title: Both TPA and SCC-Ag levels are prognostic even in high-risk stage Ib-IIa cervical carcinoma as determined by a stratification analysis.
abstract: OBJECTIVE
  To determine the prognostic values of tissue polypeptide antigen (TPA), squamous cell carcinoma antigen (SCC-Ag), and carcinoembryonic antigen (CEA) in the sera of cervical carcinoma patients, especially in those with a poor prognosis.
  
  
  METHODS
  In this retrospective study, the preoperative serum SCC-Ag, TPA, and CEA were analyzed in 779 patients with cervical squamous cell carcinoma of stage Ib-IIa who received radical hysterectomy and pelvic lymph node dissection (RAH-PLND) between 1984 and 1994.
  
  
  RESULTS
  Due to poor predictive value and poor correlation between serum CEA and clinico-pathological factors, CEA was abandoned in this study. Elevated TPA and SCC-Ag levels, pelvic lymph node metastasis (PLNM), lymphvascular space involvement (LVSI) and deep stromal invasion (DSI) were associated with poor survival time by univariate analysis. The correlation study showed that elevated serum TPA was significantly related to PLNM, LVSI, and DSI (p = 0.004, 0.008, and 0.021, respectively), and SCC-Ag was related to PLNM and bulky tumor size (p = 0.001 and 0.02, respectively). In the multivariate analysis, only PLNM and LVSI remained independently significant indicating poor survival. Further stratification studies by PLNM and LVSI showed that elevated TPA levels could even indicate higher recurrence rates in patients with PLNM (p = 0.045), as well as SCC-Ag in patients with LVSI (p = 0.038).
  
  
  CONCLUSIONS
  The results suggest that both elevated TPA and SCC-Ag levels depicting poor prognosis in stage Ib-IIa cervical SCC, especially indicates a group of high-risk patients who may need more aggressive therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taiwan.
authors.forename: C C
authors.initials: CC
authors.lastname: Yuan
authors.forename: P H
authors.initials: PH
authors.lastname: Wang
authors.forename: H T
authors.initials: HT
authors.lastname: Ng
authors.forename: L C
authors.initials: LC
authors.lastname: Tsai
authors.forename: C M
authors.initials: CM
authors.lastname: Juang
authors.forename: L M
authors.initials: LM
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000032:analysis; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D019396:Tissue Polypeptide Antigen / Q000097:blood*; D002583:Uterine Cervical Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology* / Q000601:surgery
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D019396:Tissue Polypeptide Antigen