Cancer Res Treat.  2005 Oct;37(5):302-306.

Relationship between Pre-treatment Serum SCC (squamous cell carcinoma) Antigen, Cyfra 21-1 Levels, and Survival in Squamous Cell Carcinoma of the Uterine Cervix

• Chang KH
• Ryu HS
• Chang SJ
• Byun YJ
• Lee JP

Abstract

PURPOSE
To determine the relationship between pretreatment serum squamous cell carcinoma (SCC) antigen and Cyfra 21-1 levels, and survival in patients with invasive squamous cell carcinoma of the cervix. MATERIALS AND METHODS: One hundred and one cervical squamous cell carcinoma patients were included. Pre-treatment levels of serum SCC antigen and Cyfra 21-1 were measured, with a 5 year minimum follow up. Thirty two recurrent disease (RD) patients were compared to 99 non-recurrent disease (NRD) patients with respect to tumor markers, FIGO stage, lesion size, lymph node status, and parametrial involvement. RESULTS: Pre-treatment serum SCC antigen and Cyfra 21-1 levels were significantly higher in the RD group (p<0.001). Combined serum SCC antigen and Cyfra 21-1 levels showed higher sensitivity for prediction of recurrence (90.6%). Pre-treatment SCC antigen and Cyfra 21-1 levels showed correlation with high FIGO stage, large lesion size, lymph node status, and parametrial involvement (p<0.001). Normal pre-treatment levels of SCC antigen and Cyfra 21-1 showed a 5-year survival rate of 93% and 90% respectively, while elevated levels showed significantly decreased survival rate of 63% and 59%, respectively (p<0.001). Odd ratio for cumulative survival rates were 6.87 for SCC antigen, and 5.07 for Cyfra 21-1 (p<0.001). CONCLUSIONS: Initial pre-treatment levels of serum SCC antigen and Cyfra 21-1 are closely related to FIGO stage, lesion size, lymph node and parametrial involvement in patients with squamous cell carcinoma of the cervix. Also, these markers may be of help to predicting recurrent disease and survival rates.

Keyword

Squamous cervical cancer; SCC antigen; Cyfra 21-1; Survival rate

MeSH Terms

Carcinoma, Squamous Cell*
Cervix Uteri*
Female
Follow-Up Studies
Humans
Lymph Nodes
Recurrence
Survival Rate
Biomarkers, Tumora

Figure

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  Fig. 1 ROC curve for serum SCC-Ag and Cyfra 21-1 levels.

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  Fig. 2 Cumulative survival rate according to initial serum SCC-Ag level.

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  Fig. 3 Cumulative survival rate according to initial serum Cyfra 21-1 level.

Reference

1. Montag TW. Tumor markers in gynecologic oncology. Obstet Gynecol Surv. 1990; 45:94–105. PMID: 2405313.

2. Kato H, Torigoe T. Radioimmunoassay for tumor antigen of human cervical squamous cell carcinoma. Cancer. 1977; 40:1621–1628. PMID: 332328.

3. Duk JM, de Bruijn HW, Groenier KH, Hollema H, ten Hoor KA, Krans M, et al. Cancer of the uterine cervix: sensitivity and specificity of serum squamous cell carcinoma antigen determinations. Gynecol Oncol. 1990; 39:186–194. PMID: 2227594.

4. Stieber P, Bodenmuller H, Banauch D, Hasholzner U, Dessauer A, Ofenloch-Hahnle B, et al. Cytokeratin 19 fragments: a new marker for non-small-cell lung cancer. Clin Biochem. 1993; 26:301–304. PMID: 7694815.

5. Kainz C, Sliutz G, Mustafa G, Bieglmayr C, Koelbl H, Reinthaller A, et al. Cytokeratin subunit 19 measured by CYFRA 21-1 assay in follow-up of cervical cancer. Gynecol Oncol. 1995; 56:402–405. PMID: 7535720.

6. Callet N, Cohen-Solal Le Nir CC, Berthelot E, Pichon MF. Cancer of the uterine cervix: sensitivity and specificity of serum Cyfra 21.1 determinations. Eur J Gynaecol Oncol. 1998; 19:50–56. PMID: 9476060.

7. Nasu K, Etoh Y, Yoshimatsu J, Matsu T, Narahara H, Miyakawa I. Serum levels of cytokeratin 19 fragments in cervical cancer. Gynecol Obstet Invest. 1996; 42:267–270. PMID: 8979101.

