A Novel Prognostic Score Based on Carbohydrate Antigen 125, Alpha-Fetoprotein and Carcinoembryonic Antigen for Predicting Postoperative Prognosis in Endometrial Cancer: Results from a Retrospective Cohort Study

Background: Endometrial cancer (EC) is a common gynecological malignancy with increasing incidence. While several serum biomarkers have been studied for EC, their combined prognostic value remains unclear. This study aimed to evaluate the prognostic significance of preoperative serum CA125, CA19-9, CA72-4, CEA, and AFP levels in EC patients and develop a risk score for predicting survival outcomes. Methods: A retrospective cohort study of 2,081 EC patients was conducted at Shengjing Hospital of China Medical University. Serum biomarker levels and clinicopathological data were collected. Univariate and multivariate Cox proportional hazard models were used to identify independent prognostic factors. A risk score based on CA125, CEA, and AFP levels was developed using LASSO-Cox regression, and nomograms were constructed for survival prediction. Results: Multivariate analysis identified elevated CA125 (P=0.003), AFP (P<0.0001), and CEA (P=0.014) as independent factors for overall survival (OS). These markers were also independent predictors of progression-free survival (PFS). The risk score incorporating CA125, AFP, and CEA was an independent indicator for both PFS (P<0.0001) and OS (P<0.0001). Nomograms based on the risk score and clinicopathological features demonstrated good predictive ability and calibration for survival outcomes. Conclusions: The risk score based on preoperative serum levels of CA125, CEA, and AFP is a valuable prognostic tool for predicting PFS and OS in EC patients. Nomograms incorporating this risk score accurately predict EC prognosis and may aid in clinical decision-making. Funding: This study was supported by the National Key R&D Program of China (Program Nos. 2022YFC2704400, The National Natural Science Foundation of China (No. 81872123 and 81472438); University innovation team of Liaoning Province; Special Professor of Liaoning Province 'Major Special Construction Plan' for Discipline Construction of China Medical University in 2018 (No. 3110118029); Outstanding Scientific Fund of Shengjing Hospital(No. 201601) 'Major Special Construction Plan' for Discipline Construction of China Medical University in 2018.