The prognostic value of the SCCA tumour marker in patients surgically treated for squamous cell cervical cancer

Overview

Objective:
Evaluation of the role of the SCCA (Squamous Cell Carcinoma Antigen) tumour marker in the prognosis of patients with surgically treated squamous cell cervical cancer, focusing on malignant lymphadenopathy and recurrence of the disease.

Material and methods:
We retrospectively analyzed 110 patients who had undergone radical surgical treatment of early stage squamous cell cervical cancer between 2000–2008 in the Department of Gynaecology and Obstetrics, Faculty of Medicine, Masaryk University and Faculty Hospital, Brno. An association between SCCA serum levels and local tumour size (T), determined by the definitive postoperative histology, were explored, as were any associations between regional malignant lymphadenopathy (N) and serum levels of this tumour marker. Based on their postoperative TNM classification and risk factors, the patients were referred either for follow-up or for adjuvant therapy in the form of radiotherapy or combined chemoradiotherapy, respectively. SCCA serum levels obtained during the regular one-year follow-up or at the manifestation of clinical complaints were also evaluated to detect recurrence of the disease.

Results:
The SCCA elevation was detected in 28 (25.5%) of the 110 squamous cell carcinoma patients. An association between SCCA serum levels and the local tumour size (based on the final postoperative histology) was assessed. The SCCA elevation of up to 10% was detected in the microinvasive cancer T1a stage patients. Tumour growth was associated with a significant increase in the SCCA positivity and absolute levels of the tumour marker. SCCA positivity was identified in approximately 50% of patients with bulky tumour, in whom two- and multiple-fold increase above the upper limit of serum standards was found. Metastatic involvement of regional lymph nodes per a specific SCCA serum level was examined in 3 sets of patients. Malignant lymphadenopathy was found in 8.5% of cases in the first group of patients with serum SCCA negativity. Positive lymph nodes were found in 47% of patients in the group with SCCA serum levels between 1.5 to 3.0 ng/ml. Pathological regional lymphadenopathy was detected in 69% of cases in the group of patients with SCCA serum levels above 3.0 ng/ml. Six recurrences of the disease were found in the group of 95 patients regularly attending the follow-up; in 5 patients, the disease recurred within 7–21 months from the completion of the primary therapy and it recurred after 8 years in one patient. SCCA elevation was identified in all 6 cases; SCCA sensitivity was, therefore, 100%. Elevated SCCA was the first sign of recurrence in one (17%) patient. Other recurrences were diagnosed through clinical complaints manifested outside the regular follow-up.

Conclusion:
SCCA cannot be used for the diagnosis of squamous cell cervical cancer as its elevation occurs only with an increasing volume of the tumour. SCCA negativity does not exclude metastatic involvement of regional lymph nodes; the marker specificity in our sample was 92%. SCCA elevation above the upper limit of normal is associated with an increased risk of malignant lymphadenopathy, sensitivity of this marker for metastatic regional lymph nodes involvement increases significantly only at the two- and multiple-fold SCCA elevation above the upper limit of normal (almost 70% in our group). Consequently, it is necessary to determine the status of regional lymph nodes as soon as the initial stage of cervical cancer (microinvasive stage T1a1 with lymphovascular invasion); significant risk of regional lymphadenopathy is then clearly associated with high-volume tumours. SCCA is a sensitive marker for recurrence in patients with this tumour marker elevation before the primary operation. Most recurrences are manifested within the first two years after the primary therapy, serum positivity is found in approximately 80% of recurrences in larger files.

Key words:
cervical cancer – SCCA (Squamous Cell Carcinoma Antigen) – metastasis – lymph node – radical hysterectomy – pelvic lymphadenectomy

– recurrence