Squamous Cell Carcinoma Antigen Levels Research Articles

Technical and Clinical Performance of Two Methods to Detect Squamous Cell Carcinoma Antigen Levels for Comparing Pathological Diagnosis Coincidence Rates in Lung, Cervical, and Head and Neck Cancers.

Detection of serum squamous cell carcinoma (SCC) antigen (SCCA) contributes to the diagnosis and therapeutic monitoring of SCC. However, the results obtained from different detection systems are not always consistent. In this study, we compared the performance of electrochemiluminescence assays (ECLIAs) and flow fluorescence immunoassays (FFIAs) (e.g. using a Luminex 200/xMap) in the detection of SCCA for the diagnosis of SCC of the lung (LSCC), cervix (CSCC), and head and neck (HANSCC) in serum samples from 154 healthy individuals and 236 patients with SCC. We also evaluated the consistency of the SCCA results with the pathological diagnosis for both methods. SCCA levels obtained from ECLIAs were significantly higher than those obtained from FFIAs for all groups. However, the results from the two methods were well correlated (r = 0.918). The diagnostic coincidence rates (FFIA versus ECLIA) for SCCA results in patients with LSCC, CSCC, and HANSCC were 40.82% versus 52.04%, 36.14% versus 57.14%, and 16.36% versus 23.64%, respectively, and the negative coincidence rate (FFIA versus ECLIA) in healthy individuals was 98.05% versus 98.70%. The cutoff value, sensitivity, specificity, and area under the receiver operating characteristic curve of SCCA diagnosis (FFIA versus ECLIA) in LSCC, CSCC, and HANSCC were 1.12, 77.55%, 85.34%, and 0.87 versus 3.07, 85.71%, 91.52%, and 0.91, respectively; 1.21, 81.93%, 90.2%, and 0.90 versus 3.84, 89.16%, 95.24%, and 0.95, respectively; and 1.01, 62.27%, 82%, and 0.81 versus 3.35, 58.18%, 89.65%, and 0.85, respectively. Serum SCCA levels detected by ECLIAs were significantly higher than those detected by FFIAs, with higher detection performance and pathological diagnosis coincidence rate in the patients with LSCC and CSCC simultaneously.

High serum PD-L1 level is a poor prognostic biomarker in surgically treated esophageal cancer.

BackgroundProgrammed death ligand 1 (PD‐L1) inhibitor has been approved as one of the standard therapies for various cancers. Some reports have shown that serum PD‐L1 level is associated with advanced tumor stages and poor prognosis; however, corresponding pathological information in esophageal cancer patients is lacking. Therefore, we evaluated the clinicopathological and prognostic impact of serum PD‐L1 levels in surgically treated esophageal cancer.MethodsA total of 150 patients who underwent radical resection for esophageal cancer were included in the study. Preoperative serum PD‐L1 levels were analyzed using the enzyme‐linked immunosorbent assay kit. A cutoff level of 65.6 pg/mL was used to divide the patients into two groups, and univariate and multivariate analyses were conducted to compare the clinicopathological characteristics and prognoses between these two groups.ResultsAlthough significant associations between serum PD‐L1 levels and clinicopathological variables were observed, serum PD‐L1 level was significantly associated with high neutrophil counts, high CRP levels, low albumin levels, and high squamous cell carcinoma antigen levels. Furthermore, serum PD‐L1 level was associated with poor overall survival independent to TNM factors.ConclusionsHigh preoperative level of serum PD‐L1 is a prognostic factor for poor overall survival in patients with surgically treated esophageal cancer.

Neoadjuvant Chemoradiotherapy with Cisplatin Plus Fluorouracil for Borderline Resectable Esophageal Squamous Cell Carcinoma.

The optimal treatment strategy for patients with borderline resectable (BR) esophageal squamous cell carcinoma (ESCC), in which tumors grow very close to the adjacent vital organs, remains unclear. This study evaluated the efficacy of neoadjuvant chemoradiotherapy (NACRT) with cisplatin plus fluorouracil (CF) and irradiation (40Gy) for these patients. The study cohort included 50 patients with BR-ESCC who received NACRT as the initial treatment and were allocated to one of two groups: patients who achieved curative resection (R0 group) or those who did not (Non-R0 group). The overall survival (OS), relapse-free survival (RFS), and pre-therapeutic predictive factors for Non-R0 were evaluated. Among the 50 patients, 22 (44%) achieved curative resection clinically. The median OS was significantly better in the R0 group than in the Non-R0 group (2.4 vs 0.8years; hazard ratio [HR], 0.29; 95% confidence interval [CI], 0.12-0.67; p < 0.01). The independent predictive factors before NACRT for Non-R0 were higher serum SCC antigen level (p < 0.01) and clinical nodal involvement (p = 0.02). In addition, OS was significantly worse for the patients with higher levels of serum SCC antigen than for those with lower levels (p < 0.01). Curative resection was achieved for about 40% of the patients who received NACRT for BR-ESCC. Therefore, NACRT could be a useful neoadjuvant treatment option for BR-ESCC. However, a higher serum SCC antigen level before NACRT is predictive of treatment failure and poor survival.

