A new multicenter study led by Seoul National University Bundang Hospital (SNUBH) has found that pre-menopausal women with low-risk endometrial cancer may not need lymph node dissection, even when their CA125 levels are elevated.
A Seoul National University Bundang Hospital team, led by Professor Kim Kidong, conducted a multicenter study analyzing outcomes in pre-menopausal patients with low-risk endometrial cancer, concluding that elevated CA125 levels alone may not justify lymph node dissection.
Endometrial cancer, which originates in the uterine lining, is often treated with hysterectomy and concurrent lymph node dissection due to concerns over lymphatic spread. However, the procedure is known to increase risks of postoperative complications, including lymphedema and nerve damage, leading to decreased quality of life. As a result, clinicians have increasingly sought to refine surgical guidelines, particularly for low-risk cases where tumors are well-differentiated and confined to the uterus.
One remaining dilemma, however, has been how to manage patients who present with elevated CA125 levels -- a biomarker often associated with metastatic disease. In pre-menopausal women, CA125 can also rise due to non-malignant conditions such as menstruation or endometriosis, making it an unreliable sole indicator of cancer progression.
To address this gap, the team, led by Professor Kim Kidong of the Department of Obstetrics and Gynecology, analyzed clinical outcomes of 73 pre-menopausal women diagnosed with low-risk endometrial cancer who had CA125 levels above the conventional cutoff of 35 IU/mL. The study, conducted across seven Korean hospitals, reviewed patient records from 2013 to 2021.
The five-year recurrence-free survival rate among the patients was 88.8 percent, with only five cases (6.8 percent) of disease recurrence. Crucially, there was no statistically significant difference in survival outcomes between patients who underwent lymph node dissection and those who did not, suggesting that the procedure did not confer additional survival benefit in this group.
“These findings demonstrate that elevated CA125 alone, particularly in pre-menopausal patients, should not be a sole determinant for lymphadenectomy,” Professor Kim said. “Lymph node dissection prolongs surgery and increases the risk of complications that can disrupt daily life. Our study supports a more conservative, individualized approach.” Kim added that further large-scale studies are needed to confirm these findings and help update surgical guidelines to reflect patient-specific risk factors rather than relying on CA125 alone.
The study was published in Frontiers in Oncology.
Source: https://www.koreabiomed.com/news/articleView.html?idxno=27794
