Improved preoperative risk stratification with CA-125 in low-grade endometrial cancer: a multicenter prospective cohort study

J Gynecol Oncol. 2019 Sep;30(5):e70. doi: 10.3802/jgo.2019.30.e70.


Objectives: The global obesity epidemic has great impact on the prevalence of low-grade endometrial carcinoma. The preoperative tumor serum marker cancer antigen 125 (CA-125) might contribute to improved identification of high-risk patients within this group. The study aimed to investigate the prognostic value of CA-125 in relation to established preoperative prognosticators, with a focus on identifying patients with poor outcome in low-grade endometrial carcinoma (EC) patients.

Methods: Prospective multicenter cohort study including all consecutive patients surgically treated for endometrial carcinoma in nine collaborating hospitals from September 2011 until December 2013. All preoperative histopathological diagnoses were reviewed in a blinded manner. Associations between CA-125 and clinicopathological features were determined. Univariable and multivariable analysis by Cox regression were used. Separate analyses were performed for preoperatively designated low-grade and high-grade endometrial carcinoma patients.

Results: A total of 333 patients were analyzed. CA-125 was associated with poor prognostic features including advanced International Federation of Gynecology and Obstetrics (FIGO) stage. In multivariable analysis, age, preoperative tumor and CA-125 were significantly associated with disease-free survival (DFS); preoperative grade, tumor type, FIGO and CA-125 were significantly associated with disease-specific survival (DSS). Low-grade EC patients with elevated CA-125 revealed a DFS of 80.6% and DSS of 87.1%, compared to 92.1% and 97.2% in low-grade EC patients with normal CA-125.

Conclusion: Preoperative elevated CA-125 was associated with poor prognostic features and independently associated with DFS and DSS. Particularly patients with low-grade EC and elevated CA-125 represent a group with poor outcome and should be considered as high-risk endometrial carcinoma.

Keywords: Biomarkers; CA-125 Antigen; Endometrial Neoplasms; Low-grade Carcinoma; Risk Stratification.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers, Tumor / metabolism
  • CA-125 Antigen / metabolism*
  • Endometrial Neoplasms / blood
  • Endometrial Neoplasms / mortality
  • Endometrial Neoplasms / surgery*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Grading
  • Preoperative Care
  • Prognosis
  • Prospective Studies
  • Risk Assessment


  • Biomarkers, Tumor
  • CA-125 Antigen