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Can serial evaluation of serum SCC-Ag-level predict tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix treated with definitive chemoradiotherapy? A multi-institutional analysis

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Abstract

Background

Tumor marker screening may be useful to evaluate tumor response and detect tumor recurrence. However, usefulness and cut-off value of squamous-cell carcinoma antigen (SCC-Ag) for recurrence and survival has not yet established in cervical cancer.

Methods

From January 2010 to October 2016, 304 patients with cervical squamous-cell carcinomas with FIGO stage IB-IVA who underwent curative chemoradiotherapy followed by brachytherapy at four institutions were included in this study. Serum SCC-Ag level was measured before treatment, re-measured after completion of treatment, and again at the time of relapse during follow-up. SCC-Ag levels at each measurement point were analyzed using receiver operating characteristic (ROC) curve. Their associations with recurrence-free survival (RFS) and overall survival (OS) were analyzed.

Results

During a median follow-up time of 36.5 months, there were 66 (21.7%) recurrences and 76 (25.0%) deaths. The ROC curve showed optimal Youden indices were 4, 1.5, and 4 ng/mL at pretreatment, treatment, and recurrence, respectively. In patients with SCC-Ag ≥ 4 ng/mL, not SCC-Ag < 4 ng/mL before treatment, post-treatment SCC-Ag level (≥ 1.5 ng/mL vs. < 1.5 ng/mL) showed significant differences in 3-year RFS (65.5% vs. 45.0%, p < 0.001) and OS (78.5% vs. 55.4%, p < 0.001). In 66 recurrent patients, patients with SCC-Ag ≥ 4 ng/mL at recurrence showed a significantly lower OS rate than others (59.5% vs. 33.0%, p = 0.041).

Conclusions

SCC-Ag level after treatment and at recurrence was useful for predicting recurrence and survival only when its pretreatment value was high (≥ 4 ng/mL).

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Abbreviations

FIGO:

International Federation Gynecology Obstetrics

CRT:

Chemoradiotherapy

ICR:

Intracavitary radiotherapy

OS:

Overall survival

RFS:

Recurrence-free survival

ROC:

Receiver operating characteristic

SCC-Ag:

Squamous-cell carcinoma antigen

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Acknowledgements

Statistical analyses performed in this article were advised by Catholic Medical Center Clinical Research Coordinating Center.

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Correspondence to Jong Hoon Lee.

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Choi, K.H., Yu, M., Jeong, S. et al. Can serial evaluation of serum SCC-Ag-level predict tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix treated with definitive chemoradiotherapy? A multi-institutional analysis. Int J Clin Oncol 25, 1405–1411 (2020). https://doi.org/10.1007/s10147-020-01664-3

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