鳞状细胞癌抗原与子宫颈鳞状细胞癌的临床病理特征及预后的关系

Correlation of serum squamous cell carcinoma antigen with clinico-pathoiogical features and prognosis of squamous cell carcinoma of uterine cervix

目的探讨治疗前血清鳞状细胞癌抗原(sCCAg)滴度与宫颈鳞状细胞癌(鳞癌)临床病理特征的关系,以及作为预测预后的因素的意义。方法选择114例治疗前检测过血清 SCCAg 并经治疗后长期随访的Ⅰ b1～Ⅱa期宫颈鳞癌患者,结合临床资料对 SCCAg 与临床病理特征及预后的关系进行单因素和多因素分析。结果单因素分析显示,治疗前血清 SCCAg 滴度升高(正常值≤1.5mg/L)与肿瘤直径、深肌层浸润及盆腔淋巴结转移相关(P<0.05);多因素分析显示,SCCAg 滴度升高与深肌层浸润(P=0.029)、盆腔淋巴结转移(P=0.049)相关。114例患者的5年累积无瘤生存率为78.6%,总复发率为27.2%。单因素分析显示,SCCAg 滴度升高、盆腔淋巴结转移与5年累积无瘤生存率及复发相关(P<0.05);多因素分析显示,影响预后的独立因素为 SCCAg 滴度升高(P=0.030)和盆腔淋巴结转移(P=0.003),影响复发的显著相关因素为盆腔淋巴结转移(P=0.006)。盆腔淋巴结转移且 SCCAg 滴度正常者与盆腔淋巴结转移且 SCCAg 滴度升高者,5年累积无瘤生存率(分别为50.0%、50.9%)、复发率[分别为60.0%(6/10)、47.1%(8/17)]、局部复发率[分别为3/8、20.0%(3/15)]和远处复发率[分别为1/8、20.0%(3/15)]分别比较,差异均无统计学意义(P>0.05)。盆腔淋巴结无转移且 SCCAg 滴度正常者与盆腔淋巴结无转移且 SCCAg 滴度升高者,5年累积无瘤生存率(分别为98.0%、71.8%,P=0.003)、复发率[分别为9.8%(5/51)、33.3%(12/36),P=0.006]、局部复发率[分别为2.1%(1/47)、26.5%(9/34),P=0.001]分别比较,差异均有统计学意义。结论治疗前血清 SCCAg 滴度升高和盆腔淋巴结转移是影响Ⅰb1～Ⅱa期宫颈鳞癌患者预后的独立因素。治疗前血清 SCCAg 滴度升高且盆腔淋巴结无转移患者的局部复发风险显著升高。

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 ≤ 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 ）. Condusions The independent prognostic factors for Ⅰb1 -Ⅱ a 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.