A case of de novo psoriasis induced by atezolizumab in a patient with advanced lung cancer

A 70-year-old Japanese male had de novo psoriasis after the treatment of atezolizumab, anti PD-L1 antibody agent, for lung cancer. The patient was successfully treated with the conventional therapy without discontinuation of the agent. Our case is the second case of atezolizumab-induced psoriasis. Atezolizumab is a humanized monoclonal antiprogrammed death-ligand 1 (PD-L1) antibody that started to be used internationally in 2016. It is indicated as a treatment for inoperable advanced or relapsed nonsmall cell lung cancer (NSCLC). Psoriasis may arise as an immune-related adverse event (irAE), is known to newly appear or be worsened after treatment with antiprogrammed death-1 (PD-1) agents, such as nivolumab.1, 2 However, there have been only a few reports on anti-PD-L1 agent-induced psoriasis.3, 4 Here, we report a case of de novo psoriasis induced by atezolizumab, which was successfully treated with the conventional therapy without discontinuation of atezolizumab. A 70-year-old Japanese male with no history of psoriasis started to receive atezolizumab treatment (1200 mg/body, every 3 weeks) in July 2018 for advanced squamous NSCLC (cT3N1M0, stage IIIA), originating in the left upper lung. He had already received four courses of radiochemotherapy a year before, but had exhibited progressive disease. Pruritic scaly erythematous plaques appeared after the third round of treatment with atezolizumab and rapidly worsened (Figure 1A). Laboratory data were almost normal, except for an elevated serum squamous cell carcinoma (SCC) antigen level (6.0 ng/mL, normal range: ≤2.5 ng/mL), which was regularly measured as a tumor marker of lung cancer. Histopathologically, the lesion exhibited parakeratotic hyperkeratosis, elongated rete ridges, loss of the granular layer, perivascular infiltration of lymphocytes intermingled with eosinophils in the upper dermis, and capillary dilation in the dermal papillae (Figure 1B,C). We diagnosed the patient with de novo psoriasis, triggered by atezolizumab. The patient was treated with calcipotriol/betamethasone dipropionate combination ointment without discontinuation of atezolizumab treatment. The rash gradually improved after the 7th round of treatment, and it had almost disappeared by the 11th round of treatment (Figure 1D). The patient's serum SCC antigen level was changed in parallel with his psoriatic skin activity, peaking (18.1 ng/mL) between the 7th and 8th rounds of treatment. The patient noticed small lesions a couple of days after each treatment. His lung cancer was markedly ameliorated by the fourth round and exhibited a complete response at the time of the 19th round of treatment. The blockade of PD-L1/PD-1 pathways has been demonstrated to augment T helper (Th) 1 and Th17 cell activity.5 This results in increases of various psoriasis-related cytokines, such as interferon -γ, interleukin (IL) -17A, IL-21, IL-22, and IL-6 released from Th1 and Th17 cells.6 Although little is known about which cytokines play an important role in the pathogenesis of anti-PD-1/PD-L1-induced psoriasis, Tanaka et al7 reported that the serum level of IL-6 was increased in nivolumab-associated psoriasis and suggested that IL-6 might be a key cytokine in such irAE. However, it has not yet been clarified why our patient's skin lesions subsided despite continuous atezolizumab treatment. Our case is the fourth reported case of anti-PD-L1-induced psoriasis3, 4 and the second case of atezolizumab-induced psoriasis. Among the previous cases, only our patient had no history of psoriasis and was successfully treated without discontinuation of the causative agent. The authors declare that they have no conflicts of interest.

Diagnosing ovarian cancer by identifying SCC-antigen on a multiwalled carbon nanotube-modified dielectrode sensor.

