Preoperative serum squamous cell carcinoma antigen levels in clinical decision making for patients with early-stage cervical cancer.
OBJECTIVE
To prevent morbidity associated with double modality treatment, early-stage cervical cancer patients should only be offered surgery when there is a low likelihood for adjuvant radiotherapy. We analyzed whether serum squamous cell carcinoma antigen (SCC-ag) analysis allows better preoperative identification of patients with a low likelihood for adjuvant radiotherapy than currently used clinical parameters.


METHODS
In a cohort study, International Federation of Gynecology and Obstetrics (FIGO) stage, tumor size, and preoperative serum SCC-ag levels, as determined by enzyme immunoassay, were related to the frequency of postoperative indications for adjuvant radiotherapy in 337 surgically treated, FIGO stage IB/IIA, squamous cell cervical cancer patients.


RESULTS
In patients with normal preoperative SCC-ag, 16% of IB1 and 29% of IB2/IIA had postoperative indications for adjuvant radiotherapy, in contrast to 57% of IB1 and 74% of IB2/IIA patients with elevated (> 1.9 ng/mL) serum SCC-ag (P < .001). Serum SCC-ag was the only independent predictor for a postoperative indication for radiotherapy (odds ratio, 7.1; P < .001). Furthermore, in IB1 patients that did not have indications for adjuvant radiotherapy, 15% of patients with elevated preoperative serum SCC-ag levels recurred within 2 years, compared with 1.6% of patients with normal serum SCC-ag levels (P = .02).


CONCLUSIONS
In early-stage cervical cancer, determination of serum SCC-ag levels allows more refined preoperative estimation of the likelihood for adjuvant radiotherapy than current clinical parameters, and simultaneously identifies patients at high risk for recurrence when treated with surgery only. The role of preoperative serum SCC-ag in the management of patients with early-stage cervical cancer deserves further investigation.
Reesink-Peters
Nathalie
N
Department of Gynecological Oncology, University Hospital Groningen, 9700 RB Groningen, The Netherlands.
van der Velden
Jacobus
J
Ten Hoor
Klaske A
KA
Boezen
H Marike
HM
de Vries
Elisabeth G E
EG
Schilthuis
Marten S
MS
Mourits
Marian J E
MJ
Nijman
Hans W
HW
Aalders
Jan G
JG
Hollema
Harry
H
Pras
Elisabeth
E
Duk
Jitze M
JM
van der Zee
Ate G J
AG
D000328:Adult; D000951:Antigens, Neoplasm / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015843:Serpins / Q000097:blood*; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery / Q000628:therapy*
D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D015843:Serpins; C051072:squamous cell carcinoma-related antigen