Objective: To investigate the correlation of pretreatment serum squamous cell carcinoma antigen (SCCAg) with the clinico-pathological features of squamous cell carcinoma of uterine cervix and its significance as a prognostic factor.
Methods: One hundred and fourteen patients of squamous cell carcinoma of the uterine cervix (Ib1-IIa), who underwent pretreatment serum SCCAg evaluation and long-term follow-up after treatment were selected for this study. Clinical data were used to investigate the correlation between SCCAg and clinico-pathological features and factors that influence prognosis through univariate and multivariate analysis.
Results: Univariate analysis showed elevation of SCCAg (using < or = 1.5 mg/L as the cut-off value) was correlated with tumor size, deep stromal invasion and pelvic node metastasis (P < 0.05). Multivariate analysis revealed significant correlations between elevation of SCCAg and deep stromal invasion (P = 0.029) and pelvic node metastasis (P = 0.049). The 5 years disease-free survival (DFS) was 78.6%, and recurrence rate was 27.2%. Univariate analysis revealed that elevated pretreatment SCCAg and pelvic node metastasis were significantly correlated with DFS and recurrence (P < 0.05). Multivariate analysis identified elevated pretreatment SCCAg (P = 0.030), pelvic node metastasis (P = 0.003) as independent prognostic factors, and pelvic node metastasis (P = 0.006) as a factor significantly correlated with recurrence after treatment. Comparison between pelvic node metastasis + elevated SCCAg cases and pelvic node metastasis + normal SCCAg cases showed no significant difference in DFS (50.9% vs 50.0%), recurrence rate (47.1% vs 60.0%), local recurrence (20.0% vs 3/8) and distant recurrence (20.0% vs 1/8; all P > 0.05). However, between no pelvic node metastasis + elevated SCCAg cases and no pelvic node metastasis + normal SCCAg cases, there was a significant difference in DFS (71.8% vs 98.0%, P = 0.003), recurrence rate (33.3% vs 9.8%, P = 0.006) and local recurrence (26.5% vs 2.1%, P = 0.001).
Conclusions: The independent prognostic factors for Ib1-IIa squamous cell carcinoma of uterine cervix include elevated pretreatment SCCAg and pelvic node metastasis. Patients with elevated pretreatment serum SCCAg and no metastasis to pelvic lymph node (s) are at significantly elevated risk of local recurrence, and therefore need individualized treatment to improve local control and long-term survival.