Ovarian cancer starts in the ovaries in its earlier stages and then spreads to the pelvis, uterus, and abdominal region. The success of an ovarian cancer treatment depends on the stage of the cancer and the diagnostic system. Squamous cell carcinoma antigen (SCC-Ag) is one of the most efficient cancer biomarkers, and elevated levels of SCC-Ag in ovarian cancer cells have been used to identify ovarian cancer. Carbon is a potential material for biosensing applications due to its thermal, electrical, and physical properties. Multiwalled carbon nanotubes (MWCNTs) are carbon-based materials that can be used here to detect SCC-Ag. Anti-SCC-Ag antibody was immobilized on the amine-modified MWCNT dielectric sensing surface to detect SCC-Ag. The uniformity of the surface structure was measured with a 3D nanoprofiler, and the results confirmed the detection of SCC-Ag at ∼80pM. The specific detection of SCC-Ag was confirmed with two control proteins (factor IX and human serum albumin), and the system did not show biofouling. This experimental set-up with MWCNTs a dielectric sensing surface can lead to the detection of ovarian cancer in its initial stages.

Relationship between serum tumor markers and Anaplastic Lymphoma Kinase mutations in stage IV lung adenocarcinoma in Hubei province, Central China.

ObjectiveThe aim of this study was to explore the predictive value of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCCAg), and neuron‐specific enolase (NSE) in the prediction of anaplastic lymphoma kinase (ALK) mutations in advance stage non‐small cell lung cancer (NSCLC).Subjects and MethodsA total of 482 cases with untreated lung adenocarcinoma were retrospectively reviewed. Finally, 72 patients with stage IV were enrolled because of intact data of the detection of ALK rearrangement and serum tumor markers, as well they have not received any previous anticancer therapy. We used the one‐way ANOVA analysis, correlation analysis, and multiple logistic regression analysis to evaluate the relationship between the level of serum tumor markers and ALK mutations.ResultsFifteen cases with ALK mutations and 57 cases without mutations were identified. The result of the one‐way ANOVA analysis showed only CEA was significantly associated with ALK mutations (95% CI:39.05‐148.88; P = .001). The area under the ROC curve (AUC) of CEA was 0.705 (95%CI:0.567‐0.843; P = .015). However, no significant association was observed between CEA and ALK mutations though the result of correlation analysis (P = .069) and multivariate logistic regression analysis (OR = 0.988, 95% CI: 0.972‐1.003, P = .111).ConclusionsIn our study, we performed on the patients with stage IV lung adenocarcinoma in our region and found preoperative serum levels of SCCAg, CYRF21‐1, and NSE not suitable for the detection of ALK mutation. Although we observed a significant association between CEA and ALK mutations; however, it was not strong enough to distinguish ALK status for the patients in our region.

Posttreatment Squamous Cell Carcinoma Antigen in Predicting Treatment Failure for Patients with Cervical Squamous Cell Carcinoma Treated with Concurrent Chemoradiotherapy

To analyze the association between posttreatment squamous cell carcinoma (SCC) antigen and treatment failure for patients with cervical SCC and treated with concurrent chemoradiotherapy (CCRT). We reviewed patients with cervical SCC and treated with definitive CCRT between June 2012 and May 2015 in our institute. A dose of 50.4Gy in 28 fractions was delivered to the pelvic with intensity modulated radiation therapy. With high-dose-rate brachytherapy, 30-36Gy in 5-7 fractions was prescribed to point A. The first line regimen of concurrent chemotherapy was cisplatin weekly. Posttreatment SCC antigen level was checked at 20 to 60 days after the completion of CCRT. A receiver operating characteristic (ROC) curve was performed to analyze the cutoff point of pretreatment and posttreatment SCC Ag in predicting treatment failure. Log-rank test and Cox’s proportional hazard model were used to identify whether pretreatment and posttreatment SCC Ag was significant in predicting disease-free survival (DFS). A total of 559 patients were included in this study. With ROC curve, the optimal cut-off points of pretreatment and posttreatment SCC antigen level were 8.6ng/ml (sensitivity 54.2%, specificity 65.8%) and 1.8 ng/ml (sensitivity 27.1%, specificity 96.6%). Posttreatment SCC antigen level ≥ 1.8ng/ml was observed in 47 patients. Multivariate analysis showed that posttreatment SCC Ag (hazard ratio 5.10, 95% confidence interval 3.31-7.88, p<0.001) was an independent prognostic factor of DFS. However, pretreatment SCC Ag was not significant in predicting DFS. The 3-year overall survival, DFS, local control and distant control rates of patients with posttreatment SCC antigen <1.8 ng/ml and ≥ 1.8 ng/ml were 90.7% and 46.4% (p<0.001), 84.8% and 31.9% (p<0.001), 81.4% and 69.5% (p<0.001), 90.4% and 54.1% (p<0.001), respectively. Cervical SCC patients with posttreatment SCC antigen ≥ 1.8ng/ml experienced high risk of treatment failure and poor survival. Consolidation therapy or extensive follow-up should be considered for these patients.

