SCC-Ag, lymph node metastases and sentinel node procedure in early stage squamous cell cervical cancer.
OBJECTIVE
We analyzed pretreatment SCC-Ag levels, lymph node (LN) status and disease outcome in early stage squamous cell (SCC) cervical cancer.


METHODS
Serum SCC-Ag was measured before primary treatment in 91 patients (FIGO stage IB1 72, IB2 10, and IIA 9). Of these, 58 underwent laparoscopic sentinel lymph node (SLN) procedure followed by pelvic lymphadenectomy.


RESULTS
No false negative SLN were observed. SCC-Ag levels were higher in patients with positive LN compared to patients with negative LN (p=0.010), but no difference was found in the SLN patients (p=0.344). The accuracy to predict LN metastases of SCC-Ag at ROC established cutoff of 1.65 ng/mL and 5.5 ng/mL was 76% and 78%, respectively, in stage IB1, and 53% and 79%, respectively, in stages IB2+ IIA. Whereas no deaths were observed in patients with negative LN and negative SCC-Ag levels (at previously established cutoff of 1.1 ng/mL), overall survival (OS) for patients with negative LN but elevated SCC-Ag was similar to that of patients with positive LN, irrespective of their marker levels (Kaplan-Meier analysis of all patients and in stage IB1, p=0.002 and p=0.026, respectively).


CONCLUSIONS
SCC-Ag (>1.65 ng/mL) can predict LN metastases more accurately in stage IB1 than in stage IB2+ IIA. Since SCC-Ag levels above 1.1 ng/mL are already associated with a poor prognosis, the marker seems to identify a subgroup of LN negative patients with occult disease that may benefit from full lymphadenectomy following a SLN procedure.
van de Lande
Jonas
J
Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands.
Davelaar
Elvira M
EM
von Mensdorff-Pouilly
Silvia
S
Water
Tatjana J
TJ
Berkhof
Johannes
J
van Baal
W Marchien
WM
Kenemans
Peter
P
Verheijen
René H M
RH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000097:blood*; D002294:Carcinoma, Squamous Cell / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D015843:Serpins / Q000097:blood*; D002583:Uterine Cervical Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
D000951:Antigens, Neoplasm; D015843:Serpins; C051072:squamous cell carcinoma-related antigen