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

Eng-Yen Huang,Chong-Jong Wang,Hao Lin,Hung-Chun Fu,Chan-Chao Chanchien,Chang-Yu Wang,Ching-Chou Tsai,Yu-Jie Huang,Chin-Wen Tseng,Hui-Chun Chen,Hsuan-Chih Hsu,Li-Min Sun,Yu-Che Ou

doi:10.1186/1748-717x-7-13

Abstract

BackgroundTo identify pretreatment carcinoembryonic antigen (CEA) levels as a risk factor for para-aortic lymph node (PALN) recurrence following concurrent chemoradiotherapy (CCRT) for cervical cancer.MethodsFrom 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).ResultsBoth 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.ConclusionsPretreatment 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.

Highlights

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
We first identified squamous cell carcinoma (SCC)-Ag as a significant factor of PALN recurrence in patients treated with definitive radiotherapy or CCRT [3]
PALN recurrence was detected by routine computer tomography (CT) scan examination in 7 patients (20%) without increased tumor markers or symptoms

Summary

Introduction

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. Concurrent chemoradiotherapy (CCRT) is a standard treatment for locally advanced cervical cancer [1,2], para-aortic lymph node (PALN) recurrence was not uncommon in our prior study, demonstrating that pelvic CCRT did not decrease PALN recurrence more than pelvic RT alone [3]. The strategy to reduce PALN recurrence is an important issue for the treatment of locally advanced cervical cancer. The impact of the other tumor marker, carcinoembryonic antigen (CEA), in PALN recurrence is not clear in patients undergoing pelvic CCRT. CEA may be a potential risk factor for PALN recurrence in addition to SCC-Ag

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