8. Strauss HG, Laban C, Lautenschlager C, Buchmann J, Schneider I, Koelbl H. SCC antigen in the serum as an independent prognostic factor in operable squamous cell carcinoma of the cervix. Eur J Cancer. 2002; 38:1987–1991. PMID: 12376202.

9. Gaarenstroom KN, Kenter GG, Bonfrer JM, Korse CM, Van de Vijver MJ, Fleuren GJ, et al. Can initial serum Cyfra 21-1, SCC antigen, and TPA levels in squamous cell cervical cancer predict lymph node metastases or prognosis? Gynecol Oncol. 2000; 77:164–170. PMID: 10739706.

10. Juang CM, Wang PH, Yen MS, Lai CR, Ng HT, Yuan CC. Application of tumor markers CEA, TPA, and SCC-Ag in patients with low-risk FIGO stage IB and IIA squamous cell carcinoma of the uterine cervix. Gynecol Oncol. 2000; 76:103–106. PMID: 10620449.

11. Chung TY, Ryu HS, Chang KH, Chun MS, Park CH, Park YH, et al. Clinical value of pretreatment serum CYFRA 21-1 and SCC Ag levels in cervical cancer patients. Korean J Obstet Gynecol. 1999; 42:2720–2725.

12. Duk JM, Groenier KH, de Bruijn HW, Hollema H, ten Hoor KA, van der Zee AG, et al. Pretreatment serum squamous cell carcinoma antigen: a newly identified prognostic factor in early-stage cervical carcinoma. J Clin Oncol. 1996; 14:111–118. PMID: 8558185.

13. Takeda M, Sakuragi N, Okamoto K, Todo Y, Minobe S, Nomura E, et al. Preoperative serum SCC, CA125, and CA19-9 levels and lymph node status in squamous cell carcinoma of the uterine cervix. Acta Obstet Gynecol Scand. 2002; 81:451–457. PMID: 12027820.

14. Gadducci A, Cosio S, Carpi A, Nicolini A, Genazzani AR. Serum tumor markers in the management of ovarian, endometrial and cervical cancer. Biomed Pharmacother. 2004; 58:24–38. PMID: 14739059.

15. Tsai SC, Kao CH, Wang SJ. Study of a new tumor marker, CYFRA 21-1, in squamous cell carcinoma of the cervix, and comparison with squamous cell carcinoma antigen. Neoplasma. 1996; 43:27–29. PMID: 8843956.

16. Holloway RW, To A, Moradi M, Boots L, Watson N, Shingleton HM. Monitoring the course of cervical carcinoma with the squamous cell carcinoma serum radioimmunoassay. Obstet Gynecol. 1989; 74:944–949. PMID: 2586961.

17. Moll R, Levy R, Czernobilsky B, Hohlweg-Majert P, Dallenbach-Hellweg G, Franke WW. Cytokeratins of normal epithelia and some neoplasms of the female genital tract. Lab Invest. 1983; 49:599–610. PMID: 6195450.

18. Bonfrer JM, Gaarenstroom KN, Kenter GG, Korse CM, Hart AA, Gallee MP, et al. Prognostic significance of serum fragments of cytokeratin 19 measured by Cyfra 21-1 in cervical cancer. Gynecol Oncol. 1994; 55:371–375. PMID: 7530676.

19. Gaarenstroom KN, Bonfrer JM, Korse CM, Kenter GG, Kenemans P. Value of Cyfra 21-1, TPA, and SCC-Ag in predicting extracervical disease and prognosis in cervical cancer. Anticancer Res. 1997; 17:2955–2958. PMID: 9329574.

20. Gaarenstroom KN, Bonfrer JM, Kenter GG, Korse CM, Hart AA, Trimbos JB, et al. Clinical value of pretreatment serum Cyfra 21-1, tissue polypeptide antigen, and squamous cell carcinoma antigen levels in patients with cervical cancer. Cancer. 1995; 76:807–813. PMID: 8625184.

21. Bonfrer JM, Gaarenstroom KN, Korse CM, Van Bunningen BN, Kenemans P. Cyfra 21-1 in monitoring cervical cancer: a comparison with tissue polypeptide antigen and squamous cell carcinoma antigen. Anticancer Res. 1997; 17:2329–2334. PMID: 9245246.