Prognostic value of post-radiation serum squamous cell carcinoma antigen and primary tumor regression for cervical squamous cell carcinoma

Article type: Research Article

Authors: Wan, Quan^{a; 1} | Yan, Wangxiang^{b; 1} | Liu, Yonghong^{c; 1} | Lin, Yanzhu^{c; *} | Lu, Zhiyuan^{a; *}

Affiliations: [a] Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children’s Medical Center, Guangzhou, Guangdong, China | [b] Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China | [c] Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China

Correspondence: [*] Corresponding authors: Yanzhu Lin, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, No. 651, Dongfeng Road east, Guangzhou, Guangdong 510060, China. E-mail: linyanzhu0120@163.com; Zhiyuan Lu, Department of Oral and Maxillofacial Surgery, Stomatology Medical Center, Guangzhou Women and Children’s Medical Center, 9 Jinsui Road, Guangzhou, Guangdong 510623, China. E-mail: lzy890120@163.com.

Note: [1] These authors contributed equally to this work.

Abstract: OBJECTIVE: In this study, we determined the prognostic values of magnetic resonance imaging (MRI)-based primary tumor regression and serum squamous cell carcinoma antigen (SSCC-Ag) levels 4 weeks after definitive radiotherapy (RT) in cervical squamous cell carcinoma (CSCC) patients. METHODS: This was a retrospective study involving 218 patients with histologically confirmed CSCC (stages IB-IVA). All the patients received definitive RT. Pre- and post-RT pelvic MRI and SSCC-Ag levels were measured. Locoregional control (LRC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated, and possible OS prognostic factors were analyzed. RESULTS: The median follow-up time was 25.57 (1.73–58.93) months. Thirty-six and 68 patients died and experienced recurrence, respectively, and the primary tumors of 130 (59.6%) and 88 (40.4%) patients exhibited complete response (CR) and non-CR, respectively. The 3-year OS, DFS, LRC, and DMFS rates were significantly higher in the CR than in the non-CR patients (85.2% vs. 67.9%, 78.9% vs. 39.0%, 93.4% vs. 63.8%, and 83.4% vs. 54.5%, respectively; p< 0.05). The 3-year OS, DFS, LRC, and DMFS rates were significantly lower in the patients with high post-RT SSCC-Ag levels than in those with low post-RT SSCC-Ag levels (38.0% vs. 83.9%, 21.2% vs. 66.3%, 73.0% vs. 84.9%, and 26.5% vs. 79.0%, respectively; p<0.05). Multivariate analyses indicated that SSCC-Ag levels were an independent OS predictor (HR: 5.749, 95% CI: 2.598–12.723, p< 0.001). CONCLUSION: Post-RT SSCC-Ag levels are OS independent prognostic factors in CSCC patients receiving RT. Timely and optimized treatment plans for CSCC patients after 4 weeks of RT are necessary when patients with persistent tumor and/or positive SSCC-Ag.

Keywords: Cervix uteri, squamous cell carcinoma, survival, radiation, magnetic resonance imaging

DOI: 10.3233/CBM-190934

Journal: Cancer Biomarkers, vol. 29, no. 3, pp. 327-335, 2020