Preoperatif Belirteçlerin Endometriyal İntraepitelyal Neoplazi Hastalarında Endometriyum Kanserini Öngörmedeki Rolü
Öz
Amaç: Endometriyal intraepitelyal neoplazi (EIN) tanısı olan kadınlarda preoperatif belirteçlerin endometriyal kanser (EC) için prediktif değerini belirlemektir.
Gereç ve Yöntem: Ocak 2014 ile Aralık 2021 yılları arasında tersiyer bir merkezde preoperatif endometriyal biyopsi sonucu EIN olan 611 hasta retrospektif olarak incelendi. Dahil edilme kriterlerini karşılayan 181 hasta çalışmaya alındı ve nihai patoloji sonuçlarına göre üç gruba ayrıldı: Grup 1’e benign sonuçları olan 60 hasta, grup 2’ye EIN olan 71 hasta ve grup 3’e EC olan 50 hasta dahil edildi. Üç grup arasında demografik, klinik ve biyokimyasal özellikler karşılaştırıldı. EIN’de eşzamanlı endometriyal kanser için Ca125’in prediktif değerini belirlemek için ROC analizi kullanıldı.
Bulgular: Ortalama preoperatif Ca125≥ 35U/ml seviyeleri üç grup arasında farklıydı (38.02±2.73, 41.61±6.19, 63.63±39.78, p<0.001, sırasıyla). Ca125 düzeyi en yüksek Gr3’teydi (65.8+41.7). Gr1 ile Gr3 ve Gr2 ile Gr3 arasındaki fark istatistiksel olarak anlamlıydı (p=0.017, p=0.024 sırasıyla). Ca125 cut-off değeri %70.3 duyarlılık ve %69.2 özgüllük oranı ile 41.25U/mL olarak belirlendi. Postmenopozal hasta sayısı da (n=35) kanser grubunda en yüksekti. Premenopozal dönemdeki hastaların endometriyal kalınlıkları karşılaştırıldığında üç grup arasındaki fark istatistiksel olarak anlamlıydı (9.25±4.2, 12±5.87, 15±6.87 mm, p<0.001, sırasıyla) ve en yüksek değer kanser grubunda bulundu.
Sonuç: Ca125 düzeyi özellikle postmenopozal dönemde EIN tanısı alan kadınlarda endometriyum kanserini tahmin etmede kullanılabilir. Bu konuda yapılacak çalışmalarla bu bilgi desteklenmelidir.
Anahtar Kelimeler
Endometriyal İntraepitelyal neoplazi Endometriyal kanser preoperative Ca125
Teşekkür
Destek ve ilginiz için teşekkür ederiz.
Kaynakça
- Lacey JV Jr, Chia VM, Rush BB, Carreon DJ, Richesson DA, Ioffe OB, Ronnett BM, Chatterjee N, Langholz B, Sherman ME, Glass AG. Incidence rates of endometrial hyperplasia, endometrial cancer and hysterectomy from 1980 to 2003 within a large prepaid health plan. Int J Cancer. 2012 Oct 15;131(8):1921-9.
- Raffone A, Travaglino A, Saccone G, et al. Diabetes mellitus and responsiveness of endometrial hyperplasia and early endometrial cancer to conservative treatment. Gynecol Endocrinol 2019;35(11):932-937.
- Li XC, Song WJ. Endometrial intraepithelial neoplasia (EIN) in endometrial biopsy specimens categorized by the 1994 world health organization classification for endometrial hyperplasia. Asian Pac J Cancer Prev 2013;14(10):5935-5939.
- Owings RA, Quick CM. Endometrial intraepithelial neoplasia. Archives of Pathology and Laboratory Medicine. 2014;138(4):484-491. doi:10.5858/arpa.2012-0709-RA
- Owings RA, Quick CM. Endometrial Intraepithelial Neoplasia. Archives of Pathology and Laboratory Medicine 2014;138:484-491.
- Scambia G, Benedetti Panici P, Baiocchi Gi Perrine L. Ca 15-3 as a tumor marker in gynecological malignancies. Gynecol Oncol 1988;30:265-73.
- Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000;182:1328-34
- Hsieh CH, ChangChien CC, Lin H. Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer? Gynecol Oncol 2002;86(1):28-33.
