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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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PALN recurrent rates for various combinations of pretreatment of CEA and SCC-Ag levels.
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Figure 3: PALN recurrent rates for various combinations of pretreatment of CEA and SCC-Ag levels.

Mentions: Patients with SCC-Ag levels ≥ 40 ng/mL, both CEA ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL, SCC-Ag levels of 10-40 ng/mL, and SCC-Ag levels of < 10 ng/mL had a 5-year PALN recurrence rate of 84.8%, 51.5%, 27.5%, and 9.6% (p < 0.001) (Figure 3), respectively. Hence, we categorized patients with SCC-Ag levels ≥ 40 ng/mL or both CEA ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL as the high-risk group (n = 33), in which the 5-year PALN recurrence rate was 66.5%. Patients with SCC-Ag levels of 10-40 ng/mL and SCC-Ag levels of < 10 ng/mL made up the intermediate- (n = 42) and low-risk group (n = 113), respectively.


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)

PALN recurrent rates for various combinations of pretreatment of CEA and SCC-Ag levels.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: PALN recurrent rates for various combinations of pretreatment of CEA and SCC-Ag levels.
Mentions: Patients with SCC-Ag levels ≥ 40 ng/mL, both CEA ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL, SCC-Ag levels of 10-40 ng/mL, and SCC-Ag levels of < 10 ng/mL had a 5-year PALN recurrence rate of 84.8%, 51.5%, 27.5%, and 9.6% (p < 0.001) (Figure 3), respectively. Hence, we categorized patients with SCC-Ag levels ≥ 40 ng/mL or both CEA ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL as the high-risk group (n = 33), in which the 5-year PALN recurrence rate was 66.5%. Patients with SCC-Ag levels of 10-40 ng/mL and SCC-Ag levels of < 10 ng/mL made up the intermediate- (n = 42) and low-risk group (n = 113), respectively.

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