治疗前血清鳞状细胞癌抗原对子宫颈鳞状细胞癌患者预后的预测价值及其与临床特征的相关性

Value of pre-treatment serum squamous cell carcinoma antigen in predicting the prognosis of patients with cervical squamous cell carcinoma and its correlation with clinical characteristics

目的探讨治疗前血清鳞状细胞癌抗原(SCC-Ag)对子宫颈鳞状细胞癌(CSCC)患者预后的预测价值,以及SCC-Ag与患者临床特征的相关性。方法回顾性病例系列研究。回顾性分析2016年1月至2021年10月山东省肿瘤医院收治的144例接受同步放化疗的ⅠB~ⅣA期CSCC患者的临床资料。随访截至2022年10月。根据随访过程中肿瘤是否进展,将患者分为进展组和未进展组,比较两组患者临床病理资料。绘制受试者工作特征(ROC)曲线,确定SCC-Ag预测无进展生存(PFS)的最佳临界值;根据最佳临界值,将患者分为高SCC-Ag组(>最佳临界值)和低SCC-Ag组(≤最佳临界值)。采用Kaplan-Meier法进行生存分析,并行log-rank检验。采用Cox比例风险模型对PFS的影响因素进行单因素和多因素分析。结果144例CSCC患者中位随访19.0个月,37例肿瘤进展,107例未进展;进展组肿瘤长径≥4 cm、有淋巴结转移、SCC-Ag>11.8 ng/ml患者的比例均高于未进展组,差异均有统计学意义(均P<0.05)。根据ROC曲线获得SCC-Ag预测CSCC患者PFS的最佳临界值为11.8 ng/ml,曲线下面积为0.703(95%CI:0.613~0.792,P<0.001)。高SCC-Ag(>11.8 ng/ml)组和低SCC-Ag(≤11.8 ng/ml)组不同肿瘤长径、淋巴结是否转移、国际妇产科联盟(FIGO)不同分期的患者比例比较,差异均有统计学意义(均P<0.05)。84例高SCC-Ag组和60例低SCC-Ag组患者3年PFS率分别为55.1%、88.0%,两组PFS比较差异具有统计学意义(χ^(2)=16.26,P<0.001)。肿瘤长径(HR=4.339,95%CI:1.304~14.439,P=0.017)、SCC-Ag(HR=1.006,95%CI:1.001~1.011,P=0.022)是CSCC同步放化疗后PFS的独立影响因素。结论治疗前高SCC-Ag水平可能提示CSCC患者预后不良,不同SCC-Ag水平的患者临床特征存在差异。

Objective To explore the value of pre-treatment serum squamous cell carcinoma-related antigen(SCC-Ag)in predicting the prognosis of patients with cervical squamous cell carcinoma(CSCC),and to analyze the correlation of SCC-Ag and clinical characteristics of patients.Methods A retrospective case series study was performed.The clinical data of 144 patients with stageⅠB-ⅣA CSCC who received concurrent chemoradiotherapy in Shandong Cancer Hospital from January 2016 to October 2021 were retrospectively analyzed.Follow-up ended in October 2022.They were divided into progression group and non-progression group based on whether the tumor progressed during the follow-up,and the clinical data of both groups were compared.The receiver operating characteristic(ROC)curve was drawn to determine the optimal cut-off value of SCC-Ag for predicting progression-free survival(PFS).According to the optimal cut-off value,patients were divided into the high SCC-Ag group(>optimal cut-off value)and the low SCC-Ag group(≤optimal cut-off value).The Kaplan-Meier method was used for survival analysis and log-rank test was performed.Univariate and multivariate Cox proportional hazards models were used to explore the factors influencing PFS.Results Among 144 patients with CSCC,the median follow-up was 19.0 months;37 cases progressed and 107 cases did not.The proportion of tumor diameter≥4cm,lymph node metastasis and SCC-Ag>11.8 ng/ml in progression group was higher than that in non-progression group,and the differences were statistically significant(all P<0.05).Based on the ROC curve,the optimal cut-off value of SCC-Ag for predicting PFS of CSCC patients was 11.8 ng/ml,and the area under the curve(AUC)was 0.703(95%CI:0.613-0.792,P<0.001).There were statistically significant differences in the proportion of patients with different tumor diameter,lymph node metastasis or not and different International Federation of Gynecology and Obstetrics(FIGO)stage between the high SCC-Ag group(>11.8 ng/ml)and the low SCC-Ag group(≤11.8 ng/ml),and the differences were statistically significant(all P<0.05).The 3-year PFS rate of 84 patients in the high SCC-Ag group was 55.1%,and that of 60 patients in the low SCC-Ag group was 88.0%;and the difference in PFS between both groups was statistically significant(χ^(2)=16.26,P<0.001).Tumor diameter(HR=4.339,95%CI:1.304-14.439,P=0.017)and SCC-Ag(HR=1.006,95%CI:1.001-1.011,P=0.022)were independent factors influencing PFS of patients with CSCC after concurrent chemoradiotherapy.Conclusions High SCC-Ag level before treatment may indicate poor prognosis in patients with CSCC.The clinical characteristics of patients with different SCC-Ag levels are different.