Preoperative measurement of serum CA-125 levels : is it useful in the risk assessment of low volume lymph node disease in cervical cancer?

Marcin Sniadecki , Szymon Wojtylak , Ewa Wycinka , Sambor Sawicki , Juliusz Kobierski , Marcin Liro , Dariusz Grzegorz Wydra


BACKGROUND: Elevated serum cancer antigen 125 (CA-125) is observed in some cervical cancers (CCs). Is the correlation of CA-125 with the presence of nodal events useful in predicting early metastasis to the lymph nodes?

METHODS: The study included 45 patients with CC FIGO (2009) stages IA1-IIA1 and known preoperative CA-125 concentration, surgery treated (05.2011-05.2014). Investigated pretreatment: age (pre-, postmenopausal), histological type, grade, confounding factors - prior cone biopsy, ovarian cyst, endometriosis, liver or colon pathology, concomitant malignancy. LN metastases (LNM) were defined as macro (MAC, >2mm) and/or micrometastases (mic, 0.2 - 2 mm), and LVLND as mic or/and ITC (single CC cells clusters) in LNs. Ultrastaging of all LNs (sentinel and non-sentinel, 4 μm thick slices/150 μm intervals) was performed with hematoxylin and eosin staining and with immunohistochemistry (IHC - AE1/AE3 cytokeratin antibodies). Non-parametrical analysis and receiver operating curve analysis were used to determine correlation between CA-125 and LNM including LVLND.

RESULTS: The median age was 55 (23-71). 806 LNs were extracted. LNM was found in 12, LVLND in 6 patients. LNM but not LVLND was correlated with higher grade (G2-G3, p<0.05). LVLND was positively correlated with premenopausal age (p<0.05) but not with tumor histology or grade. Liver disease only was found to influence CA-125 levels (p=0.064). There were no differences within CA-125 concentration among LVLND, LNM, and node-negative patients groups, however a trend was found between higher CA-125 and lower LVLND risk.

CONCLUSIONS: Elevated levels of CA-125 may be less likely due to LVLND than to LN positivity. Grade is an important feature in prediction of LNM but not LVLND. CA-125 level was found to be not predictive of LNM nor LVLND, as confirmed by ultrastaging.

Author Marcin Sniadecki
Marcin Sniadecki,,
, Szymon Wojtylak
Szymon Wojtylak,,
, Ewa Wycinka (FM / DS)
Ewa Wycinka,,
- Department of Statistics
, Sambor Sawicki
Sambor Sawicki,,
, Juliusz Kobierski
Juliusz Kobierski,,
, Marcin Liro
Marcin Liro,,
, Dariusz Grzegorz Wydra
Dariusz Grzegorz Wydra,,
Journal seriesRevista Romana de Medicina de Laborator, ISSN 1841-6624, (A 15 pkt)
Issue year2017
Publication size in sheets0.5
Keywords in Englishtumor biomarkers, CA-125, cervical cancer, lymph nodes metastases, ultrastaging
ASJC Classification2704 Biochemistry, medical; 3607 Medical Laboratory Technology; 1308 Clinical Biochemistry
Languageen angielski
Score (nominal)15
Score sourcejournalList
ScoreMinisterial score = 15.0, 26-02-2020, ArticleFromJournal
Publication indicators WoS Citations = 0; Scopus SNIP (Source Normalised Impact per Paper): 2016 = 0.145; WoS Impact Factor: 2017 = 0.4 (2) - 2017=0.32 (5)
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