Abstract
Aim: To evaluate the usefulness of serum squamous-cell carcinoma antigen (SCC-Ag) and 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) for the detection of recurrent squamous-cell carcinoma (SqCC) of the uterine cervix, and its prediction of patient survival. Methods: FDG-PET/CT was performed for patients with serum SCC-Ag levels elevated to ≥1.5 ng/mL (Group 1) and those with suspicious recurrences without any increase in serum SCC-Ag levels (Group 2). The results were analyzed on the basis of histological data, disease progression and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 6 months of FDG-PET/CT. The outcome was determined using medical records. Results: In total, 88 consecutive patients with cervical SqCC cancer with suspected recurrence (62 in Group 1 and 26 in Group 2) were enrolled. Recurrences were observed in 55 patients (77.4% (48/62) in Group 1 vs. 26.9% (7/26) in Group 2, p < 0.001). The overall sensitivity, specificity and accuracy of serum SCC-Ag were 87.3%, 57.6% and 76.1%, respectively, and those of FDG-PET/CT were 98.2%, 90.9% and 95.5%, respectively; the corresponding values were 97.9%, 92.9% and 96.8% for Group 1 and 100%, 89.5% and 92.3% for Group 2. Surgical resection was performed for 16 patients. At the end of the study, 40.3% (25/62) of Group 1 patients and 88.5% (23/26) of Group 2 patients were alive (p < 0.001). The survival of patients who underwent surgical resection for recurrent tumors was higher than that of patients who did not undergo resection (62.5% (10/16) vs. 17.9% (7/39), p = 0.001). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) derived from FDG-PET/CT showed significantly different in-patient survival. Conclusions: Serum SCC-Ag could predict tumor recurrence and the survival of patients with SqCC cervical cancer. As such, the surgical resection of limited recurrent disease, as determined using FDG-PET/CT, might improve the survival of patients with cervical cancer. MTV and TLG may serve as a prognostic biomarker of survival in patients with recurrent cervical cancer.
Highlights
Uterine cervical cancer is the fourth most common cancer in women worldwide [1], but the incidence of cervical cancer has been reduced owing to economic development [2]
The recurrence of cervical cancer has a significant impact on prognosis, and the early detection of disease recurrence might improve the overall survival (OS) and disease-free survival (DFS) of these patients
Serum squamous-cell carcinoma antigen (SCC-Ag) can serve as a surrogate as a deciding metric for the recurrence of cervical squamous-cell carcinoma (SqCC) that is just as effective as fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET)/computed tomography (CT)
Summary
Uterine cervical cancer is the fourth most common cancer in women worldwide [1], but the incidence of cervical cancer has been reduced owing to economic development [2]. Europe have the highest rates of morbidity and mortality due to cervical cancer [3]. According to the healthcare data from Taiwan, both the incidence and mortality rates of cervical cancer have decreased, cervical cancer is the seventh most common cancer among women [4]. Considering the natural progression of cancer, the cure rate is high if the disease is detected early, but approximately one-third of patients treated for cervical cancer develop recurrences within the first 2 years of completing therapy [5]. Considering the patient benefits, attempts to improve surveillance after treatment might lead to the earlier detection of relapse, and precise assessment of the recurrence status could improve outcomes
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