Significance of elevated SCC-Ag level on tumor recurrence and patient survival in patients with squamous-cell carcinoma of uterine cervix following definitive chemoradiotherapy: a multi-institutional analysis

Abstract

ObjectiveThere is no definitive guideline for the significance and cut-off value of squamous-cell carcinoma antigen (SCC-Ag) in cervical cancer. Thus, we analyzed the significance and optimal cut-off value of SCC-Ag for predicting tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix.MethodsFrom January 2010 to October 2016, we enrolled 304 cervical cancer patients with squamous-cell carcinoma staging International Federation of Gynecology and Obstetrics (FIGO) Ib–IVa and treated with definitive chemoradiotherapy (CRT) followed by intra-cavitary radiotherapy (ICR). The cut-off value of SCC-Ag level for tumor recurrence was calculated using the receiver operating characteristic (ROC) curve. The recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier method to estimate the significance of SCC-Ag level.ResultsThe optimal cut-off value of SCC-Ag level for predicting tumor recurrence was calculated and set at 4.0 ng/mL in the ROC curve. After a median follow-up period of 36.5 months, the 3-year RFS (56.6% vs. 80.2%, p<0.001) and OS (72.1% vs. 86.8%, p=0.005) were significantly lower in SCC-Ag ≥4 ng/mL arm than in <4 ng/mL arm. The 3-year locoregional recurrence (17.6% vs. 7.0%, p=0.012), distant metastasis (20.4% vs. 6.9%, p=0.002), and para-aortic recurrence (9.4% vs. 2.1%, p=0.012) rates were significantly higher in SCC-Ag ≥4 ng/mL arm than in SCC-Ag <4 ng/mL arm.ConclusionPre-treatment SCC-Ag level higher than 4 ng/mL may be a useful predictor of tumor recurrence in patients with squamous-cell carcinoma of uterine cervix treated with definitive CRT and ICR.

Predictive value of preoperative serum squamous cell carcinoma antigen (SCC–Ag) level on tumor recurrence in cervical squamous cell carcinoma patients treated with radical surgery: A single-institution study

“…The potential use of serum SCC-Ag level in the clinical management of cervical squamous cell carcinoma patients has been suggested [11,15e18]. In agreement with some studies [10,14,19,20], our results not only confirmed the predictive capability of serum SCC-Ag level for both PFS and OS but showed a prognostic variable for high-risk patients who may need more aggressive therapy.…”

“…The same conclusions were reported in a study by Oh et al [12], in which serum SCC-Ag test was found to be helpful in detecting recurrent cervical squamous cell carcinoma during post-treatment surveillance, and the optimal cut-off value was !2.0 ng/mL. Choi et al [14] enrolled 304 cervical cancer patients with squamous cell carcinoma (FIGO Fig. 3.…”

Preoperative SCC-Ag as a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma with intermediate-risk factors

“…[5] Many studies found that pre-treatment SCC-Ag level could predict disease progression after treatments. [6][7][8][9][10][11][12] Besides, SCC-Ag was also employed to evaluate the response to treatment. [13] However whether preoperative SCC-Ag can be a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma is still unknown.…”

The kinetic profile and clinical implication of SCC-Ag in squamous cervical cancer patients undergoing radical hysterectomy using the Simoa assay: a prospective observational study

“…The role of serum SCC-Ag in squamous cervical cancer has been extensively evaluated in previous works [4,7,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24], and several reviews and metaanalyses have been published in the literature [5,[25][26][27]. Most studies were of retrospective design and only detected SCC-Ag at one time-point.…”

“…Most studies were of retrospective design and only detected SCC-Ag at one time-point. They could be roughly divided into two groups according to the SCC-Ag measurement time: first, the clinical relevance of pretreatment SCC-Ag, which is still debated [4,5,14,15,18,20,[22][23][24], and second, the value of SCC-Ag in the monitoring of response to treatment and follow-up [7,8,17,18,20]. To date, few studies have investigated the dynamic change in serum SCC-Ag levels during treatment, from surgery to adjuvant therapies.…”