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Pretreatment carcinoembryonic antigen level is a risk factor for para-aortic lymph node recurrence in addition to squamous cell carcinoma antigen following definitive concurrent chemoradiotherapy for squamous cell carcinoma of the uterine cervix.

Huang EY, Huang YJ, Chanchien CC, Lin H, Wang CJ, Sun LM, Tseng CW, Tsai CC, Ou YC, Fu HC, Chen HC, Hsu HC, Wang CY - Radiat Oncol (2012)

Bottom Line: CEA levels ≥ 10 ng/mL or SCC-Ag levels ≥ 10 ng/mL at PALN recurrence were associated with overall survival after an isolated PALN recurrence.Pretreatment CEA levels ≥ 10 ng/mL were also associated with survival after an isolated PALN recurrence.More comprehensive examinations before CCRT and intensive follow-up schedules are suggested for early detection and salvage in patients with SCC-Ag or CEA levels ≥ 10 ng/mL.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Chang Gung University College of Medicine, Kaohsiung, Taiwan. huangengyen@gmail.com

ABSTRACT

Background: To identify pretreatment carcinoembryonic antigen (CEA) levels as a risk factor for para-aortic lymph node (PALN) recurrence following concurrent chemoradiotherapy (CCRT) for cervical cancer.

Methods: From March 1995 to January 2008, 188 patients with squamous cell carcinoma (SCC) of the uterine cervix were analyzed retrospectively. No patient received PALN irradiation as the initial treatment. CEA and squamous cell carcinoma antigen (SCC-Ag) were measured before and after radiotherapy. PALN recurrence was detected by computer tomography (CT) scans. We analyzed the actuarial rates of PALN recurrence by using Kaplan-Meier curves. Multivariate analyses were carried out with Cox regression models. We stratified the risk groups based on the hazard ratios (HR).

Results: Both pretreatment CEA levels ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL (p < 0.001, HR = 8.838), SCC-Ag levels ≥ 40 ng/mL (p < 0.001, HR = 12.551), and SCC-Ag levels of 10-40 ng/mL (p < 0.001, HR = 4.2464) were significant factors for PALN recurrence. The corresponding 5-year PALN recurrence rates were 51.5%, 84.8%, and 27.5%, respectively. The 5-year PALN recurrence rate for patients with both low (< 10 ng/mL) SCC and CEA was only 9.6%. CEA levels ≥ 10 ng/mL or SCC-Ag levels ≥ 10 ng/mL at PALN recurrence were associated with overall survival after an isolated PALN recurrence. Pretreatment CEA levels ≥ 10 ng/mL were also associated with survival after an isolated PALN recurrence.

Conclusions: Pretreatment CEA ≥ 10 ng/mL is an additional risk factor of PALN relapse following definitive CCRT for SCC of the uterine cervix in patients with pretreatment SCC-Ag levels < 10 ng/mL. More comprehensive examinations before CCRT and intensive follow-up schedules are suggested for early detection and salvage in patients with SCC-Ag or CEA levels ≥ 10 ng/mL.

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(A) CEA ≥ 10 ng/mL at recurrence and (B) pretreatment CEA levels predicted overall survival after isolated PALN recurrence.
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Figure 2: (A) CEA ≥ 10 ng/mL at recurrence and (B) pretreatment CEA levels predicted overall survival after isolated PALN recurrence.

Mentions: The 5-year actuarial PALN recurrence rates were 23.8%. No further treatment was noted in 13 patients. At the time, 12, 1, and 9 patients were undergoing radiotherapy plus chemotherapy, radiotherapy, and chemotherapy for salvage, respectively. The 3-year overall survival rates after non- isolated PALN recurrence were 7%. The corresponding rates of isolated PALN recurrence were 40.9%. The 3-year survival rates in patients with isolated recurrence were 52.7% and 0% (p < 0.001) at SCC-Ag levels < 10 and ≥ 10 ng/mL of isolated PALN recurrence (Figure 1A), respectively. However, pretreatment SCC-Ag levels did not affect survival rates after isolated PALN recurrence (p = 0.146) (Figure 1B). Both CEA levels ≥ 10 ng/mL (p = 0.039) at PALN recurrence (Figure 2A) and pretreatment CEA levels ≥ 10 ng/mL (p = 0.038) (Figure 2B) were prognostic factors of overall survival following isolated PALN recurrence. The 3-year survival rate was 64.8% in patients undergoing salvage CCRT for isolated PALN recurrence.


