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Pretreatment carcinoembryonic antigen combined with cancer antigen-125 for predicting lymph node metastasis in endometrial carcinoma: a retrospective cohort study

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Abstract

Purpose

To investigate whether the cost-effective, pretreatment tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen-125 (CA-125) can be used to predict lymph node metastasis (LNM) in endometrioid-type endometrial cancer (EC) and to develop a predictive model.

Methods

This was a single-center retrospective study of patients with endometrioid-type EC who underwent complete staging surgery between January 2015 and June 2022. We identified the optimal cut-off values of CEA and CA-125 for predicting LNM using receiver operating characteristic (ROC) curves. Stepwise multivariate logistic regression analysis was used to identify independent predictors. A nomogram for predicting LNM was constructed and validated by bootstrap resampling.

Results

The optimal cut-off values of CEA and CA-125 were 1.4 ng/mL (area under the ROC curve (AUC) 0.62) and 40 U/mL (AUC 0.75), respectively. Multivariate analysis showed that CEA (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.01–3.74) and CA-125 (OR 8.75; 95% CI 4.42–17.31) were independent predictors of LNM. Our nomogram showed adequate discrimination with a concordance index of 0.78. Calibration curves for the probability of LNM showed optimal agreement between the predicted and actual probabilities. The risk of LNM for markers below the cut-offs was 3.6%. The negative predictive value and negative likelihood ratio were 96.6% and 0.26, respectively, with moderate ability to rule out the possibility of LNM.

Conclusion

We report a cost-effective method of using pretreatment CEA and CA-125 levels to identify patients with endometrioid-type EC who are at a low risk for LNM, which may guide decision-making regarding aborting lymphadenectomy.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

We thank the Biostatistics Center of Kaohsiung Chang Gung Memorial Hospital for their assistance with statistical analyses.

Funding

This research received no external funding.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Road, Niao Sung District, Kaohsiung City, Taiwan, R.O.C.

    Szu-Yu Huang, Hung-Chun Fu, Chen-Hsuan Wu, Shao-Chi Wang, Yu-Che Ou, Ching-Chou Tsai, Ying-Yi Chen, Szu-Wei Huang, Ying-Wen Wang & Hao Lin

  2. Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan

    Yu-Che Ou

Authors
  1. Szu-Yu Huang
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  2. Hung-Chun Fu
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  10. Hao Lin
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Contributions

H.L. and S.-Y.H. assisted with idea conception, search design, organization of the research team, and interpretation or analyses of the data. S.-Y.H. and S.-C.W. contributed to the methodological design, prepared the protocol, assisted in the search process, led the data extraction, and assessed the study quality. S. -Y. H. and H.L. wrote the manuscript. C.-H.W., Y.-C.O., C.-C.T., Y.-Y.C., S.-W.H., Y.-W.W., H.-C.F., and H.L. supervised the protocol development and search process and participated in editing and revision of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Hao Lin.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of Chang Gung Memorial Hospital (ethics approval number: 202300225B0).

Consent to participate

The need for informed consent was waived due to the retrospective nature of the study.

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Not applicable.

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Huang, SY., Fu, HC., Wu, CH. et al. Pretreatment carcinoembryonic antigen combined with cancer antigen-125 for predicting lymph node metastasis in endometrial carcinoma: a retrospective cohort study. J Cancer Res Clin Oncol 149, 11807–11813 (2023). https://doi.org/10.1007/s00432-023-05087-1

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  • DOI: https://doi.org/10.1007/s00432-023-05087-1

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