Predictive value of preoperative serum squamous cell carcinoma antigen (SCC–Ag) level on tumor recurrence in cervical squamous cell carcinoma patients treated with radical surgery: A single-institution study

ObjectiveWe seek to explore the clinical significance of serum squamous cell carcinoma antigen (SCC–Ag) and the optimal cut-off value for predicting tumor recurrence and survival in operable cervical squamous cell carcinoma patients. MethodsA total of 3471 patients with cervical squamous cell carcinoma who underwent radical surgery were enrolled in this study. The cut-off value of serum SCC-Ag for tumor recurrence was calculated using the receiver operating characteristic (ROC) curve. The progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method and multivariate analysis was further performed. ResultsThe optimal cut-off value of serum SCC-Ag level for predicting tumor recurrence was calculated and set at 2.75 ng/mL. Compared to the value of 1.5 ng/mL used in clinical practice, our results showed that serum SCC-Ag level >2.75 ng/mL was closely related to extrapelvic metastases in relapsed patients (P = 0.035). Multivariate analysis showed that neither serum SCC-Ag level >1.5 ng/mL nor serum SCC-Ag level >2.75 ng/mL was independent risk factors for PFS and OS in all patients. However, among 964 patients with at least one high-risk factor (parametrial invasion, vaginal margin invasion and lymph node metastasis), serum SCC-Ag level > 2.75 ng/mL, instead of serum SCC-Ag level > 1.5 ng/mL, could be used as an independent factor affecting PFS (P = 0.018). ConclusionPreoperative serum SCC-Ag level > 2.75 ng/mL is closely related to extrapelvic recurrence, and is an independent factor for tumor recurrence and survival in cervical squamous cell carcinoma patients with high-risk factors.

Diagnostic value of heat shock protein 90α and squamous cell carcinoma antigen in detection of cervical cancer.

ObjectiveTo ascertain plasma levels of heat shock protein 90α (HSP90α) and squamous cell carcinoma antigen (SCC-Ag) and their diagnostic potential in cervical cancer.MethodsIn a cross-sectional study, patients’ cervical tissue samples were screened for high risk (HR) human papilloma virus (HPV) DNA and underwent a thinprep-liquid based cytology test (TCT). Plasma samples were analysed by enzyme-linked immunosorbent assay (ELISA) for HSP90 α and SCC-Ag levels.ResultsOf the 295 women who underwent screening, 75 were healthy controls 75 (HR-HPV−ve TCT−ve), 110 were HR-HPV+ve, TCT−ve and 110 were HR-HPV+ve TCT+ve. There were significant differences between levels of HSP90α and SCC-Ag proteins across the patient groups with those positive for cervical cancer having the greatest levels of proteins compared with other groups. For patients with high grade SCC there was a significant correlation between levels of HSP90α and SCC-Ag. The area under the ROC curve for combined HSP90α*SCC-Ag was the largest compared with the single proteins. Using a cut-off value of 16.4 ng/ml to delineate cervical cancer diagnosis, the sensitivity and specificity of HSP90α*SCC-Ag were 90.3% and 95.1% respectively.ConclusionPlasma HSP90α protein levels correlated well with SCC-Ag levels in patients with cervical cancer and the combination of HSP90α*SCC-Ag may be a useful diagnostic biomarker.

Clinicopathologic characteristics and survival analysis in stage IVB cervical cancer with hematogenous metastasis

