Liu Chan-Zhen, Zeng Hao-Xia, Zhao Jing-Jing, Rong Yan, Mo Zhe-Lun, Li Li A, Zhang Jie-Qing
*Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning; and †Gynecological and Obstetric Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Int J Gynecol Cancer. 2017 Jun;27(5):994-1000. doi: 10.1097/IGC.0000000000000990.
There are no generally accepted biomarkers for the optimal selection of radiotherapy-based or surgical-based treatment options for nonbulky early-stage squamous cell carcinoma of the cervix (IA1-IB1 and IIA1). The objective of this study was to assess the value of human squamous cell carcinoma-associated antigen (SCC-Ag) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) in evaluation of patients with nonbulky early-stage squamous cell carcinoma of the cervix to determine if radiotherapy is warranted after radical surgery.
Patients with stage IA1-IB1 and IIA1 squamous cell carcinoma of the cervix who were treated at the Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, from March 2012 to August 2014 (n = 308) were treated with radical hysterectomy and pelvic lymphadenectomy. The levels of SCC-Ag and CYFRA21-1 were detected by enzyme-linked immunosorbent assay before surgery. The relationship between the concentrations of SCC-Ag and CYFRA21-1 and risk factors was estimated through logistic regression and analysis of variance t test. The cutoff values of these 2 markers to evaluate the need for postoperative radiotherapy were identified and validated by receiver operating characteristic curve and κ consistency test, respectively.
Serum SCC-Ag and CYFRA21-1 levels are significantly increased in patients who require postoperative radiotherapy with a risk factor score of at least 2 (n = 162). Logistic regression analysis revealed that deep stromal invasion and lymph node metastasis are independent risk factors for serum SCC-Ag value, and deep stromal invasion is an independent risk factor for the serum CYFRA21-1 value. Receiver operating characteristic curve revealed that the best predictive cutoff points of SCC-Ag and CYFRA21-1 values were 1.425 and 3.210 ng/mL, respectively. These results were validated by the κ consistency test applied to a validation group of patients. The results suggest that most patients with SCC-Ag and CYFRA21-1 values of at least 1.425 and 3.210 ng/mL, respectively, require postoperative radiotherapy.
Detection of the levels of SCC-Ag and CYFRA21-1 may help guide an individual primary treatment plan for patients with nonbulky early-stage squamous cell carcinoma of the cervix.
对于非大块型早期宫颈癌（IA1 - IB1和IIA1期），目前尚无普遍认可的生物标志物用于基于放疗或手术的治疗方案的最佳选择。本研究的目的是评估人鳞状细胞癌相关抗原（SCC - Ag）和细胞角蛋白19片段抗原21 - 1（CYFRA21 - 1）在评估非大块型早期宫颈癌患者中的价值，以确定根治性手术后是否需要放疗。
2012年3月至2014年8月在广西医科大学附属肿瘤医院妇科肿瘤科接受治疗的IA1 - IB1和IIA1期宫颈癌鳞状细胞癌患者（n = 308）接受了根治性子宫切除术和盆腔淋巴结清扫术。术前通过酶联免疫吸附测定法检测SCC - Ag和CYFRA21 - 1的水平。通过逻辑回归和方差分析t检验评估SCC - Ag和CYFRA21 - 1浓度与危险因素之间的关系。分别通过受试者工作特征曲线和κ一致性检验确定并验证这两种标志物评估术后放疗需求的临界值。
在危险因素评分至少为2的需要术后放疗的患者（n = 162）中，血清SCC - Ag和CYFRA21 - 1水平显著升高。逻辑回归分析显示，深部间质浸润和淋巴结转移是血清SCC - Ag值的独立危险因素，深部间质浸润是血清CYFRA21 - 1值的独立危险因素。受试者工作特征曲线显示，SCC - Ag和CYFRA21 - 1值的最佳预测临界值分别为1.425和3.210 ng/mL。这些结果通过应用于患者验证组的κ一致性检验得到验证。结果表明，大多数SCC - Ag和CYFRA21 - 1值分别至少为1.425和3.210 ng/mL的患者需要术后放疗。
检测SCC - Ag和CYFRA21 - 1的水平可能有助于指导非大块型早期宫颈癌患者的个体化初始治疗方案。
