Duk J M, Groenier K H, de Bruijn H W, Hollema H, ten Hoor K A, van der Zee A G, Aalders J G
Department of Obstetrics and Gynecology, University Hospital Groningen, The Netherlands.
J Clin Oncol. 1996 Jan;14(1):111-8. doi: 10.1200/JCO.1996.14.1.111.
To investigate the prognostic value of pretreatment serum squamous cell carcinoma antigen (SCC-ag) levels in patients with cervical squamous cell carcinoma in relation to well-established conventional risk factors.
Sera from 653 women treated for squamous cervical cancer between 1978 and 1994 were analyzed for the presence of SCC-ag and related to clinicopathologic characteristics and patient outcome using univariate and multivariate analyses.
Increased pretreatment SCC-ag levels correlated strongly with unfavorable clinicopathologic characteristics (International Federation of Gynecology and Obstetrics [FIGO] stages IB to IV [P < or = .00005]; stages IB and IIA: tumor size [P = .0236], deep stromal infiltration [P = .00009], and lymph node metastasis [P = .0001]). After multivariate analysis, elevated pretreatment serum SCC-ag levels (P = .001), lesion size (P = .043), and vascular invasion by tumor cells (P = .001) were independent predictors for the presence of lymph node metastases. In Cox regression analysis, controlling for SCC-ag, lesion size, grade, vascular invasion, depth of stromal infiltration, and lymph node status only the initial SCC-ag level had a significant independent effect on survival (P = .0152). Even in node-negative patients, the risk of recurrence was three times higher if the SCC-ag level was elevated before therapy.
The determination of pretreatment serum SCC-ag level provides a new prognostic factor in early-stage disease, particularly in patients with small tumor size. In future trials to assess the value of new treatment strategies, pretreatment serum SCC-ag levels can be used to help identify patients with a poor prognosis.
探讨治疗前血清鳞状细胞癌抗原（SCC-ag）水平对宫颈鳞状细胞癌患者的预后价值，并与已确立的传统危险因素进行关联分析。
分析了1978年至1994年间接受宫颈鳞状细胞癌治疗的653名女性患者的血清中SCC-ag的存在情况，并通过单因素和多因素分析将其与临床病理特征及患者预后相关联。
治疗前SCC-ag水平升高与不良临床病理特征密切相关（国际妇产科联盟[FIGO]分期IB至IV期[P≤0.00005]；IB期和IIA期：肿瘤大小[P = 0.0236]、深层间质浸润[P = 0.00009]和淋巴结转移[P = 0.0001]）。多因素分析后，治疗前血清SCC-ag水平升高（P = 0.001）、病变大小（P = 0.043）和肿瘤细胞血管浸润（P = 0.001）是淋巴结转移的独立预测因素。在Cox回归分析中，在控制SCC-ag、病变大小、分级、血管浸润、间质浸润深度和淋巴结状态后，仅初始SCC-ag水平对生存有显著独立影响（P = 0.0152）。即使在淋巴结阴性患者中，如果治疗前SCC-ag水平升高，复发风险也会高出三倍。
治疗前血清SCC-ag水平的测定为早期疾病提供了一个新的预后因素，尤其是在肿瘤较小的患者中。在未来评估新治疗策略价值的试验中，治疗前血清SCC-ag水平可用于帮助识别预后不良的患者。
