Significance and implication on changes of serum squamous cell carcinoma antigen in the diagnosis of recurrence squamous cell carcinoma of cervix / 中华妇产科杂志

ABSTRACT

Objective To explore the significance of serum squamous cell carcinoma antigen (SCC-Ag) in the diagnose of recurrent squamous cell carcinoma of cervix, and seek an effective approach to monitor tumor recurrence after treatment as early as possible. Methods All the data were collected from 1 557 patients with cervical squamous cell carcinoma treated in the First Affiliated Hospital of Bengbu Medical College from Jan. 2004 to Dec. 2010, the data of un-controlled cases(patients whose serum level of SCC-Ag failed to decrease to normal level or patients with incomplete tumor extinction)were eliminated, there were 1 394 cases of complete remission were analyzed,the median age was 46 years( rang, 18-72 years). According to International Federation of Gynecology and Obstetrics stages (FIGO, 1994), 71 cases were in stageⅠa, 360 cases stageⅠb, 254 cases stageⅡa, 207 cases stageⅡb, 95 cases stageⅢa, 289 cases stageⅢb, 106 cases stageⅣa and 12 cases stageⅣb. Radical hysterectomy was performed in 685 cases with stageⅠ-Ⅱa, concurrent radiation and chemotherapy was performed in 709 cases with stageⅡb-Ⅳ. Taking serum cut off value of SCC-Ag was 1.95 μg/L, the level ≤1.95 μg/L as SCC-Ag negative expression and>1.95μg/L as SCC-Ag positive expression. The positive expression status of SCC-Ag before treatment, the relationship between the post-treatment recurrence rate after SCC-Ag becoming negative and the clinicopathological features of the patients with cervical squamous cell carcinoma were analyzed, concurrently combined with gynecological check-up, pathological and imaging examination, followed by comparative analysis with the results of monitoring. Results Among 1 394 patients with cervical squamous cell carcinoma, there were 1 169 cases with positive SCC-Ag, the positive expression rate of SCC-Ag before treatment was closely related with the clinical stages and tumor size(all P0.05). The positive expression of SCC-Ag in 1 169 patients before treatment turned negative after treatment, 279 patients with recurrence whose positive expression of SCC-Ag turned negative after treatment, the recurrence rate was closely related with clinical stages, pathological grade, lymphatic metastasis and tumor size(all P5μg/L for patients with central recurrence was 4.2%(4/96), whilein the group of pelvic wall recurrence group was 56.2%(45/80)and in distant metastasis group was 87.4%(90/103). The level of SCC-Ag>5μg/L from the patients with pelvic wall recurrence and distant metastasis were much higher than that of patients with central recurrence (P<0.01), and the same results were shown between distant metastasis group and pelvic wall recurret group (P<0.01). Conclusions SSC-Ag expression in serum of patients with cervical squamous carcinoma is closely related with clinical stages and the tumor size. Dynamic monitoring the level of SSC-Ag could contribute to the early diagnosis for tumor recurrence, but it has some limitations for patients with central recurrence, which should deserve our attention.