Obstet Gynecol Sci.  2016 Jul;59(4):269-278. 10.5468/ogs.2016.59.4.269.

Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with locally advanced cervical cancer treated with radiation or chemoradiation

• Oh J
• Lee HJ
• Lee TS
• Kim JH
• Koh SB
• Choi YS

• KMID: 2329047
• DOI: http://doi.org/10.5468/ogs.2016.59.4.269

Abstract

OBJECTIVE
The objective of this study was to evaluate the clinical benefits of routine squamous cell carcinoma antigen (SCC-Ag) monitoring of patients with locally advanced cervical squamous cell carcinoma treated with radiation or chemoradiation.
METHODS
A total of 53 patients with recurrent cervical squamous cell carcinoma treated with radiotherapy or chemoradiation were enrolled in this study. A retrospective review of medical records was conducted. The role of routine monitoring of serum SCC-Ag was evaluated in terms of cost effectiveness and effect on survival after diagnosis of recurrence.
RESULTS
Serum SCC-Ag abnormality (≥2.5 ng/mL) was observed in 62.3% of patients when recurrent disease was diagnosed. The first indicator of relapse was abnormal serum SCC-Ag level in 21 patients (39.6%), 10 of whom had asymptomatic recurrent disease amenable to salvage therapy. Adding SCC-Ag measurement to the basic follow up protocol improved the sensitivity for detecting recurrence (The sensitivity of the basic protocol vs. addition of SCC-Ag: 49.1% vs. 88.7%, P<0.001). Twenty-three patients who were candidates for salvage therapy with curative intent showed better survival compared with those who were not candidates for therapy (5-year survival: 36.6% vs. 0%, P=0.012).
CONCLUSION
Surveillance with routine serum SCC-Ag monitoring can better detect asymptomatic recurrent disease that is potentially amenable to salvage therapy with curative intent. Early diagnosis of recurrent disease that can be treated with salvage therapy may lead to better survival.

Keyword

Chemoradiotherapy; Squamous cell carcinoma-related antigen; Surveillance; Uterine cervical neoplasms

MeSH Terms

Carcinoma, Squamous Cell*
Chemoradiotherapy
Cost-Benefit Analysis
Diagnosis
Early Diagnosis
Epithelial Cells*
Follow-Up Studies*
Humans
Medical Records
Radiotherapy
Recurrence
Retrospective Studies
Salvage Therapy
Uterine Cervical Neoplasms*

Figure

• 

  Fig. 1 The number of patients showing each first indicator of relapse according to post-treatment surveillance protocol and the proportion of patients who were candidates for salvage therapy. PE, physical examination; Pap, Papanicolaou smear; SCC-Ag, squamous cell carcinoma antigen; Tx, treatment.

• 

  Fig. 2 (A) The comparison of the sensitivity in the ability to detect recurrence between the basic protocol and the addition of serum squamous cell carcinoma antigen (SCC-Ag) to basic protocol in all the patients with recurrence. Basic protocol: history-taking, physical examination, Pap smear. (B) The comparison of the sensitivity in the ability to detect recurrence between the basic protocol and the addition of serum SCC-Ag to basic protocol in patients with recurrence who were candidates for salvage therapy. Sx, symptom; PE, physical examination; Pap, Papanicolaou smear.

• 

  Fig. 3 (A) The comparison of survival outcomes between the patients who were candidates for salvage therapy and those who were not. (B) The comparison of survival outcomes between the patients who received aggressive therapy (radiotherapy/chemoradiation/surgery) and those who received palliative therapy. Tx, treatment; OS, overall survival.

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