Objective There are no generally accepted biomarkers for the optimal selection of radiotherapy-based or surgical-based treatment options for nonbulky early-stage squamous cell carcinoma of the cervix (IA1–IB1 and IIA1). The objective of this study was to assess the value of human squamous cell carcinoma–associated antigen (SCC-Ag) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) in evaluation of patients with nonbulky early-stage squamous cell carcinoma of the cervix to determine if radiotherapy is warranted after radical surgery.
Methods Patients with stage IA1–IB1 and IIA1 squamous cell carcinoma of the cervix who were treated at the Department of Gynecological Oncology, Affiliated Tumor Hospital of Guangxi Medical University, from March 2012 to August 2014 (n = 308) were treated with radical hysterectomy and pelvic lymphadenectomy. The levels of SCC-Ag and CYFRA21-1 were detected by enzyme-linked immunosorbent assay before surgery. The relationship between the concentrations of SCC-Ag and CYFRA21-1 and risk factors was estimated through logistic regression and analysis of variance t test. The cutoff values of these 2 markers to evaluate the need for postoperative radiotherapy were identified and validated by receiver operating characteristic curve and κ consistency test, respectively.
Results Serum SCC-Ag and CYFRA21-1 levels are significantly increased in patients who require postoperative radiotherapy with a risk factor score of at least 2 (n = 162). Logistic regression analysis revealed that deep stromal invasion and lymph node metastasis are independent risk factors for serum SCC-Ag value, and deep stromal invasion is an independent risk factor for the serum CYFRA21-1 value. Receiver operating characteristic curve revealed that the best predictive cutoff points of SCC-Ag and CYFRA21-1 values were 1.425 and 3.210 ng/mL, respectively. These results were validated by the κ consistency test applied to a validation group of patients. The results suggest that most patients with SCC-Ag and CYFRA21-1 values of at least 1.425 and 3.210 ng/mL, respectively, require postoperative radiotherapy.
Conclusions Detection of the levels of SCC-Ag and CYFRA21-1 may help guide an individual primary treatment plan for patients with nonbulky early-stage squamous cell carcinoma of the cervix.
- ROC curve
- Squamous cell carcinoma of the cervix
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C.L. and H.Z. contributed equally to this work.
C.L. conceived and designed this study, performed main study, analyzed the data, provided fund support, and wrote the paper; H.Z. mainly performed data analysis and statistics; J.Z. performed main experiment; Y.R. and Z.M. performed some experiment; L.L. guided the study and contributed materials; J.Z. conceived and designed this study and contributed materials.
The study was approved by the Ethics Committee of Guangxi Medical University (reference 11.07.11). Informed consent was obtained from each participant.
This study was supported by the National Natural Science Foundation of China (81560425) and Natural Science Foundation of Guangxi (2013GXNSFBA019195).
The authors declare no conflicts of interest.