Background:  High pre‐operative CA125 levels in women with endometrial cancer may be related to lymph node metastases and poor prognosis.
Aim:  To evaluate whether pre‐operative cancer antigen 125 (CA125) levels are associated with lymph node metastases and prognosis in endometrial cancer.
Methods:  One hundred and twenty women with endometrial cancer were retrospectively reviewed for pre‐operative CA125 levels. The results were then correlated with the clinicopathological outcome.
Results:  An elevated CA125 (>40 U/mL) was significantly correlated with higher stage, higher grade, increased depth of myometrial invasion, lymph node metastases and the presence of lympho‐vascular space involvement in endometrial cancer. Five‐year overall survival (OS) and recurrence‐free survival (RFS) rates were significantly higher in women with endometrial cancer with CA125 ≤ 40 U/mL than those with CA125 > 40 U/mL (P < 0.001). When women were further stratified according to CA125 levels and lymph node status, OS and RFS were highest for those with CA125 ≤ 40 U/mL and without lymph node metastases, and lowest for those with lymph node metastases and CA125 > 40 U/mL (P < 0.001). Conclusion:  The testing of pre‐operative CA125 levels may a useful prognostic tool in endometrial cancer management.