A combination of serum tumor markers identifies high-risk patients with early-stage squamous cervical cancer
A combination of serum tumor markers identifies high-risk patients with early-stage squamous cervical cancer
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DOI：
10.1159/000132566
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发表时间：
2008-01-01
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影响因子：
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通讯作者：
Kenemans, Peter
中科院分区：
文献类型：
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作者：
Davelaar, Elvira M.;van de Lande, Jonas;Kenemans, Peter
我们的目的是调查是否预处理血清水平的鳞状细胞癌（SCC）抗原（SCC-Ag），细胞角蛋白19（CYFRA 21-1）和两种粘蛋白（CA 15-3和CA 125）确定患者的隐匿性疾病的早期阶段的宫颈鳞状细胞癌。因此，从78例宫颈SCC患者（52例IB，9例IIA和18例IIB）中获得治疗前血清样本，并使用商业免疫测定法测量肿瘤标志物。在单变量分析中，SCC-Ag、CYFRA 21-1和CA 15-3（作为连续变量分析）与总体（OS）和无病生存期（DFS）显著相关（所有病例p < 0.001）。多变量分析确定淋巴结状态是OS和DFS的最强预测因子（分别为p < 0.001和p = 0.001），其次是CYFRA 21-1（分别为p = 0.060和p = 0.027）和CA 15-3（分别为p = 0.082和p = 0.017）。通过最大化总人群中OS的对数秩统计量来定义每种标志物的临床临界值：SCC-Ag为1.1 μ g/l（n = 47，60.3%），CYFRA 21-1为1.4 μ g/l（n = 47，60.3%），CA 15-3为40 U/ml（n = 11，14.1%），CA 125为30 U/ml（n = 10，12.8%）。SCC-Ag和CYFRA 21-1阳性的IB期患者的OS显着较低（平均8.3年，95%置信区间，CI，5.8-10.7年）和DFS（平均7.3年，95% CI 4.6-10年）（OS，平均14.5年，95% CI 13.5-15.5年; DFS，平均13.9年，95% CI 12.5-15.4年）。肿瘤<4cm或淋巴结阴性且SCC-Ag和CYFRA 21-1阳性的IB期患者与同一组中的所有其他患者相比具有显著较差的OS和DFS。CA 125和CA 15-3水平升高（3例患者）与极差的预后相关。总之，SCC-Ag和CYFRA 21-1的组合可能有助于识别需要辅助治疗的隐匿性疾病的早期宫颈癌患者。版权所有（C）2008 S. Karger AG，巴塞尔。
We aimed to investigate whether pretreatment serum levels of squamous cell carcinoma (SCC) antigen (SCC-Ag), cytokeratin 19 (CYFRA 21-1) and two mucins (CA 15-3 and CA 125) identify patients with occult disease in early-stage SCC of the cervix. Therefore, pretreatment serum samples were obtained from 78 patients with SCC of the cervix (52 IB, 9 IIA and 18 IIB), and tumor markers were measured with commercial immunoassays. SCC-Ag, CYFRA 21-1 and CA 15-3 (analyzed as continuous variables) were significantly associated with overall (OS) and disease-free survival (DFS) in univariate analysis (p < 0.001 in all cases). Multivariate analysis identified lymph node status as the strongest predictor for OS and DFS (p < 0.001 and p = 0.001, respectively), followed by CYFRA 21-1 (p = 0.060 and p = 0.027, respectively) and CA 15-3 (p = 0.082 and p = 0.017, respectively). Clinical cutoff values for each marker were defined by maximizing the log-rank statistics for OS in the total population: 1.1 mu g/l for SCC-Ag (n = 47, 60.3%), 1.4 mu g/l for CYFRA 21-1 (n = 47, 60.3%), 40 U/ml for CA 15-3 (n = 11, 14.1%) and 30 U/ml for CA 125 (n = 10, 12.8%). Stage IB patients with positive SCC-Ag and CYFRA 21-1 had significantly lower OS (mean 8.3 years, 95% confidence interval, CI, 5.8-10.7 years) and DFS (mean 7.3 years, 95% CI 4.6-10 years) than all other stage IB patients (OS, mean 14.5 years, 95% CI 13.5-15.5 years; DFS, mean 13.9 years, 95% CI 12.5-15.4 years). Stage IB patients with tumors < 4 cm or with negative lymph nodes and positive SCC-Ag and CYFRA 21-1 had significantly poorer OS and DFS compared to all other patients in the same group. Elevated levels of both CA 125 and CA 15-3 (3 patients) were associated with an extremely poor prognosis. In conclusion, a combination of SCC-Ag and CYFRA 21-1 may help to identify early-stage cervical cancer patients with occult disease requiring adjuvant therapy. Copyright (C) 2008 S. Karger AG, Basel.