J Gynecol Oncol.  2013 Oct;24(4):321-329. 10.3802/jgo.2013.24.4.321.

Utility of serum squamous cell carcinoma antigen levels at the time of recurrent cervical cancer diagnosis in determining the optimal treatment choice

• Shimura K
• Mabuchi S
• Yokoi T
• Sasano T
• Sawada K
• Hamasaki T
• Kimura T

• KMID: 2177873
• DOI: http://doi.org/10.3802/jgo.2013.24.4.321

Abstract

OBJECTIVE
To investigate the utility of serum squamous cell carcinoma antigen (SCC-Ag) levels upon the diagnosis of recurrent cervical cancer for decision making in patient management.
METHODS
Clinical records from 167 cervical cancer patients who developed recurrence between April 1996 and September 2010 were reviewed. A Cox proportional hazards regression model was used to investigate the prognostic significance of serum SCC-Ag levels at the time of recurrence. The effects of various salvage treatments on survival outcomes of recurrent cervical cancer were examined with respect to serum SCC-Ag levels.
RESULTS
Serum SCC-Ag levels were elevated (>2.0 ng/mL) in 125 patients (75%) when recurrence was diagnosed. These patients exhibited significantly shorter postrecurrence survival than those with normal SCC-Ag levels (log-rank; p=0.033). Multivariate analyses revealed that an elevated serum SCC-Ag level was an independent prognostic factor for poor postrecurrence survival. In patients with SCC-Ag levels <14.0 ng/mL, radiotherapy or surgery resulted in improved survival compared with chemotherapy or supportive care. In contrast, in patients with SCC-Ag levels of > or =14.0 ng/mL, salvage treatment with radiotherapy had only a minimal impact on postrecurrence survival.
CONCLUSION
The serum SCC-Ag level measured when cervical cancer recurrence is diagnosed can be useful for deciding upon the appropriate salvage treatment.

Keyword

Decision-making; Recurrent cervical cancer; Squamous cell carcinoma antigen; Survival

MeSH Terms

Antigens, Neoplasm
Carcinoma, Squamous Cell
Decision Making
Humans
Multivariate Analysis
Recurrence
Serpins
Uterine Cervical Neoplasms
Antigens, Neoplasm
Serpins

Figure

• 

  Fig. 1 Kaplan-Meier estimates of postrecurrence survival according to the serum squamous cell carcinoma antigen (SCC-Ag) level. (A) Patients with serum SCC-Ag levels >2.0 ng/mL had a significantly shorter postrecurrence survival than those with serum SCC-Ag levels ≤2.0 ng/mL (p=0.033). (B) Patients with serum SCC-Ag levels ≥14.0 ng/mL also had a significantly shorter postrecurrence survival than those with serum SCC-Ag levels <14.0 ng/mL (p<0.001).

• 

  Fig. 2 Postrecurrence survival according to (A) the site of recurrence, (B) salvage treatment, (C) disease-free interval (DFI), and (D) performance status.

• 

  Fig. 3 Kaplan-Meier estimates of postrecurrence survival according to the serum squamous cell carcinoma antigen (SCC-Ag) level in patients with (A) pelvic central, single distant, or lymph node recurrences and (B) pelvic sidewall or multiple recurrences. Kaplan-Meier estimates of postrecurrence survival according to salvage treatment in patients with (C) serum SCC-Ag levels<14.0 ng/mL and (D) serum SCC-Ag levels ≥ 14.0 ng/mL.

• 

  Fig. 4 Kaplan-Meier estimates of postrecurrence survival according to the number of poor prognostic factors. (A) Patients with serum squamous cell carcinoma antigen (SCC-Ag) levels <14.0 ng/mL. (B) Patients with serum SCC-Ag levels ≥14.0 ng/mL.

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