Identification of a Preoperative Predictive Factor for Lymph Node Metastasis in Uterine Papillary Serous Carcinoma: Long-term Results From a Single Institution

ObjectiveThe purpose of this study was to identify preoperative clinicopathological predictive factors for lymph node (LN) metastasis in women diagnosed with uterine papillary serous carcinoma (UPSC).MethodsWomen diagnosed with UPSC in our institution from 1997 to 2012 were identified. All patients underwent hysterectomy and bilateral salpingo-oophorectomy plus pelvic and/or para-aortic lymphadenectomy. The predictive values of the risk factors for LN metastasis were analyzed using χ2 and multivariate logistic regression analyses.ResultsA total of 94 patients met our study criteria. A CA-125 cutoff of 47.5 IU/mL on the receiver operating characteristic curve provided the best sensitivity and specificity (56.5% vs 90.1%, respectively) for LN metastasis prediction. The sensitivities and specificities of old age (≥60 years), body mass index of 25 kg/m2 or greater, deep myometrial invasion, tumor size greater than 2 cm, tumor size greater than 4 cm, preoperative CA-125 greater than 47.5 IU/mL, LN metastasis on imaging, and extrauterine spread on imaging for the presence of a positive LN were 39.1%, 34.8%, 30.4%, 34.8%, 21.7%, 56.5%, 43.5%, and 52.2%, and 52.1%, 45.1%, 78.9%, 57.7%, 83.1%, 90.1%, 93.0%, and 90.1%, respectively. Preoperative CA-125 (P < 0.001), LN metastasis on preoperative imaging (P < 0.001), and extrauterine spread on preoperative imaging (P = 0.009) were risk factors for LN metastasis on univariate analysis. Multivariate analysis revealed that preoperative CA-125 (P = 0.001) was the only independent risk factor for LN metastasis.ConclusionsPreoperative CA-125 is a preoperative predictive factor for LN metastasis in UPSC.

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Cancer Antigen 125 Levels are Significantly Associated With Prognostic Parameters in Uterine Papillary Serous Carcinoma

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001300 ◽

2018 ◽

Vol 28 (7) ◽

pp. 1311-1317 ◽

Cited By ~ 2

Author(s):

Meirav Schmidt ◽

Yakir Segev ◽

Rotem Sadeh ◽

Erica Suzan ◽

Ido Feferkorn ◽

...

Keyword(s):

Lymph Node ◽

Serous Carcinoma ◽

Ca 125 ◽

Prognostic Parameters ◽

Cancer Antigen 125 ◽

Optimal Cutoff ◽

Positive Cytology ◽

Cancer Antigen ◽

Uterine Papillary Serous Carcinoma ◽

Papillary Serous Carcinoma

ObjectivesUterine papillary serous carcinoma (UPSC) is a highly aggressive subtype of endometrial carcinoma. Histopathologically, it resembles the pattern of serous papillary carcinoma of the ovary. Cancer antigen 125 (CA-125) is the most widely used biomarker in epithelial ovarian carcinoma. Its use in UPSC evaluation has yet to be determined. The purpose of this study was to investigate the significance of preoperative serum CA-125 as a prognostic factor in patients with UPSC.MethodsThe study cohort included all women with UPSC operated in our institution between January 2002 and June 2016. All patients underwent complete surgical staging. Preoperative CA-125 was reviewed and correlated with clinical and pathological parameters.ResultsSixty-one women met the study criteria. Median preoperative CA-125 was found to be significantly associated with disease stage. Patients with disease stages I to IV had median preoperative CA-125 levels of 12.15, 19.6, 22.6, and 177.5 U/mL (P < 0.0001) respectively. Levels of CA-125 were significantly associated with positive cytology (P < 0.0001), omental disease (P < 0.0001), pelvic or para-aortic lymph node metastasis (P < 0.0001), and adnexal involvement (P < 0.0001). The optimal cutoff that provided the best sensitivity and specificity for omental and parametrial involvement as well as positive cytology was 57.5 U/mL. For adnexal and lymph node involvement, the optimal cutoff value was 41.8 U/mL.ConclusionsIn patients with UPSC, preoperative CA-125 level correlates with known prognostic parameters of endometrial carcinoma and is associated with extrauterine involvement. These data should stimulate the need for further evaluation of the role of CA-125 in predicting recurrence and survival in UPSC.

