TY - JOUR
T1 - Prognostic value of pretreatment carcinoembryonic antigen after definitive radiotherapy with or without concurrent chemotherapy for squamous cell carcinoma of the uterine cervix
AU - Huang, Eng Yen
AU - Hsu, Hsuan Chih
AU - Sun, Li Min
AU - Chanchien, Chan Chao
AU - Lin, Hao
AU - Chen, Hui Chun
AU - Tseng, Chih Wen
AU - Ou, Yu Che
AU - Chang, Hung Yao
AU - Fang, Fu Min
AU - Huang, Yu Jie
AU - Wang, Chang Yu
AU - Lu, Hsien Ming
AU - Tsai, Ching Chou
AU - Ma, Yen Ying
AU - Fu, Hung Chun
AU - Wang, Yu Ming
AU - Wang, Chong Jong
PY - 2011/11/15
Y1 - 2011/11/15
N2 - Purpose: To evaluate whether pretreatment carcinoembryonic antigen (CEA) levels have a prognostic role in patients after definitive radiotherapy for squamous cell carcinoma (SCC) of the uterine cervix. Methods and Materials: A retrospective study of 550 patients was performed. The SCC antigen (SCC-Ag) and CEA levels were regarded as elevated when they were ≥2 and ≥5 ng/mL, respectively. A total of 208 patients underwent concurrent chemoradiotherapy (CCRT). The Kaplan-Meier method was used to calculate the distant metastasis (DM), local failure (LF), disease-free survival (DFS), and overall survival (OS) rates. Multivariate analysis was performed using the Cox proportional hazards model. The hazard ratio (HR) with 95% confidence interval (CI) was evaluated for the risk of a poor prognosis. Results: Compared with the patients with normal CEA/SCC-Ag levels, CEA levels ≥10 ng/mL but without elevated SCC-Ag levels was an independent factor for LF (HR, 51.81; 95% CI, 11.51-233.23; p <.001), DM (HR, 6.04; 95% CI, 1.58-23.01; p =.008), DFS (HR, 10.17; 95% CI, 3.18-32.56; p <.001), and OS (HR, 5.75; 95% CI, 1.82-18.18; p =.003) after RT alone. However, no significant role for CEA was noted in patients with SCC-Ag levels ≥2 ng/mL. In patients undergoing CCRT, a CEA level ≥10 ng/mL was an independent factor for LF (HR, 2.50; 95% CI, 1.01-6.21; p =.047), DM (HR, 3.41; 95% CI, 1.56-7.46; p =.002), DFS (HR, 2.73; 95% CI, 1.39-5.36; p =.003), and OS (HR, 3.93; 95% CI 1.99-7.75; p <.001). A SCC-Ag level of ≥40 ng/mL was another prognostic factor for DM, DFS, and OS in patients undergoing not only CCRT, but also RT alone. The 5-year OS rate for CCRT patients with CEA <10 ng/mL and ≥10 ng/mL was 75.3% and 35.8%, respectively (p <.001). CCRT was an independent factor for better OS (HR, 0.69; 95% CI, 0.50-0.97; p =.034). Conclusion: Pretreatment CEA levels in patients with SCC of the uterine cervix provide complementary information for predicting LF, DM, DFS, and OS, except for in patients with abnormal SCC-Ag levels before RT alone. More aggressive therapy might be advisable for patients with CEA levels of ≥10 ng/mL.
AB - Purpose: To evaluate whether pretreatment carcinoembryonic antigen (CEA) levels have a prognostic role in patients after definitive radiotherapy for squamous cell carcinoma (SCC) of the uterine cervix. Methods and Materials: A retrospective study of 550 patients was performed. The SCC antigen (SCC-Ag) and CEA levels were regarded as elevated when they were ≥2 and ≥5 ng/mL, respectively. A total of 208 patients underwent concurrent chemoradiotherapy (CCRT). The Kaplan-Meier method was used to calculate the distant metastasis (DM), local failure (LF), disease-free survival (DFS), and overall survival (OS) rates. Multivariate analysis was performed using the Cox proportional hazards model. The hazard ratio (HR) with 95% confidence interval (CI) was evaluated for the risk of a poor prognosis. Results: Compared with the patients with normal CEA/SCC-Ag levels, CEA levels ≥10 ng/mL but without elevated SCC-Ag levels was an independent factor for LF (HR, 51.81; 95% CI, 11.51-233.23; p <.001), DM (HR, 6.04; 95% CI, 1.58-23.01; p =.008), DFS (HR, 10.17; 95% CI, 3.18-32.56; p <.001), and OS (HR, 5.75; 95% CI, 1.82-18.18; p =.003) after RT alone. However, no significant role for CEA was noted in patients with SCC-Ag levels ≥2 ng/mL. In patients undergoing CCRT, a CEA level ≥10 ng/mL was an independent factor for LF (HR, 2.50; 95% CI, 1.01-6.21; p =.047), DM (HR, 3.41; 95% CI, 1.56-7.46; p =.002), DFS (HR, 2.73; 95% CI, 1.39-5.36; p =.003), and OS (HR, 3.93; 95% CI 1.99-7.75; p <.001). A SCC-Ag level of ≥40 ng/mL was another prognostic factor for DM, DFS, and OS in patients undergoing not only CCRT, but also RT alone. The 5-year OS rate for CCRT patients with CEA <10 ng/mL and ≥10 ng/mL was 75.3% and 35.8%, respectively (p <.001). CCRT was an independent factor for better OS (HR, 0.69; 95% CI, 0.50-0.97; p =.034). Conclusion: Pretreatment CEA levels in patients with SCC of the uterine cervix provide complementary information for predicting LF, DM, DFS, and OS, except for in patients with abnormal SCC-Ag levels before RT alone. More aggressive therapy might be advisable for patients with CEA levels of ≥10 ng/mL.
KW - CEA
KW - Carcinoembryonic antigen
KW - Cervical cancer
KW - Concurrent radiotherapy
KW - Radiotherapy
KW - SCC antigen
KW - SCC-Ag
KW - Squamous cell carcinoma
UR - http://www.scopus.com/inward/record.url?scp=80255135603&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2010.07.011
DO - 10.1016/j.ijrobp.2010.07.011
M3 - 文章
C2 - 20932670
AN - SCOPUS:80255135603
SN - 0360-3016
VL - 81
SP - 1105
EP - 1113
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -
