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血清鳞状细胞癌抗原水平变化在诊断子宫颈鳞癌复发中的临床意义

Significance and implication on changes of serum squamous cell carcinoma antigen in the diagnosis of recurrence squamous cell carcinoma of cervix

摘要:

目的探讨血清鳞状细胞癌抗原(SCC-Ag)水平变化在诊断子宫颈鳞癌复发中的临床意义。方法收集2004年1月—2010年12月间蚌埠医学院第一附属医院收治并有完整随访资料的1394例完全缓解的子宫颈鳞癌患者纳入本研究,患者年龄18~72岁,中位年龄46岁;临床分期:依据国际妇产科联盟(FIGO)1994年的分期标准,Ⅰa期71例,Ⅰb期360例,Ⅱa期254例,Ⅱb期207例,Ⅲa期95例,Ⅲb期289例,Ⅳa期106例,Ⅳb期12例。其中685例Ⅰ~Ⅱa期患者行子宫广泛性切除术,709例Ⅱb~Ⅳ期患者予同步放化疗。动态监测治疗前后患者血清SCC-Ag水平的变化,以血清SCC-Ag水平≤1.95μg/L为SCC-Ag阴性表达,>1.95μg/L为SCC-Ag阳性表达,分析治疗前SCC-Ag阳性表达情况、经治疗SCC-Ag转阴后的复发率与子宫颈鳞癌患者临床病理特征的关系;同时联合妇科检查、细胞学检查和影像学检查,比较复发的子宫颈鳞癌患者中血清SCC-Ag水平再升高时间与临床检查或影像学检查发现异常时间的差异;并对不同复发部位的子宫颈鳞癌患者血清SCC-Ag水平进行比较。结果(1)1394例子宫颈鳞癌患者中,治疗前SCC-Ag阳性患者1169例,治疗前SCC-Ag阳性表达率与临床分期、肿瘤直径明显相关(P<0.01);而与病理分级、淋巴结转移无关(P>0.05)。1169例治疗前SCC-Ag阳性表达患者治疗后均转阴,经治疗SCC-Ag转阴后复发患者279例,其复发率与临床分期、病理分级、淋巴结转移、肿瘤直径明显相关(P<0.01)。(2)279例复发的子宫颈鳞癌患者中,血清SCC-Ag水平再升高的中位时间为12.4个月,临床检查或影像学检查发现异常的中位时间为19.0个月,前者早于后者3~9个月,患者血清SCC-Ag水平再升高的中位时间与临床检查或影像学检查发现异常的中位时间比较,差异有统计学意义(P<0.01)。(3)279例复发的子宫颈鳞癌患者中,中心性复发患者中血清SCC-Ag水平>5μg/L者占4.2%(4/96),盆壁复发者占56.2%(45/80),远处转移者占87.4%(90/103),远处转移和盆壁复发患者血清SCC-Ag水平>5μg/L者所占比例分别与中心性复发患者比较,差异均有统计学意义(P<0.01);远处转移患者血清SCC-Ag水平>5μg/L者所占比例与盆壁复发患者比较,差异也有统计学意义(P<0.01)。结论子宫颈鳞癌患者血清SCC-Ag阳性表达与临床期别及肿瘤直径密切相关。动态监测血清SCC-Ag水平,有助于早期发现子宫颈鳞癌的复发,但对中心性复发患者存在局限性,应引起注意。

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abstracts:

Objective To explore the significance of serum squamous cell carcinoma antigen (SCC-Ag) in the diagnose of recurrent squamous cell carcinoma of cervix, and seek an effective approach to monitor tumor recurrence after treatment as early as possible. Methods All the data were collected from 1 557 patients with cervical squamous cell carcinoma treated in the First Affiliated Hospital of Bengbu Medical College from Jan. 2004 to Dec. 2010, the data of un-controlled cases(patients whose serum level of SCC-Ag failed to decrease to normal level or patients with incomplete tumor extinction)were eliminated,&nbsp;there were 1 394 cases of complete remission were analyzed,the median age was 46 years( rang, 18-72 years). According to International Federation of Gynecology and Obstetrics stages (FIGO, 1994), 71 cases were in stageⅠa, 360 cases stageⅠb, 254 cases stageⅡa, 207 cases stageⅡb, 95 cases stageⅢa, 289 cases stageⅢb, 106 cases stageⅣa and 12 cases stageⅣb. Radical hysterectomy was performed in 685 cases with stageⅠ-Ⅱa, concurrent radiation and chemotherapy was performed in 709 cases with stageⅡb-Ⅳ. Taking serum cut off value of SCC-Ag was 1.95 μg/L, the level ≤1.95 μg/L as SCC-Ag negative expression and>1.95μg/L as SCC-Ag positive expression. The positive expression status of SCC-Ag before treatment, the relationship between the post-treatment recurrence rate after SCC-Ag becoming negative and the clinicopathological features of the patients with cervical squamous cell carcinoma were analyzed, concurrently combined with gynecological check-up, pathological and imaging examination, followed by comparative analysis with the results of monitoring. Results Among 1 394 patients with cervical squamous cell carcinoma, there were 1 169 cases with positive SCC-Ag, the positive expression rate of SCC-Ag before treatment was closely related with the clinical stages and tumor size(all P<0.01),which was not related with pathological grade and lymphatic metastasis(all P>0.05). The positive expression of SCC-Ag in 1 169 patients before treatment turned negative after treatment, 279 patients with recurrence whose positive expression of SCC-Ag turned negative after treatment, the recurrence rate was closely related with clinical stages, pathological grade, lymphatic metastasis and tumor size(all P<0.01). Among 279 cases of recurret squamous cell carcinoma of cervix, the median time of the increase in serum level of SCC-Ag was 12.4 months, and the median time of clinical or imaging examination was 19.0 months. And the recurrence time in the increase of patients′ serum level of SCC-Ag occurred obviously earlierthan that in clinical or radiographic manifestation (P<0.01), the median time of recurrence of the increase in serum level of SCC-Ag was obviously earlier than that of abnormality found by clinical or imaging examination(P<0.01). Among 279 cases withrecurrent squamous cell carcinoma of cervix, the serum level of SCC-Ag>5μg/L for patients with central recurrence was 4.2%(4/96), whilein the group of pelvic wall recurrence group was 56.2%(45/80)and in distant metastasis group was 87.4%(90/103). The level of SCC-Ag>5μg/L from the patients with pelvic wall recurrence and distant metastasis were much higher than that of patients with central recurrence (P<0.01), and the same results were shown between distant metastasis group and pelvic wall recurret group (P<0.01). Conclusions SSC-Ag expression in serum of patients with cervical squamous carcinoma is closely related with clinical stages and the tumor size. Dynamic monitoring the level of SSC-Ag could contribute to the early diagnosis for tumor recurrence, but it has some limitations for patients with central recurrence, which should deserve our attention.

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