection of patients with intermediate- or high-risk disease who need adjuvant radiotherapy in EEC. However, serum CA-125 levels may be helpful in preoperative counseling for young patients who want ovarian preservation, and > 70 U/mL could be considered as a risk factor for poor survival.