- Antonsen, S.L.; Ulrich, L.; Hogdall, C. Patients with atypical hyperplasia of the endometrium should be treated in oncological centers. Gynecol Oncol 2012, 125, 124–128.
- Zhou, L.; Meng, Z.; Wu, Y.; Zhu, H.; Wang, X. Prediction of endometrial carcinogenesis probability while diagnosed as atypical endometrial hyperplasia: A new risk model based on age, CA199 and CA125 assay. Eur J Obstet Gynecol Reprod Biol 2014, 183, 5–9.
- Gungorduk K, Ozdemir A, Ertas I.E, Sahbaz A, Asicioglu O, Gokcu M, et al. A novel preoperative scoring system for predicting endometrial cancer in patients with complex atypical endometrial hyperplasia and accuracy of frozen section pathological examination in this context: A multicenter study. Gynecol Obstet Investig 2015, 79, 50–56.
- Trimble, C.L.; Kauderer, J.; Zaino, R.; Silverberg, S.; Lim, P.C.; Burke, J.J., 2nd; Alberts, D.; Curtin, J. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study. Cancer 2006, 106, 812–819.
- Merisio, C.; Berretta, R.; De Ioris, A.; Pultrone, D.C.; Rolla, M.; Giordano, G.; Tateo, S.; Melpignano, M. Endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Eur J Obstet Gynecol Reprod Biol 2005, 122, 107–111.
- Lou, Y.; Liao, J.; Shan, W.; Xu, Z.; Chen, X.; Guan, J. Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery. Diagnostics 2022, 12, 6.
- Sood, A.K.; Buller, R.E.; Burger, R.A.; Dawson, J.D.; Sorosky, J.I.; Berman, M. Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome. Obstet. Gynecol 1997, 90, 441–447.
- Panyavaranant P, Manchana T. Preoperative markers for the prediction of high-risk features in endometrialcancer. World J Clin Oncol 2020; 11(6):378388[PMID: 32874951 DOI: 10.5306/wjco.v11.i6.378
- Vetter, M.H.; Smith, B.; Benedict, J.; Hade, E.M.; Bixel, K.; Copeland, L.J.; Cohn, D.E.; Fowler, J.M.; O’Malley, D.; Salani, R.; et al. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Am J Obstet Gynecol 2020, 222, 60.e1–60.e7.
Predictive Value of Preoperative Markers in Endometrial Intraepithelial Neoplasia for Concurrent Endometrial Cancer
Öz
Aim: The purpose of this study was to determine the predictive value of preoperative markers for endometrial cancer in endometrial intraepithelial neoplasia (EIN).
Materials and Methods: Six hundred eleven patients with EIN were retrospectively studied at a tertiary referral center in Turkey between January 2014 and December 2021. 181 patients with EIN who met the inclusion criteria were enrolled in the study and divided into three groups according to the final pathological results: Group 1 with benign findings (n=60), Group 2 with EIN (n=71) and Group 3 with endometrial cancer (n=50). Demographic, clinical and biochemical characteristics were compared among the three groups. Receiver operating characteristic analysis (ROC) was used to evaluate the predictive value of Ca125 for concurrent endometrial cancer in EIN.
Results: Mean preoperative Ca125≥35U/mL levels were different among three groups (38.02±2.73, 41.61±6.19, 63.63±39.78, p<0.001, respectively). The highest value of Ca125 level was found in cancer group and difference within pairs were statistically significant (p<0.001). The cut-off value was detected as ≥41.25U/mL for Ca125 and sensitivity, specificity were 70.3 %, 69.2 %, respectively (p<0.001). Number of postmenopausal patients (n=35) was also highest in the cancer group. Premenopausal endometrial thickness was different among three groups also (9.25±4.2, 12±5.87, 15±6.87 mm, p<0.001, respectively) and highest value was in cancer group.
Conclusion: Ca125 level could be used in prediction of endometrial cancer especially in postmenopausal women. The optimal cutoff value determined in our study could be considered in predicting endometrial cancer in EIN.
Anahtar Kelimeler
Endometrial intraepithelial neoplasia (EIN) preoperative Ca125 endometrial cancer
Kaynakça
- Lacey JV Jr, Chia VM, Rush BB, Carreon DJ, Richesson DA, Ioffe OB, Ronnett BM, Chatterjee N, Langholz B, Sherman ME, Glass AG. Incidence rates of endometrial hyperplasia, endometrial cancer and hysterectomy from 1980 to 2003 within a large prepaid health plan. Int J Cancer. 2012 Oct 15;131(8):1921-9.
