title: Pretreatment carcinoembryonic antigen level is a risk factor for para-aortic lymph node recurrence in addition to squamous cell carcinoma antigen following definitive concurrent chemoradiotherapy for squamous cell carcinoma of the uterine cervix.
abstract: BACKGROUND
  To identify pretreatment carcinoembryonic antigen (CEA) levels as a risk factor for para-aortic lymph node (PALN) recurrence following concurrent chemoradiotherapy (CCRT) for cervical cancer.
  
  
  METHODS
  From March 1995 to January 2008, 188 patients with squamous cell carcinoma (SCC) of the uterine cervix were analyzed retrospectively. No patient received PALN irradiation as the initial treatment. CEA and squamous cell carcinoma antigen (SCC-Ag) were measured before and after radiotherapy. PALN recurrence was detected by computer tomography (CT) scans. We analyzed the actuarial rates of PALN recurrence by using Kaplan-Meier curves. Multivariate analyses were carried out with Cox regression models. We stratified the risk groups based on the hazard ratios (HR).
  
  
  RESULTS
  Both pretreatment CEA levels ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL (p < 0.001, HR = 8.838), SCC-Ag levels ≥ 40 ng/mL (p < 0.001, HR = 12.551), and SCC-Ag levels of 10-40 ng/mL (p < 0.001, HR = 4.2464) were significant factors for PALN recurrence. The corresponding 5-year PALN recurrence rates were 51.5%, 84.8%, and 27.5%, respectively. The 5-year PALN recurrence rate for patients with both low (< 10 ng/mL) SCC and CEA was only 9.6%. CEA levels ≥ 10 ng/mL or SCC-Ag levels ≥ 10 ng/mL at PALN recurrence were associated with overall survival after an isolated PALN recurrence. Pretreatment CEA levels ≥ 10 ng/mL were also associated with survival after an isolated PALN recurrence.
  
  
  CONCLUSIONS
  Pretreatment CEA ≥ 10 ng/mL is an additional risk factor of PALN relapse following definitive CCRT for SCC of the uterine cervix in patients with pretreatment SCC-Ag levels < 10 ng/mL. More comprehensive examinations before CCRT and intensive follow-up schedules are suggested for early detection and salvage in patients with SCC-Ag or CEA levels ≥ 10 ng/mL.
authors.affiliation: Department of Radiation Oncology, Chang Gung University College of Medicine, Kaohsiung, Taiwan. huangengyen@gmail.com
authors.forename: Eng-Yen
authors.initials: EY
authors.lastname: Huang
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Huang
authors.forename: Chan-Chao
authors.initials: CC
authors.lastname: Chanchien
authors.forename: Hao
authors.initials: H
authors.lastname: Lin
authors.forename: Chong-Jong
authors.initials: CJ
authors.lastname: Wang
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Sun
authors.forename: Chin-Wen
authors.initials: CW
authors.lastname: Tseng
authors.forename: Ching-Chou
authors.initials: CC
authors.lastname: Tsai
authors.forename: Yu-Che
authors.initials: YC
authors.lastname: Ou
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Fu
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Hsuan-Chih
authors.initials: HC
authors.lastname: Hsu
authors.forename: Chang-Yu
authors.initials: CY
authors.lastname: Wang
mesh_terms: D000951:Antigens, Neoplasm / Q000378:metabolism*; D014408:Biomarkers, Tumor / Q000378:metabolism; D001918:Brachytherapy; D002272:Carcinoembryonic Antigen / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D059248:Chemoradiotherapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology* / Q000528:radiation effects; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D009367:Neoplasm Staging; D011379:Prognosis; D011863:Radioimmunoassay; D012189:Retrospective Studies; D012307:Risk Factors; D015843:Serpins / Q000378:metabolism*; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000628:therapy
chemical_list: D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D015843:Serpins; C051072:squamous cell carcinoma-related antigen