[Significance and implication on changes of serum squamous cell carcinoma antigen in the diagnosis of recurrence squamous cell carcinoma of cervix].

OBJECTIVE

To explore the significance of serum squamous cell carcinoma antigen (SCC-Ag) in the diagnose of recurrent squamous cell carcinoma of cervix, and seek an effective approach to monitor tumor recurrence after treatment as early as possible.

METHODS

All the data were collected from 1 557 patients with cervical squamous cell carcinoma treated in the First Affiliated Hospital of Bengbu Medical College from Jan. 2004 to Dec. 2010, the data of un-controlled cases(patients whose serum level of SCC- Ag failed to decrease to normal level or patients with incomplete tumor extinction)were eliminated, there were 1 394 cases of complete remission were analyzed, the median age was 46 years( rang, 18-72 years). According to International Federation of Gynecology and Obstetrics stages (FIGO, 1994), 71 cases were in stage Ia, 360 cases stage Ib, 254 cases stage IIa, 207 cases stage IIb, 95 cases stage IIIa, 289 cases stage IIIb, 106 cases stage IVa and 12 cases stage IVb. Radical hysterectomy was performed in 685 cases with stage I-IIa, concurrent radiation and chemotherapy was performed in 709 cases with stage IIb-IV. Taking serum cut off value of SCC- Ag was 1.95 µg/L, the level ≤ 1.95 µg/L as SCC- Ag negative expression and >1.95 µg/L as SCC-Ag positive expression. The positive expression status of SCC-Ag before treatment, the relationship between the post-treatment recurrence rate after SCC-Ag becoming negative and the clinicopathological features of the patients with cervical squamous cell carcinoma were analyzed, concurrently combined with gynecological check- up, pathological and imaging examination, followed by comparative analysis with the results of monitoring.

RESULTS

Among 1 394 patients with cervical squamous cell carcinoma, there were 1 169 cases with positive SCC-Ag, the positive expression rate of SCC-Ag before treatment was closely related with the clinical stages and tumor size(all P < 0.01), which was not related with pathological grade and lymphatic metastasis(all P > 0.05). The positive expression of SCC-Ag in 1 169 patients before treatment turned negative after treatment, 279 patients with recurrence whose positive expression of SCC- Ag turned negative after treatment, the recurrence rate was closely related with clinical stages, pathological grade, lymphatic metastasis and tumor size(all P < 0.01). Among 279 cases of recurrent squamous cell carcinoma of cervix, the median time of the increase in serum level of SCC-Ag was 12.4 months, and the median time of clinical or imaging examination was 19.0 months. And the recurrence time in the increase of patients' serum level of SCC- Ag occurred obviously earlier than that in clinical or radiographic manifestation (P < 0.01), the median time of recurrence of the increase in serum level of SCC-Ag was obviously earlier than that of abnormality found by clinical or imaging examination(P < 0.01). Among 279 cases with recurrent squamous cell carcinoma of cervix, the serum level of SCC-Ag >5 µg/L for patients with central recurrence was 4.2% (4/96), while in the group of pelvic wall recurrence group was 56.2% (45/80)and in distant metastasis group was 87.4% (90/103). The level of SCC- Ag >5 µg/L from the patients with pelvic wall recurrence and distant metastasis were much higher than that of patients with central recurrence (P < 0.01), and the same results were shown between distant metastasis group and pelvic wall recurrent group (P < 0.01).

CONCLUSIONS

SSC-Ag expression in serum of patients with cervical squamous carcinoma is closely related with clinical stages and the tumor size. Dynamic monitoring the level of SSC-Ag could contribute to the early diagnosis for tumor recurrence, but it has some limitations for patients with central recurrence, which should deserve our attention.