BackgroundThe purpose of this study was to analyze the clinical characteristics, treatment modalities and prognosis of stage IVB cervical cancer patients with hematogenous metastasis.MethodsBetween March 2005 and December 2017, a total of 160 patients FIGO (International Federation of Gynecology and Obstetrics, version 2018) stage IVB cervical cancer patients with hematogenous metastasis were included in this retrospective study. Patients were excluded from this analysis if they had lymphatic metastasis alone. Survival analyses included the Kaplan-Meier method, log-rank test, and Cox proportional hazards model.ResultsAmong 160 patients with hematogenous metastasis, 78 patients (48.8%, 78/160) exhibited only hematogenous metastases, while 82 (51.3%, 82/160) exhibited distant organ and lymph node (LN) metastases. Bone (37.5%, 60/160) was the most frequent metastatic site compared to lung (23.1%, 37/160) and liver (12.5%, 20/160). The median duration overall survival (OS) was 26 months and the 3-year OS rate was 35.3%. In univariate analysis, a significant difference was found in prognostic factors related to OS including tumor size (P=0.030), histology (P=0.006), white blood cell (WBC) count (P<0.001), squamous cell carcinoma antigen (SCCA) level (P=0.026), numbers of distant metastasis (P=0.017) and primary treatment (P=0.015). In multivariate analysis, the WBC was reported as an independent risk factor of progression free survival (PFS) (P=0.012, HR =3.25, 95% CI, 1.30–8.14) and OS (P=0.000, HR =6.18, 95% CI, 2.39–15.95). In addition, chemoradiotherapy was found to prolong the OS of stage IVB cervical cancer patients with hematogenous metastasis (32 vs. 24 months, P=0.049, HR =0.46, 95% CI, 0.21–0.99) compared with chemotherapy alone.ConclusionsFor stage IVB cervical cancer with hematogenous metastasis, the WBC count was an independent recurrence and death risk factor. Also, stage IVB cervical cancer patients with hematogenous metastasis should not be treated with systemic chemotherapy alone, palliative radiotherapy should also be integrated into the treatment plan. However, future large scale prospective clinical trial was desperately in need.

The added value of fasting blood glucose to serum squamous cell carcinoma antigen for predicting oncological outcomes in cervical cancer patients receiving neoadjuvant chemotherapy followed by radical hysterectomy.

ObjectiveTo determine the combination of fasting blood glucose (FBG) with squamous cell carcinoma antigen (SCCA) assessments in the prediction of tumor responses to chemotherapy and pretreatment prognostication among patients receiving neoadjuvant chemotherapy (NACT) for locally advanced cervical cancer (LACC).MethodsData of 347 LACC patients were retrospectively reviewed. Receiver operating characteristic (ROC) curves were constructed, and areas under the curves (AUCs) were compared to evaluate the ability to predict complete response (CR) following NACT. Patients were stratified into groups with low and high levels of SCCA and FBG and combined into low‐ or high‐SCCA and low‐ or high‐FBG groups. Cox regression analysis was performed to identify determinants of recurrence‐free survival (RFS) and overall survival (OS).ResultsThe AUCs were 0.70, 0.68, and 0.66 for SCCA, FBG, and a combination of SCCA and FBG for predicting CR following NACT, respectively; however, the differences among AUCs were not significant (P = .496). Pretreatment SCCA and FBG levels were identified as independent predictors of RFS and OS. The high‐SCCA/high‐FBG group showed significantly worse prognosis than the low‐SCCA/low‐FBG group. After adjusting for other variables, high‐SCCA/high‐FBG remained independently associated with an increased risk of tumor recurrence and death.ConclusionSCCA, FBG, and a combination of SCCA and FBG could acceptably predict CR following NACT. Pretreatment SCCA and FBG levels were independent prognostic factors. The combination of SCCA and FBG levels refined the prognostic stratification of LACC patients, which allowed the group of patients with the highest risk of recurrence and death to be identified.

Risk Factors of Regional Lymph Node Metastasis in Patients with Cervical Cancer.

ObjectivesTo explore the risk factors related to regional lymph node metastasis in cervical cancer and analyze the value of independent risk factors in predicting regional lymph node metastasis.MethodsWe retrospectively analyzed the clinical data of 699 patients who underwent surgery for stage IB1–IIA2 cervical cancer in Quanzhou First Hospital affiliated to Fujian Medical University from 2010 to 2016. The patients were divided into metastasis (n = 92) and non-metastasis (n = 607) groups based on the postoperative pathology of regional lymph node status. The relevant clinicopathological features of the metastasis and non-metastasis groups were compared through variance analysis and chi-square tests. Logistic regression was adopted to screen relevant independent risk factors of regional lymph node metastasis.ResultsIn univariate analysis, International Federation of Gynecology and Obstetrics (FIGO) stages, serum squamous cell carcinoma antigen (SCC-Ag), histological type of squamous carcinoma and maximal tumor diameter were related factors for lymphatic metastasis in patients with cervical cancer. In multivariate analysis, SCC-Ag and histological type of squamous carcinoma were independent prognostic factors for lymphatic metastasis in patients with cervical cancer. Pre-treatment SCC-Ag serum levels, as a predictor of lymph node metastasis of cervical cancer, revealed a sensitivity of 62.07% (95% confidence interval (CI): 51.03–72.62%), specificity of 65.15% (59.07–70.89%), and area under the receiver operating characteristic (ROC) curve of 0.69 (95% CI: 0.61–0.76).ConclusionsCervical cancer patients whose pathological type is squamous carcinoma with high levels of SSC-Ag pre-operation are more likely to be diagnosed with regional lymph node metastasis. Standardized lymph node dissection should be implemented during operation.