- Raffone A, Travaglino A, Saccone G, et al. Diabetes mellitus and responsiveness of endometrial hyperplasia and early endometrial cancer to conservative treatment. Gynecol Endocrinol 2019;35(11):932-937.
- Li XC, Song WJ. Endometrial intraepithelial neoplasia (EIN) in endometrial biopsy specimens categorized by the 1994 world health organization classification for endometrial hyperplasia. Asian Pac J Cancer Prev 2013;14(10):5935-5939.
- Owings RA, Quick CM. Endometrial intraepithelial neoplasia. Archives of Pathology and Laboratory Medicine. 2014;138(4):484-491. doi:10.5858/arpa.2012-0709-RA
- Owings RA, Quick CM. Endometrial Intraepithelial Neoplasia. Archives of Pathology and Laboratory Medicine 2014;138:484-491.
- Scambia G, Benedetti Panici P, Baiocchi Gi Perrine L. Ca 15-3 as a tumor marker in gynecological malignancies. Gynecol Oncol 1988;30:265-73.
- Dotters DJ. Preoperative CA 125 in endometrial cancer: is it useful? Am J Obstet Gynecol 2000;182:1328-34
- Hsieh CH, ChangChien CC, Lin H. Can a preoperative CA 125 level be a criterion for full pelvic lymphadenectomy in surgical staging of endometrial cancer? Gynecol Oncol 2002;86(1):28-33.
- Antonsen, S.L.; Ulrich, L.; Hogdall, C. Patients with atypical hyperplasia of the endometrium should be treated in oncological centers. Gynecol Oncol 2012, 125, 124–128.
- Zhou, L.; Meng, Z.; Wu, Y.; Zhu, H.; Wang, X. Prediction of endometrial carcinogenesis probability while diagnosed as atypical endometrial hyperplasia: A new risk model based on age, CA199 and CA125 assay. Eur J Obstet Gynecol Reprod Biol 2014, 183, 5–9.
- Gungorduk K, Ozdemir A, Ertas I.E, Sahbaz A, Asicioglu O, Gokcu M, et al. A novel preoperative scoring system for predicting endometrial cancer in patients with complex atypical endometrial hyperplasia and accuracy of frozen section pathological examination in this context: A multicenter study. Gynecol Obstet Investig 2015, 79, 50–56.
- Trimble, C.L.; Kauderer, J.; Zaino, R.; Silverberg, S.; Lim, P.C.; Burke, J.J., 2nd; Alberts, D.; Curtin, J. Concurrent endometrial carcinoma in women with a biopsy diagnosis of atypical endometrial hyperplasia: A Gynecologic Oncology Group study. Cancer 2006, 106, 812–819.
- Merisio, C.; Berretta, R.; De Ioris, A.; Pultrone, D.C.; Rolla, M.; Giordano, G.; Tateo, S.; Melpignano, M. Endometrial cancer in patients with preoperative diagnosis of atypical endometrial hyperplasia. Eur J Obstet Gynecol Reprod Biol 2005, 122, 107–111.
- Lou, Y.; Liao, J.; Shan, W.; Xu, Z.; Chen, X.; Guan, J. Menopausal Status Combined with Serum CA125 Level Significantly Predicted Concurrent Endometrial Cancer in Women Diagnosed with Atypical Endometrial Hyperplasia before Surgery. Diagnostics 2022, 12, 6.
- Sood, A.K.; Buller, R.E.; Burger, R.A.; Dawson, J.D.; Sorosky, J.I.; Berman, M. Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome. Obstet. Gynecol 1997, 90, 441–447.
- Panyavaranant P, Manchana T. Preoperative markers for the prediction of high-risk features in endometrialcancer. World J Clin Oncol 2020; 11(6):378388[PMID: 32874951 DOI: 10.5306/wjco.v11.i6.378
- Vetter, M.H.; Smith, B.; Benedict, J.; Hade, E.M.; Bixel, K.; Copeland, L.J.; Cohn, D.E.; Fowler, J.M.; O’Malley, D.; Salani, R.; et al. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Am J Obstet Gynecol 2020, 222, 60.e1–60.e7.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 22 Eylül 2022 |
| Kabul Tarihi | 29 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 4 Sayı: 3 |
