van de Lande Jonas, Davelaar Elvira M, von Mensdorff-Pouilly Silvia, Water Tatjana J, Berkhof Johannes, van Baal W Marchien, Kenemans Peter, Verheijen René H M
Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
Gynecol Oncol. 2009 Jan;112(1):119-25. doi: 10.1016/j.ygyno.2008.09.042. Epub 2008 Nov 12.
We analyzed pretreatment SCC-Ag levels, lymph node (LN) status and disease outcome in early stage squamous cell (SCC) cervical cancer.
Serum SCC-Ag was measured before primary treatment in 91 patients (FIGO stage IB1 72, IB2 10, and IIA 9). Of these, 58 underwent laparoscopic sentinel lymph node (SLN) procedure followed by pelvic lymphadenectomy.
No false negative SLN were observed. SCC-Ag levels were higher in patients with positive LN compared to patients with negative LN (p=0.010), but no difference was found in the SLN patients (p=0.344). The accuracy to predict LN metastases of SCC-Ag at ROC established cutoff of 1.65 ng/mL and 5.5 ng/mL was 76% and 78%, respectively, in stage IB1, and 53% and 79%, respectively, in stages IB2+ IIA. Whereas no deaths were observed in patients with negative LN and negative SCC-Ag levels (at previously established cutoff of 1.1 ng/mL), overall survival (OS) for patients with negative LN but elevated SCC-Ag was similar to that of patients with positive LN, irrespective of their marker levels (Kaplan-Meier analysis of all patients and in stage IB1, p=0.002 and p=0.026, respectively).
SCC-Ag (>1.65 ng/mL) can predict LN metastases more accurately in stage IB1 than in stage IB2+ IIA. Since SCC-Ag levels above 1.1 ng/mL are already associated with a poor prognosis, the marker seems to identify a subgroup of LN negative patients with occult disease that may benefit from full lymphadenectomy following a SLN procedure.
我们分析了早期鳞状细胞宫颈癌患者的治疗前鳞状细胞癌抗原（SCC-Ag）水平、淋巴结状态及疾病转归。
对91例患者（国际妇产科联盟（FIGO）分期：IB1期72例、IB2期10例、IIA期9例）在接受初始治疗前检测血清SCC-Ag水平。其中58例患者接受了腹腔镜前哨淋巴结（SLN）活检，随后进行盆腔淋巴结清扫术。
未观察到假阴性SLN。与淋巴结阴性患者相比，淋巴结阳性患者的SCC-Ag水平更高（p = 0.010），但在SLN活检的患者中未发现差异（p = 0.344）。在ROC设定的1.65 ng/mL和5.5 ng/mL临界值下，SCC-Ag预测IB1期淋巴结转移的准确率分别为76%和78%，在IB2 + IIA期分别为53%和79%。在淋巴结阴性且SCC-Ag水平阴性（先前设定的临界值为1.1 ng/mL）的患者中未观察到死亡病例，而淋巴结阴性但SCC-Ag水平升高的患者的总生存期（OS）与淋巴结阳性患者相似，无论其标志物水平如何（对所有患者及IB1期患者进行Kaplan-Meier分析，p分别为0.002和0.026）。
SCC-Ag（>1.65 ng/mL）在IB1期比在IB2 + IIA期能更准确地预测淋巴结转移。由于SCC-Ag水平高于1.1 ng/mL已与预后不良相关，该标志物似乎可识别出一组隐匿性疾病的淋巴结阴性患者亚组，这些患者可能从SLN活检后行根治性淋巴结清扫术中获益。
