术前血清鳞状细胞癌抗原水平与早期子宫颈鳞状细胞癌淋巴结转移的关系

Correlation of the levels of preoperative serum squamous cell carcinoma antigen with early-stage lymphatic metastasis of squamous cell cervical cancer

目的:探讨术前血清鳞状上皮细胞癌抗原(SCCAg)水平与早期子宫颈鳞状细胞癌淋巴结转移的关系。方法:对391例行根治性手术的早期子宫颈鳞状细胞癌患者的临床病理资料进行回顾性分析,检测术前SCCAg水平,并将其与各临床病理参数的关系进行统计学分析。结果:术前SCCAg水平在FIGO分期、肿瘤直径、肌层浸润深度、子宫颈旁有无受侵及淋巴结有无转移间差异均有统计学意义(P<0.01),而在肿瘤的组织学分级和脉管有无浸润间差异均无统计学意义(P>0.05)。仅有肿瘤直径(P=0.001 5)和淋巴结转移(P=0.000 1)是影响SCCAg水平的独立危险因素,且淋巴结转移比肿瘤直径对SCCAg水平影响更大。在Ⅰb1期,当选择截断值为2.5 ng/ml时,有较好的灵敏度(0.54)和特异度(0.83),Youden指数(0.37)最高,预测效果最佳;而在Ⅰb2和Ⅱa期,当选择截断值为4.5 ng/ml时,有较好的灵敏度(0.55)和特异度(0.79),Youden指数(0.34)最高,预测效果最佳。结论:术前SCCAg水平对评估淋巴结转移有一定的价值。在Ⅰb1期和Ⅰb2+Ⅱa期,分别选择截断值为2.5 ng/ml和4.5 ng/ml时,有最佳预测效果。

Objective：To investigate the correlation of preoperative serum squamous cell carcinoma antigen（SCCAg） with early-stage lymphatic metastasis of squamous cell cervical cancer. Methods：The clinically pathologic data of 391 cases with early-stage squamous cell cervical cancer undergoing radical hysterectomy were analyzed preoperatively. The serum levels of SCC-Ag preoperation were detected, and its correlation with the clinically pathologic data were statistically analyzed. Results ： The levels of SCCAg preoperative and the FIGO staging, tumor size, depth of muscular infihration, parametrial involvement and lymphatic metastasis had significantly association （ P 〈 0.01 ）, but the degree of differentiation and tumor vascular invasion was not statistically significant （ P 〉 0. 05 ）. The lymph node metastasis and tumor diameter were the independent risk factors of affecting serum marker levels and lymphatic metastasis had more effects on the levels of SCC-Ag than tumor diameter. The better sensitivity （ 0.54 ） and specificity （ 0.83 ）, highest Yonden index（0.37 ） and best predictive results could be achieved when the cut-off value was 2.5 ng/ml during the Ⅰ b1 stage period. But for Ⅰ b2 and Ⅱ a stage, the cut-off value was 4.5 ng/ml. Conclusions ： The serum levels of SCC-Ag preoperation have a＇ certain value in evaluating the lymphatic metastasis. During I bx and Ⅰ b2 andⅡ a. stage, the predictive resuhs are the best when the cut-off values are 2.5 and 4.5 ng,/ml respectively.