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Performance of Serum CA125 as a Prognostic Biomarker in Patients With Uterine Papillary Serous Carcinoma

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31821091b5 ◽

2011 ◽

Vol 21 (3) ◽

pp. 529-534 ◽

Cited By ~ 15

Author(s):

Divya Gupta ◽

Marc J. Gunter ◽

Kathleen Yang ◽

Stephen Lee ◽

Lisa Zuckerwise ◽

...

Keyword(s):

Lymph Node ◽

Metastatic Disease ◽

Lymph Node Metastases ◽

Disease Recurrence ◽

Serous Carcinoma ◽

Ca 125 ◽

Uterine Papillary Serous Carcinoma ◽

Serum Ca125 ◽

Node Metastases ◽

Papillary Serous Carcinoma

HypothesisSerum CA125 is a potential biomarker for metastatic disease and recurrence in patients with uterine papillary serous carcinoma (UPSC).MethodsAll patients with UPSC who had preoperative CA125 measurement and surgical staging between 1998 and 2008 at the participating institutions were included in this analysis (N = 52). Data were extracted from patients' records. Fisher exact and χ2tests were used to assess the association of CA125 levels with clinical and pathological variables. The correlation between CA125 levels (high/low) and lymph node metastases (positive/negative) was evaluated using Spearman correlation coefficients. The association of CA125 elevation with recurrence-free survival was assessed using Cox proportional hazards regression modeling.ResultsPreoperative CA125 elevation (>30 U/mL) was observed in 9 (17%) patients and was associated with advanced International Federation of Gynecologists and Obstetricians (FIGO) stage III/IV disease (P= 0.002), lymph node involvement (P= 0.007), and presence of omental metastases (P= 0.001). Disease recurrence and survival data were available for 51 of the 52 patients. During a mean follow-up time of 36 months, 15 (29%) patients experienced disease recurrence and 10 (19%) patients died. There was a moderate positive correlation between CA125 levels and lymph node metastases (r2= 0.39). On multivariate survival analysis, an elevated CA125 level compared to nonelevated CA-125 was not associated with disease recurrence (hazard ratio, 1.61; 95% confidence interval, 0.55-4.77).ConclusionsPreoperative CA125 levels were significantly associated with metastatic disease in patients with UPSC. However, in this study of surgically staged UPSC patients, preoperative CA125 elevation was not an independent predictor of disease recurrence.

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Serum CA-125 as a marker of disease activity in uterine papillary serous carcinoma

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s004320050336 ◽

1999 ◽

Vol 125 (12) ◽

pp. 697-698 ◽

Cited By ~ 21

Author(s):

Drew Abramovich ◽

Maurie Markman ◽

Alexander Kennedy ◽

Kenneth Webster ◽

Jerome Belinson

Keyword(s):

Disease Activity ◽

Serous Carcinoma ◽

Ca 125 ◽

Uterine Papillary Serous Carcinoma ◽

Papillary Serous Carcinoma

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Utility of pre-operative serum CA-125 in the management of uterine papillary serous carcinoma

Gynecologic Oncology ◽

10.1016/j.ygyno.2008.05.027 ◽

2008 ◽

Vol 110 (3) ◽

pp. 293-298 ◽

Cited By ~ 31

Author(s):

Alexander B. Olawaiye ◽

Jose Alejandro Rauh-Hain ◽

Matthew Withiam-Leitch ◽

Bo Rueda ◽

Annekathryn Goodman ◽

...

Keyword(s):

Serous Carcinoma ◽

Ca 125 ◽

Uterine Papillary Serous Carcinoma ◽

Papillary Serous Carcinoma

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Preoperative CA-125 predicts extra-uterine disease and survival in uterine papillary serous carcinoma patients

The International Journal of Biological Markers ◽

10.5301/jbm.2012.9346 ◽

2012 ◽

Vol 27 (3) ◽

pp. 263-271 ◽

Cited By ~ 5

Author(s):

Thijs Roelofsen ◽

Marjanka Mingels ◽

Jan C.M. Hendriks ◽

Rahul A. Samlal ◽

Marc P. Snijders ◽

...

