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Research article 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
Correspondence should be addressed to: Marcin Sniadecki
Abstract: 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. Keywords: tumor biomarkers;CA-125;cervical cancer;lymph nodes metastases;ultrastaging
Received: 30.12.2016 |
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Sniadecki M, Wojtylak S, Wycinka E, Sawicki S, Kobierski J, Liro M, et al. Preoperative measurement of serum CA-125 levels: is it useful in the risk assessment of low volume lymph node disease in cervical cancer?. Rev Romana Med Lab. 2017;25(2):191-201. DOI:10.1515/rrlm-2017-0015
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