Chan Y M, Ng T Y, Ngan H Y S, Wong L C
Department of Obstetrics and Gynecology, University of Hong Kong, Hong Kong SAR, China.
Gynecol Oncol. 2002 Jan;84(1):7-11. doi: 10.1006/gyno.2001.6497.
The aim of this study was to assess the cost-effectiveness of serial squamous cell carcinoma antigen (SCC) monitoring in the clinical setting.
All patients with squamous cell carcinoma of the cervix and SCC measurement from 1994 to 1999 were reviewed. The cost of the investigations, including blood tests, X rays, and computer tomography; and clinic visits were adjusted to 2001 dollars for all cases over the 6-year study period. The effectiveness measure was the number of cases detected by SCC monitoring before the onset of clinical symptoms or abnormal physical examination findings. Altered clinical management due to early detection was considered successful.
Two thousand eight hundred fifty-one SCC antigen assays were performed from 384 patients. An elevated pretreatment SCC level was associated with poorer cumulative survival over time (P < 0.05). Fifty-five patients had recurrences, with 10 local and 45 distant recurrences. SCC levels were elevated in 47 patients (85%). The median lead time was 7.8 months. The cost of finding 1 recurrence was US$4750. SCC monitoring does not alter clinical management and has no advantage over clinical examination in detecting local recurrence. Most of the recurrent diseases were detected too late for curative treatment. Only 1 patient, in whom the diagnosis could have been made by clinical examination without SCC monitoring, may have potentially benefited from exenteration.
Posttreatment SCC monitoring is not cost-effective in the absence of curative treatment for distant spread of disease.
本研究旨在评估在临床环境中连续监测鳞状细胞癌抗原（SCC）的成本效益。
回顾了1994年至1999年所有患有宫颈癌且进行了SCC检测的患者。在为期6年的研究期间，将包括血液检查、X线检查和计算机断层扫描在内的检查成本以及门诊就诊成本均调整为2001年的美元价值。有效性指标是在临床症状出现或体格检查发现异常之前通过SCC监测检测到的病例数。因早期检测而改变的临床管理被视为成功。
对384例患者进行了2851次SCC抗原检测。治疗前SCC水平升高与随时间累积生存率较差相关（P<0.05）。55例患者出现复发，其中10例为局部复发，45例为远处复发。47例患者（85%）的SCC水平升高。中位提前期为7.8个月。发现1例复发的成本为4750美元。SCC监测未改变临床管理，在检测局部复发方面与临床检查相比无优势。大多数复发病例发现时已太晚，无法进行根治性治疗。只有1例患者可能因扩大手术而受益，而该例患者即使不进行SCC监测通过临床检查也可作出诊断。
在对疾病远处转移缺乏根治性治疗的情况下，治疗后SCC监测不具有成本效益。
