Predictive Role Of Serum Cytokeratin 19 Level For The Feasibility Of Conserving Ovaries In Patients With Endometrial Cancer

Objective: To determine the efficiency of CK19 to predict adnexal metastasis in patients with endometrial cancer and seek the correlation between CK19 and clinical characterists and prognosis.Methods: In this retrospective case-control study,517 patients with endometrial cancer(EC)treated between November 2010 to June 2016 were reviewed.Preoperative serum CA125,HE4,CA19-9 and CK19 were measured by electrochemiluminescence immunoassay and ROMA index was calculated.The predictive role of these tumor markers for adnexal metastasis was analyzed.Survival analysis was performed using Kaplan–Meier and Cox multivariate regression analyses and log-rank test was used to assess.Results:(1)Among all parameters analyzed,CK19 >3.3ng/ml(OR=4.233,95% CI 1.673-10.714,P=0.002),CA125 ? 35u/ml(OR=13.076,95% CI 4.254-40.189,P<0.001)and type II EC(OR=3.176,95% CI 1.222-8.259,P=0.018)were testified significant to predict the risk of adnexal involvement.However,only CK19>3.3ng/ml(OR=22.156,95% CI 1.324-370.857,P=0.031)and Type II EC(OR=11.992,95% CI 1.019-141.163,P=0.048)were testified to be independent risk factors to predict adnexal metastasis in premenopausal women.(2)Higher preoperative CK19 levels were observed to be linked with deep myometrial invasion,lymphovascular space invasion,adnexal metastasis,Type II EC and with advanced FIGO stage.In premenopausal women with Type I EC(n=140),CK19>3.3ng/ml could predict the risk of adnexal metastasis(AUC=0.878,95%CI 0.722-1.000,P=0.002),with the sensitivity,specificity,positive and negative predictive value of 66.7%,91.8%,26.7% and 98.4%,respectively.(3)Cox multivariate analysis demonstrated that elevated CK19 was an independent predictor of shorter progression free survival(HR=3.583,95% CI 1.391–9.226,P=0.008)after adjusting for advanced FIGO stage,age and deep myometrial invasion.Conclusions: The present study suggested the necessity of incorporating serum CK19 measurement into our pretreatment assessment of EC,especially into our ovarian preservation counseling.