title: Preoperative serum SCC, CA125, and CA19-9 levels and lymph node status in squamous cell carcinoma of the uterine cervix.
abstract: BACKGROUND
  We wanted to investigate the clinical usefulness of determining the pretreatment levels of multiple serum tumor markers in predicting lymph node status and the prognosis for patients with cervical carcinoma.
  
  
  METHODS
  The preoperative serum levels of squamous cell carcinoma antigen (SCC), cancer antigens CA125 and CA19-9 were assayed simultaneously in 103 patients with stages IB to IIB cervical SCC undergoing radical hysterectomy. The cut-off values of SCC, CA125, and CA19-9 in this study were 1.5 ng/ml, 35 U/ml, and 37 U/ml, respectively. The relation between preoperative tumor marker levels and histopathologic prognostic factors including lymph node metastasis and patient survival was studied.
  
  
  RESULTS
  Preoperative serum SCC, CA125, and CA19-9 levels were significantly related to the FIGO stage. In addition, serum SCC and CA125 levels were significantly related to tumor diameter, depth of cervical stromal invasion, lymph-vascular space invasion, and lymph node metastasis. We subsequently created a double-tumor-marker (DTM) index, which incorporated the number of positive markers of SCC and CA125. The DTM index was strongly related to the number of positive pelvic lymph nodes (p = 0.0002) and to the site of positive nodes (none vs. pelvic only vs. common iliac/paraaortic) (p = 0.0005). Probability of lymph node metastasis according to the DTM index = 0, 1, and 2 was 6/48 (12.5%), 14/45 (31.1%), and 8/10 (80.0%), respectively. The rate of common iliac/paraaortic node metastasis according to the DTM index = 0, 1, and 2 was 1/48 (2.1%), 2/45 (4.4%), and 3/10 (30.0%), respectively. By logistic regression analysis, it was shown that the DTM index and tumor diameter were independently related to lymph node metastasis. Using multivariate Cox regression analysis including singly determined serum SCC and CA125 levels, clinical stage (IB/IIA vs. IIB), tumor diameter (<or= 2 vs. 2-4 vs. > 4 cm), parametrial invasion, lymph node metastasis, and the DTM index, the DTM index was found to be the most important prognostic factor (p = 0.0005). However, when the sites of positive nodes were included in the multivariate analysis, only the sites of positive nodes (p = 0.0008) and parametrial invasion (p = 0.041) showed independent prognostic significance.
  
  
  CONCLUSIONS
  Combination assay of pretreatment serum SCC and CA125 levels seems to be useful in estimating lymph node status and the prognosis for patients with cervical SCC in a preoperative setting.
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Kitaku, Sapporo, Japan.
authors.forename: Mahito
authors.initials: M
authors.lastname: Takeda
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.forename: Shin-Ichiro
authors.initials: S
authors.lastname: Minobe
authors.forename: Eiji
authors.initials: E
authors.lastname: Nomura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Negishi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Oikawa
authors.forename: Ritsu
authors.initials: R
authors.lastname: Yamamoto
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Fujimoto
mesh_terms: D000328:Adult; D000368:Aged; D000951:Antigens, Neoplasm / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood; D018395:CA-19-9 Antigen / Q000097:blood; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000097:blood* / Q000276:immunology / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D010388:Pelvis; D011237:Predictive Value of Tests; D011300:Preoperative Care; D015843:Serpins; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000276:immunology / Q000401:mortality / Q000473:pathology* / Q000601:surgery
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D018395:CA-19-9 Antigen; D015843:Serpins; C051072:squamous cell carcinoma-related antigen