title: The prognostic value of squamous cell carcinoma antigen for predicting tumor recurrence in cervical squamous cell carcinoma patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate the prognostic value of squamous cell carcinoma antigen (SCC-Ag) and the optimal cut-off value for predicting recurrence in cervical squamous cell carcinoma patients with complete remission after primary treatment.
  
  
  METHODS
  We reviewed the records of 783 cervical squamous cell cancer patients who underwent primary therapy and showed complete remission at our institution between January 2000 and April 2014. A receiver operating characteristic curve was used to determine the optimal SCC-Ag threshold to predict recurrence. Cox regression model for disease free survival was used to assess differences in outcome.
  
  
  RESULTS
  The median follow-up period was 41.2 months, and 154 patients (19.7%) had recurrent disease. The median pretreatment and posttreatment SCC-Ag level was 2.6 ng/mL (range, 0.1 to 532.0 ng/mL) and 0.7 ng/mL (range, 0.0 to 46.8 ng/mL), respectively. Both pretreatment and posttreatment SCC-Ag levels were higher in the recurrence group (P=0.017 and P=0.039). Optimal cut-off value of pretreatment and posttreatment SCC-Ag for predicting recurrence was 1.86 ng/mL (area under the curve, 0.663; P=0.000), and 0.9 ng/mL (area under the curve, 0.581; P=0.002), respectively. In the multivariate Cox regression model, pretreatment SCC-Ag >1.86 ng/mL (odds ratio, 2.11; 95% confidence interval, 1.38 to 3.22; P=0.001) and posttreatment SCC-Ag >0.9 ng/mL (odds ratio, 1.64; 95% confidence interval, 1.18 to 2.28; P=0.003) were significantly associated with poor disease free survival.
  
  
  CONCLUSIONS
  Patients with pretreatment SCC-Ag >1.86 ng/mL or posttreatment SCC-Ag >0.9 ng/mL should be considered at high risk for cancer recurrence after complete remission, and therefore, closer surveillance is needed.
authors.affiliation: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Ryu
authors.affiliation: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Ji Sun
authors.initials: JS
authors.lastname: Baek
authors.affiliation: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Woo Dae
authors.initials: WD
authors.lastname: Kang
authors.affiliation: Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Seok Mo
authors.initials: SM
authors.lastname: Kim
keywords: Cervical squamous cell cancer; Cut-off value; Disease-free survival; Squamous cell carcinoma-related antigen