The predictive value of serum squamous cell carcinoma antigen in patients with cervical cancer who receive neoadjuvant chemotherapy followed by radical surgery: a single-institute study

PLoS One. 2015 Apr 10;10(4):e0122361. doi: 10.1371/journal.pone.0122361. eCollection 2015.

Abstract

Objective: Neoadjuvant chemotherapy (NACT) could affect the levels of squamous cell carcinoma antigen (SCC-Ag). This study evaluates the predictive value of pre- and posttreatment SCC-Ag levels in patients with cervical cancer who were treated with NACT followed by radical surgery.

Methods: A total of 286 patients with Stage IB1-IIIB squamous cell carcinoma of the uterine cervix who were treated with NACT followed by radical hysterectomy were analyzed retrospectively. The relationship between SCC-Ag levels, the clinicopathologic parameters, the response to NACT and the three-year survival rate was investigated.

Results: The levels of SCC-Ag were elevated (>3.5 ng/mL) in 43.8% of patients before NACT, and 13.0% of patients after NACT. Pre- and posttreatment levels of SCC-Ag correlated with the response to NACT (P = 0.010, and P<0.001), deep stromal infiltration (P = 0.041, and P = 0.006), and lymph node status (P<0.001, and P<0.001). In the multivariate analysis, the elevated pretreatment level of SCC-Ag was demonstrated to be an independent risk factor for Lymph node metastases (P<0.001). Patients with both pre- and posttreatment SCC-Ag levels ≤3.5 ng/mL showed the best 3-year disease-free survival (DFS) and 3-year overall survival (OS) compared with patients with either pre- or posttreatment levels >3.5 ng/mL (P<0.001, and P<0.001, respectively). A multivariate analysis showed that posttreatment SCC-Ag levels were a strong independent predictor of OS (P = 0.001) and DFS (P = 0.012).

Conclusion: Elevated pretreatment levels of SCC-Ag (>3.5 ng/mL) indicated a poor response to NACT and a higher risk of lymph node metastases. Elevated posttreatment levels of SCC-Ag were correlated with poor DFS and OS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antigens, Neoplasm / blood*
  • Biomarkers, Tumor / blood
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy*
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy
  • Lymphatic Metastasis
  • Middle Aged
  • Multivariate Analysis
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Serpins / blood*
  • Survival Rate
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / therapy*

Substances

  • Antigens, Neoplasm
  • Biomarkers, Tumor
  • Serpins
  • squamous cell carcinoma-related antigen

Grants and funding

This study was endorsed by the Key Basic Research and Development Program Foundation of China (973 Program; No. 2015CB553903, 2009CB521806) and was supported by grants from the National Natural Science Foundation of China (No. 81230038; 81472783; 81272422; 81172464; 81090414; 81101964). No other potential conflict of interest relevant to this article was reported. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.