CA 125 and Grade 1 endometrial cancer: analyzing the risk of metastases

Background: The purpose of this article was to relate preoperative serum CA 125 to risk of nodal metastases in women with Grade 1 endometrial cancer that were fully surgically staged. Materials and Methods: Charts were reviewed to determine all patients with preoperative Grade 1 endometrial carcinoma and a serum CA 125 undergoing complete surgical staging. Charts were also reviewed for final stage, grade, and site of metastases. All serum CA 125s were drawn within four weeks of definitive surgery. Results: Analysis was completed on 737 patients with Grade 1 endometrial cancer. The mean age of the population was 61.9 years (95% CI 61.3-62.4). Extrauterine disease was found in 14.7% of patients and nodal disease in 12.6%. A significant difference in BMI was seen between those not having lymph node metastases (mean 38.7 kg/m²; 95% CI 38.1, 39.3) and those having positive nodes (mean 35.3 kg/m²; 95% CI 34.3-36.3) (p < 0.001). The mean CA 125 for the cohort was 25.6 mIU/ml (95% CI 22.0-29.2). No patients with preoperative Grade 1 disease and a CA 125 < 15 mIU/ml (0/239) had nodal disease at surgical staging while 18.7% (93/498) with a CA 125 ≥ 15 mIU/ml had nodal metastases (p < 0.001). Conclusion: In patients with Grade 1 endometrial adenocarcinomas, CA 125 can be used to determine who needs full surgical staging with minimal risk of missing nodal positive patients.

Endometrial cancer; CA 125; Grade 1

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