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

BackgroundTo identify pretreatment carcinoembryonic antigen (CEA) levels as a risk factor for para-aortic lymph node (PALN) recurrence following concurrent chemoradiotherapy (CCRT) for cervical cancer.MethodsFrom 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).ResultsBoth 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.ConclusionsPretreatment 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.

Carcinoembryonic antigen as a marker of radioresistance in colorectal cancer: a potential role of macrophages

“…The preoperative CEA level may serve as a marker of occult metastasis and radioresistance to PORT in rectal cancer. This study also confirmed the results of our previous study that investigated the role of pretreatment CEA levels in the LRs, DMs, and OSs of patients undergoing definitive radiotherapy for cervical cancer [ 2 , 24 ]. We also found that LR usually preceded DM, and a higher DM rate was noted in patients with LR than in those without LR.…”

The value of squamous cell carcinoma antigen (SCCa) to determine the lymph nodal metastasis in cervical cancer: A meta-analysis and literature review

“…It has a high mortality within 2 years despite aggressive salvage treatment[ 32 ]. The prediction of isolated para-aortic node recurrence significantly correlated with SCCa elevation as the initial sign has been reported previously [ 17 , 31 , 33 ]. Chou found SCCa>4ng/mL was a statistically significant predictive factor for para-aortic lymph node recurrence.…”

“…Huang[ 17 ] investigated the risk factors and prognosis of IB-IIB cervical carcinoma with common iliac lymph node metastasis in 960 patients who received radical hysterectomy and bilateral pelvic lymphadenectomy. SCCa >4 ng/ml before treatment was found to be the independent risk factors in the common iliac lymph node metastasis.…”

The association between serum squamous cell carcinoma antigen and recurrence and survival of patients with cervical squamous cell carcinoma: A systematic review and meta-analysis

“…Although many studies have investigated the roles of SCC-Ag in squamous cell cervical cancer, applying its roles to clinical practice is still debatable. Some studies assessed the predictive effects of pretreatment SCC-Ag on disease progression (i.e., recurrence or death) after receiving treatments either as an additional predictor in the presence of other previously known predictors [12,13] or by itself [14][15][16][17][18][19], as well as in monitoring the response to treatment [20]. In addition, SCC-Ag was also found to be associated with disease progression in some studies [19,[21][22][23][24][25].…”