Published online Jun 24, 2020. doi: 10.5306/wjco.v11.i6.378
Peer-review started: December 20, 2019
First decision: April 2, 2020
Revised: May 11, 2020
Accepted: June 2, 2020
Article in press: June 2, 2020
Published online: June 24, 2020
Processing time: 187 Days and 8.9 Hours
Core tip: Standard surgical treatment in endometrial cancer consists of hysterectomy with bilateral salpingo-oophorectomy. Node dissection is performed in selected patients with high-risk features such as grade 3 tumors, large tumor sizes (more than 2 cm), deep myometrial invasion (more than 50%), lymphovascular space invasion, cervical involvement, and extrauterine involvement. Preoperative cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) levels were significantly elevated in clinical stage 1 postmenopausal endometrial cancer patients with these high-risk features and an increased risk of upstaging. CA125 levels above 20 U/mL and HE4 levels above 113 pmol/L were used as the optimal cut-off values for the prediction of high-risk features, and they were also shown to be poor prognostic factors. Preoperative CA125 and HE4 may be an acceptable screening test for general gynecologists to consider the referral of these high-risk patients to gynecologic oncologists to perform complete surgical staging.