Utility of pre-operative serum CA-125 in the management of uterine papillary serous carcinoma
Introduction
Uterine papillary serous carcinoma (UPSC) is an aggressive endometrial neoplasm that resembles ovarian serous carcinoma morphologically; the tumor has complex papillary architecture, is accompanied by marked nuclear atypia and psammoma bodies may be present in approximately 60% of cases. It represents less than 10% of endometrial carcinomas but accounts for over 50% of all relapses and deaths caused by this disease [1], [2], [3]. Unlike typical endometrioid adenocarcinomas of the endometrium, these tumors have a higher propensity for lymphovascular space invasion, and present frequently with involvement of cervical tissue, broad ligament, fallopian tubes, ovaries, peritoneal surfaces of the pelvis and abdomen, metastasis to the liver, brain, and skin [3]; mimicking the usual distribution of ovarian papillary serous cancer. Patients with UPSC have a poor 5-year overall survival of only 18–27% [4], [5]. At the time of presentation, approximately 60 to 70% of women with UPSC will have disease spread outside of the uterus [3], [6], and even in cases apparently confined to the uterus, 31–80% of patients develop recurrent disease [7]. Survival of patients with stages I–II UPSC (35–50%), is remarkably different from those patients with stages III–IV disease, 0–15% [8]. A test that distinguishes between these stages will help in management planning, prognostication and counseling.
The tumor-associated antigen CA-125 has played a role in monitoring of treatment, detection of recurrence and as a prognostic marker in women with epithelial ovarian carcinoma [9], [10]. Elevations of CA-125 were first described in patients with recurrent and advanced endometrial cancer by Niloff et al. [11] in 1984. A number of studies have since shown that elevated pre-operative serum CA-125 correlate with extra-uterine tumor spread [12], [13], [14], [15]. Furthermore, patients with pre-operative serum CA-125 elevation showed reduced actuarial survival in at least one study [16]. However, all these studies included different types of histology. To our knowledge, none of the previous studies in the literature have evaluated the potential clinical implications of pre-operative serum CA-125 solely in patients diagnosed with UPSC.
We hypothesized that pre-operative serum CA-125 levels would correlate with disease stage and have an impact on prognosis in patients diagnosed with UPSC.
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Patients and methods
Between January 1995 and December 2005, 54 patients with a histologically verified USPC were identified from our Cancer Registry database who have had primary surgery at our institution. In every case, the surgery was performed by a gynecologic oncologist. Staging surgery was in accordance with FIGO adopted system and included peritoneal washing for cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy. This study was approved by our
Results
The demographic and histopathologic characteristics of the 41 patients who were included in the final analysis are presented in Table 1. Ages ranged from 46 to 87 years, with a median age of 68 years. Of the 41 patients, 12 (29.3%) had stage I disease, 2 (4.9%) had stage II disease, 15 (36.5%) had stage III disease and 12 (29.3%) had stage IV disease. Fourteen percent of the tumors were grade 1, 46% grade 2 and 39% grade 3. Complete surgical staging including washing cytology, total abdominal
Discussion
The tumor antigen, CA-125, was first introduced by Bast in 1981 [17]. Since then, it has been evaluated for ovarian cancer screening [18], [19], [20], diagnosis [21], [22], [23], and post-treatment monitoring [24], [25], [26], [27]. The current body of literature does not support the use of CA-125 as a screening tool for ovarian cancer in routine populations but it helps in diagnosis and has become an established method of monitoring response to treatment, as well as disease
Conflict of interest statement
The authors have no conflicts of interest to declare.
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2013, Gynecologic OncologyCitation Excerpt :Thirty five women had USC in this study [51]. In women with type I endometrial cancers, factors such as grade, myometrial invasion, tumor size and location predict risk of nodal involvement and allow the surgeon to intraoperatively tailor the need for lymphadenectomy in women undergoing hysterectomy [42–56]. However, for USC, it is well appreciated that women may have metastatic disease in the absence of conventional uterine risk factors for metastasis, with several retrospective studies documenting this risk as 37–63% [54–56].