Keyword(s):

Elevated Serum ◽

Progression Free Survival ◽

Figo Stage ◽

Serous Carcinoma ◽

Ca 125 ◽

Uterine Disease ◽

Uterine Papillary Serous Carcinoma ◽

Kaplan Meier ◽

Preoperative Serum ◽

Papillary Serous Carcinoma

Objective We determined the clinical utility of preoperative serum CA-125 as predictor of extra-uterine disease and as prognosticator for survival in patients with uterine papillary serous carcinoma (UPSC). Methods Patients diagnosed with UPSC, identified between 1992 and 2009, and with preoperative CA-125 measurement were included. A receiver operator characteristic (ROC) curve was used to quantify marker performance. Overall and progression free survival were analyzed using the Kaplan-Meier method. Regression analyses were used to investigate the association of preoperative CA-125 levels and other clinicopathological variables with the presence of extra-uterine disease and the effects on survival. Results Sixty-six patients met the study criteria. Using ROC, the CA-125 concentration of 45 U/mL as cutoff level provided the best sensitivity (75%) and specificity (74%) for extra-uterine disease, with a positive predictive value of 86%. Survival was significantly longer in patients with preoperative CA-125 =45 U/mL (p<0.001). Only preoperative CA-125 >45 U/mL remained significantly associated with extra-uterine disease (OR=6.30, 95% CI 1.93–20.62). Furthermore, advanced FIGO stage (HR=4.53, 95% CI 1.50–13.62) and preoperative CA-125 >45 U/mL (HR=3.12, 95% CI 1.13–8.73) were associated with decreased survival. Conclusion Preoperative elevated serum CA-125 is an independent predictor for the presence of extra-uterine disease and an independent risk factor for survival in UPSC patients.

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Extrauterine Spread, Adjuvant Treatment, and Prognosis in Noninvasive Uterine Papillary Serous Carcinoma of the Endometrium: A Retrospective Multicenter Study

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000838 ◽

2016 ◽

Vol 27 (1) ◽

pp. 102-108 ◽

Cited By ~ 2

Author(s):

Gokhan Boyraz ◽

Mehmet Coskun Salman ◽

Derman Basaran ◽

Nejat Ozgul ◽

Taner Turan ◽

...

Keyword(s):

Lymph Node ◽

Lymph Nodes ◽

Adjuvant Treatment ◽

Multicenter Study ◽

Surgical Staging ◽

Serous Carcinoma ◽

Uterine Papillary Serous Carcinoma ◽

Aortic Lymph Node ◽

Papillary Serous Carcinoma ◽

Retrospective Multicenter Study

ObjectivesThe aim of this retrospective multicenter study was to investigate the frequency of extrauterine metastasis and to evaluate the importance of surgical staging and adjuvant treatment among patients with noninvasive uterine papillary serous carcinoma (UPSC) of the endometrium.Materials and MethodsA multicenter, retrospective department database review was performed to identify patients with UPSC of the endometrium who underwent surgical staging between 2000 and 2015 at 4 Gynecologic Oncology Centers in Turkey. Demographic, clinicopathological, and survival data were collected.ResultsA total of 182 patients with primary UPSC of the endometrium were identified. Of these, 33 (18.1%) had tumors limited to the endometrium with no myometrial invasion. Twenty (60.6%) of these 33 patients had no extrauterine involvement and International Federation of Gynecology and Obstetrics 2009 stage 1A disease was diagnosed after complete staging. The remaining 13 (39.4%) patients had disease beyond the uterine corpus including 5 with omental, 3 with adnexal, 1 with cervical stromal involvement, 1 with disease in the pelvic lymph nodes, and 1 with isolated para-aortic lymph node metastasis. Two patients had metastases in more than one location including omentum/adnexa/pelvic–para-aortic lymph nodes and omentum/pelvic–para-aortic lymph nodes, respectively. Of the 20 patients with disease confined to the endometrium, 6 (30%) patients received adjuvant treatment.ConclusionsNoninvasive UPSC has a high tendency for extrauterine spread and omentum is the most commonly involved location. Therefore, comprehensive surgical staging including omentectomy and pelvic–para-aortic lymph node dissection is mandatory in this group of patients. Risk of extrauterine spread is significantly associated with the presence of lymphovascular space invasion, elevated preoperative CA 125 levels, and positive peritoneal cytology. Adjuvant therapy for women with endometrium-confined disease improves neither progression-free survival nor overall survival.

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