Pretreatment carcinoembryonic antigen level is a risk factor for para-aortic lymph node recurrence in addition to squamous cell carcinoma antigen following definitive concurrent chemoradiotherapy for squamous cell carcinoma of the uterine cervix.

Huang EY, Huang YJ, Chanchien CC, Lin H, Wang CJ, Sun LM, Tseng CW, Tsai CC, Ou YC, Fu HC, Chen HC, Hsu HC, Wang CY - Radiat Oncol (2012)

(A) CEA ≥ 10 ng/mL at recurrence and (B) pretreatment CEA levels predicted overall survival after isolated PALN recurrence.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298789&req=5

Figure 2: (A) CEA ≥ 10 ng/mL at recurrence and (B) pretreatment CEA levels predicted overall survival after isolated PALN recurrence.
Mentions: The 5-year actuarial PALN recurrence rates were 23.8%. No further treatment was noted in 13 patients. At the time, 12, 1, and 9 patients were undergoing radiotherapy plus chemotherapy, radiotherapy, and chemotherapy for salvage, respectively. The 3-year overall survival rates after non- isolated PALN recurrence were 7%. The corresponding rates of isolated PALN recurrence were 40.9%. The 3-year survival rates in patients with isolated recurrence were 52.7% and 0% (p < 0.001) at SCC-Ag levels < 10 and ≥ 10 ng/mL of isolated PALN recurrence (Figure 1A), respectively. However, pretreatment SCC-Ag levels did not affect survival rates after isolated PALN recurrence (p = 0.146) (Figure 1B). Both CEA levels ≥ 10 ng/mL (p = 0.039) at PALN recurrence (Figure 2A) and pretreatment CEA levels ≥ 10 ng/mL (p = 0.038) (Figure 2B) were prognostic factors of overall survival following isolated PALN recurrence. The 3-year survival rate was 64.8% in patients undergoing salvage CCRT for isolated PALN recurrence.

Bottom Line: CEA levels ≥ 10 ng/mL or SCC-Ag levels ≥ 10 ng/mL at PALN recurrence were associated with overall survival after an isolated PALN recurrence.Pretreatment CEA levels ≥ 10 ng/mL were also associated with survival after an isolated PALN recurrence.More comprehensive examinations before CCRT and intensive follow-up schedules are suggested for early detection and salvage in patients with SCC-Ag or CEA levels ≥ 10 ng/mL.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, Chang Gung University College of Medicine, Kaohsiung, Taiwan. huangengyen@gmail.com

ABSTRACT

Background: To identify pretreatment carcinoembryonic antigen (CEA) levels as a risk factor for para-aortic lymph node (PALN) recurrence following concurrent chemoradiotherapy (CCRT) for cervical cancer.

Methods: From March 1995 to January 2008, 188 patients with squamous cell carcinoma (SCC) of the uterine cervix were analyzed retrospectively. No patient received PALN irradiation as the initial treatment. CEA and squamous cell carcinoma antigen (SCC-Ag) were measured before and after radiotherapy. PALN recurrence was detected by computer tomography (CT) scans. We analyzed the actuarial rates of PALN recurrence by using Kaplan-Meier curves. Multivariate analyses were carried out with Cox regression models. We stratified the risk groups based on the hazard ratios (HR).

Results: Both pretreatment CEA levels ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL (p < 0.001, HR = 8.838), SCC-Ag levels ≥ 40 ng/mL (p < 0.001, HR = 12.551), and SCC-Ag levels of 10-40 ng/mL (p < 0.001, HR = 4.2464) were significant factors for PALN recurrence. The corresponding 5-year PALN recurrence rates were 51.5%, 84.8%, and 27.5%, respectively. The 5-year PALN recurrence rate for patients with both low (< 10 ng/mL) SCC and CEA was only 9.6%. CEA levels ≥ 10 ng/mL or SCC-Ag levels ≥ 10 ng/mL at PALN recurrence were associated with overall survival after an isolated PALN recurrence. Pretreatment CEA levels ≥ 10 ng/mL were also associated with survival after an isolated PALN recurrence.

Conclusions: Pretreatment CEA ≥ 10 ng/mL is an additional risk factor of PALN relapse following definitive CCRT for SCC of the uterine cervix in patients with pretreatment SCC-Ag levels < 10 ng/mL. More comprehensive examinations before CCRT and intensive follow-up schedules are suggested for early detection and salvage in patients with SCC-Ag or CEA levels ≥ 10 ng/mL.

Show MeSH
Related in: MedlinePlus