The role of pretreatment squamous cell carcinoma antigen in predicting nodal metastasis in early stage cervical cancer

Purpose. To evaluate whether the presence of pelvic lymph node metastasis can be predicted by pretreatment squamous cell carcinoma antigen (SCC-Ag) levels in early stage squamous cervical carcinoma. Materials and methods. Between 1994 and 1998, 284 patients with stage Ib and IIa cervical squamous cell carcinoma undergoing radical hysterectomy had preoperative SCC-Ag determination. The correlation between clinicopathological findings on SCC-Ag levels were examined. The Mann-Whitney U test was used to statistically analyze differences between node positive and negative patients, Multiple regression analysis and a multiple logistic model were employed to examine the effect of clinicopathological findings on SCC-Ag levels. Results. Of the 284 patients, 56 patients were found to have nodal metastasis. Median serum levels and 90% ranges of SCC-Ag were 0.74 mu g/l (0.5-7.8) in the 228 nodal negative patients and 4.33 mu g/l (0.5-48.5) in the 56 nodal positive patients (p<0.001). Lymph node metastasis and tumor size were found to have a significant impact on SCC-Ag levels. Around 86% of the patients with SCC-Ag levels below 8 mu g/l showed no nodal metastasis, while about 65% of the patients with serum levels above 8 mu g/l exhibited nodal metastasis. Multivariate analyses confirmed that only lymph node metastasis had a significant impact on the SCC-Ag levels exceeding 8 mu g/l. Conclusion. For predicting nodal metastasis preoperatively, SCC-Ag levels greater than 8 mu g/l 1 can be considered a high-risk zone for nodal metastasis.