J Gynecol Oncol.  2013 Oct;24(4):313-320. 10.3802/jgo.2013.24.4.313.

Posttreatment cut-off levels of squamous cell carcinoma antigen as a prognostic factor in patients with locally advanced cervical cancer treated with radiotherapy

• Kawaguchi
• Furukawa N
• Kobayashi
• Asakawa I

• KMID: 2177872
• DOI: http://doi.org/10.3802/jgo.2013.24.4.313

Abstract

OBJECTIVE
The aim of the present study was to assess prognostic factors for patients with locally advanced cervical cancer treated with radiotherapy as the primary treatment and to assess the posttreatment cut-off levels of squamous cell carcinoma antigen (SCC-Ag) to predict three-year overall survival (OS) rates.
METHODS
One hundred and twenty-eight patients with cervical squamous cell carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage IIB-IVA) treated using radiotherapy or concurrent chemoradiotherapy were identified. Of these patients, 116 who had SCC-Ag levels >1.5 ng/mL prior to treatment were analyzed retrospectively.
RESULTS
Median age was 68 years (range, 27 to 79 years). The complete response rate was 70.7% and the three-year OS rate was 61.1%. The median levels of pretreatment and posttreatment SCC-Ag were 11.5 ng/mL (range, 1.6 to 310.0 ng/mL) and 0.9 ng/mL (range, 0.4 to 41.0 ng/mL), respectively. Multivariate analysis showed that pretreatment anemia (p=0.041), pelvic lymph node metastasis (p=0.016) and posttreatment SCC-Ag levels (p=0.001) were independent prognostic factors for three-year OS. The SCC-Ag level cut-off point for three-year OS rates, calculated using a receiver operating characteristic curve, was 1.15 ng/mL (sensitivity, 80.0%; specificity, 74.0%).
CONCLUSION
Pretreatment anemia and pelvic lymph node metastasis are poor prognostic factors in locally advanced cervical cancer. Furthermore, posttreatment SCC-Ag levels <1.15 ng/mL predicted better three-year OS rates.

Keyword

Cervical cancer; Radiotherapy; Squamous cell carcinoma antigen

MeSH Terms

Anemia
Antigens, Neoplasm
Carcinoma, Squamous Cell
Chemoradiotherapy
Gynecology
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Obstetrics
ROC Curve
Sensitivity and Specificity
Serpins
Uterine Cervical Neoplasms
Antigens, Neoplasm
Serpins

Figure

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  Fig. 1 Receiver operating curve for posttreatment serum squamous cell carcinoma antigen in predicting 3-year survival rate in patients treated with radiotherapy or concurrent chemoradiotherapy. AUC, area under the curve; CI, confidence interval.

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  Fig. 2 Overall survival depending on the posttreatment squamous cell carcinoma antigen (SCC-Ag) level.

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  Fig. 3 Progression-free survival depending on the posttreatment squamous cell carcinoma antigen (SCC-Ag) level.

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