鳞状上皮细胞癌抗原与子宫颈鳞癌预后的关系

Correlation between the levels of serum squamous carcinoma antigen and the prognosis of cervical squamous carcinoma

目的分析鳞状上皮细胞癌抗原（SCCAg）与治疗前宫颈鳞癌患者的临床病理学特征的关系；探讨血清SCCAg在监测宫颈鳞癌复发患者诊断中的意义及与预后的关系，研究复发的宫颈鳞癌患者的生存率。方法采用酶联免疫吸附试验（ELISA）法检测治疗前300例、治疗后复查的500例宫预鳞癌患者血清中SCCAg水平。结果①单因素分析显示，治疗前宫颈鳞癌患者血清中SCCAg含量与患者的临床分期、盆腔淋巴结转移、肌层浸润密切相关（F=3．61，P〈0．05；t=6．81，P〈0．001；t=3．64，P〈0．01）；与患者的年龄、脉栓、肿瘤的生长类型无关（t=0．77，P〉0．05；t=1．12，P〉0．05；t=1．06，P〉0．05）；多因素Logistic回归分析结果，治疗前SCCAg水平与患者临床分期、盆腔淋巴结转移以及肌层浸润相关。②治疗后复查的500例宫颈鳞癌患者有180例复发，SCCAg升高者161例（161／180，89．4％）。其中SCCAg提前升高者60例，无任何临床症状以及影像学检查也未发现复发病灶。血清SCCAg提前升高的中位时间是2．3个月，肿瘤标志物水平升高与出现转移和（或）病情进展的影像学表现时间两：著最长相差150d。180例复发的宫颈鳞癌患者失访20例，其余160例中位生存时间为9个月，平均生；年时间为20个月，总的3年生存率为23．4％，5年生存率17．8％。③单因素分析结果显示，复发患者的临床分级、复发部位、治疗后SCCAg水平与患者的生存时间密切相关（x2=10．26，P〈0．005；x2=14．65，P〈0．005；x2=8．97，P〈0．01），血清SCCAg提前升高的复发患者与血清SCCAg未提前升高的复发患者生存率没有统计学差异（x2=0．89，P〉0．05）。多因素分析显示，复发患者的临床分期、复发后SCCAg的水平是预后影响因素（x2=10．3372，P=0．0013；x2=4．3889，P=0．0362）。结论治疗前血清SCCAg水平与患者的临床分期、盆腔淋巴结转移、肌层浸润密切相关；血清SCCAg水平对宫颈鳞癌复发的早期检测以及预后评估有重要价值。

Objective To analyze the correlation between the levels of squamous cell carcinoma antigen （SCCAg） and the clinicopathological characteristics of patients with cervical squamous carcinoma. To study the relationship of serum SCCAg levels of patients with recurrent cervical squamous carcinoma and disease prognosis and to investigate the survival rate of patients with recurrent cervical squamous carcinoma. Method ELISA method was used to determine the serum SCCAg levels for the patients, which included 300 cases before treat- ment and 500 cases after treatment. Results （ 1 ） Single factor analysis indicated that, before the treatment, the serum SCCAg levels were closely related to clinical stages, lymphatic metastasis, and deep myometrial inwLsion （t=3.01, P〈0.05; t =6.81, P〈O. 001; t=3.01, P〈0.05; respectively）. However, they were not related to patient＇s age, vascular embolization and tumor growth type （t = O. 77, t = 1.12, t = 1.06; respec- tively, all P 〉 0.05 ）. Multifactor logistic regression analysis showed that the pretreatment SCCAg levels of patients were related to clinical stages, cavum pelvis lymphatic metastasis and myometrial invasion （ X2 = 2.88, P=0.0084; X2 =2.612, P=0.0156; x2 =2.570, P=0.0171; respectively）. （2） Overall, recurrent dis- ease developed in 180 of the 500 patients with cervical squamous carcinoma. One hundred and sixty-one recur- rent patients showed elevated SCCAg levels （ 161/180, 89.4% ）. For the 60 patients who showed elevated SCCAg levels without any clinical symptoms as well as no sign of tumors by iconography, the median time for signs of elevating levels of serum SCCAg was 2.3 months. The longest time range was 150d between the increasing levels of the tumor markers and the appearance of the imaging features of pachygyria while the patients condition was going on. The 160 patients out of the 180 cases with recurrent cervical squamous carci noma who were followed up had a median survival time of 9 months, with an average of 20 months. The total 3 year Survival rate and 5 year survival rate was respectively 23.4% and 17.8%. （3） Single factor analysis indi- cated that recurrent patients＂ clinical stages, recurrent region and recurrent post treatment SCCAg levels were closely related with patients＇ survival time （ X2 = 10.26, P 〈 0. 005 ; X2 = 14.65, P 〈 0.005 ; X2 = 8.97, P 〈 0.01; respectively）. There was no statistical difference between the survival rate of recurrent patients with increased SCCAg level and patients without increased SCCAg levels （ X2 = 0.89, P 〉 0.05 ）. Multiple factor analysis indicated that the clinical stages, recurrent post treatment SCCAg levels of patients with recurrence were independent prognostic factors （ X2 = 10. 3372, P = 0. 0013 ; X2 = 4. 3889, P = 0. 0362 ; respectively）. Conclusion The pretreatment SCCAg levels are closely related to patients＇clinical stages, cavum pelvis lymphatic metastasis and deep myometrial invasion. Serum SCCAg levels are important for the advanced detection of cervi- cal squamous carcinoma recurrence and prognosis prediction.