Scoping Review: Pre-Operative Serum Value of Cancer Antigen-125 (CA-125) Assessment as Independent Predictor of Outcome in Endometrial Carcinoma

Abstract

Abstract

There is an upsurge in endometrial cancer (EC) prevalence globally with rising incidence of obesity and more women attaining the postmenopausal milestone. The most important predictor of EC outcome is lymph node metastasis (LNM), and preoperative CA-125 has significant correlation with LNM, advanced disease and survival. This scoping review is aimed at investigating primary studies on role of preoperative CA-125 assessment in predicting outcome of EC and identify gaps for consideration in further studies. Three themes: Populations investigated, optimum cut-off value of preoperative CA-125, and coexisting patients’ clinical, tumor, and radiological parameters in primary studies. The method searched two databases, PubMed and CINHAL to identify primary studies, extract, collate and summarize data and results tabulated, which yielded 199 publications. Fifty met selection criteria and 26 articles met the inclusion criteria. Twenty-six full articles from 13 countries were included; 13 studies were from Europe. Twenty-three articles were retrospective while 3 prospective studies. Only one prospective study was multi-centered. One study included only Asian patients while two others did not consider racial preference. Two studies had significant proportion of premenopausal women, 35.7% and 21.4% respectively. Of the 8550-total population across studies, 31.2% were from China. The mean age of patients ranges between 38 and 69 years. Obesity was assessed in eight studies. The cut-off values of CA-125 was 10.9-110.5U/ml and demonstrated diverse correlation with disease outcome with sensitivities and specificities ranges of 27.5-98.6% and 33.0-93.7% respectively; and negative predictive values. Forty-six percent of studies used radiological investigations to support patient evaluation with conflicting findings. In conclusion, high value of preoperative CA-125 predicts LNM, myometrial invasion, disease metastasis and reduced chance of survival in patients with EC and optimum cut-off value are discrepant across studies. Addition of clinical, tumor and radiological parameters to CA-125 values offer conflicting supporting evidence in predicting outcome variable.

Keywords: serum cancer antigen-125, endometrial cancer, survival, lymph node metastasis, lymphatic involvement, metastasis, recurrence.