Clinical significance of serum squamous cell carcinoma antigen in patients with early cervical squamous cell carcinoma

Objective: To explore the clinical significance of serum squamous cell carcinoma antigen (SCC-Ag) in early cervical squamous cell carcinoma. Methods: The clinicopathological data and follow-up information of 1435 patients with stage ⅠA2-ⅡA cervical squamous cell carcinoma were collected. The correlation between serum SCC-Ag level and clinicopathological feature and prognosis were analyzed. The best cut-off of serum SCC-Ag for predicting pelvic lymph node metastasis and survival of cervical squamous cell carcinoma patients were also identified. Results: The result of univariate analysis showed that The International Federation of Gynecology and Obstetrics (FIGO) staging, tumor size, depth of cervical stromal invasion, lymphovascular space involvement, pelvic lymph node metastasis, common iliac lymph node metastasis and para-aortic lymph node metastasis were significantly related with serum SCC-Ag level (all P<0.05). The result of multivariate logistic regression analysis showed that tumor size, depth of cervical stromal invasion, pelvic lymph node metastasis and common iliac lymph node metastasis were the independent risk factors of preoperative serum SCC-Ag>2.65 ng/ml (all P<0.001). Multivariate Cox regression analysis showed that lymphovascular space involvement, SCC-Ag>3.15 ng/ml, common iliac lymph node metastasis and tumor size >4 cm were the independent prognostic risk factors (all P<0.05). The univariate analysis showed that, the tumor size, FIGO stage, depth of cervical stromal invasion and SCC-Ag level were significantly related with the recurrence of 1 096 patients without postoperative high risk factors (all P<0.05). Multivariate logistic regression analysis showed that FIGO stage (OR=1.671) and SCC-Ag>2.65 ng/ml (OR=4.490) were the independent risk factors for recurrence (both P<0.05). The best cut off of SCC-Ag for predicting early postoperative cervical lymph node metastasis of cervical squamous cell carcinoma was 2.65 ng/ml, the sensitivity was 60.8%, the specificity was 71.8%. The best cut off of SCC-Ag for predicting prognosis of cervical squamous cell carcinoma was 3.15 ng/ml, the sensitivity was 53.5%, the specificity was 71.1%. Conclusions: Preoperative serum squamous cell carcinoma antigen is an independent prognostic risk factor of survival of patients with early cervical squamous cell carcinoma, and is significantly related with recurrence of patients without postoperative high-risk factors. It can be used as a reference factor for postoperative adjuvant radiotherapy.

Predictive significance of CYFRA21-1, squamous cell carcinoma antigen and carcinoembryonic antigen for lymph node metastasis in patients with esophageal squamous cancer.

From January 2018 to May 2018, 108 patients with thoracic esophageal cancer underwent esophagectomy with two- to three-field lymph node dissection. Serum cytokeratin 19 fragment antigen 21-1 (CYFRA21-1), squamous cell carcinoma antigen, and carcinoembryonic antigen levels were detected before surgery. Preoperative serum levels of CYFRA21-1 and squamous cell carcinoma antigen were correlated closely with pN stage (P = 0.000 and P = 0.045). CYFRA21-1 and pathological T status were independent predictors of lymph node metastasis (P = 0.000). The area under the curve values of CYFRA21-1 and squamous cell carcinoma antigen for predicting lymph node metastasis were 0.731 (P =0.000) and 0.650 (P =0.007), respectively. Our study demonstrated that serum CYFRA21-1 and squamous cell carcinoma antigen levels were associated with lymph node metastasis in esophageal squamous cell carcinoma, especially in patients at the early T stage. The preoperative serum CYFRA21-1 level was an independent predictor of lymph node metastasis.

The indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer

Objective: To explore the indication and surgery scope for laparoscopic extraperitoneal lymphadenectomy in locally advanced cervical cancer. Methods: Laparoscopic extraperitoneal lymphadenectomy was initially performed on patients with locally advanced cervical cancer. The results of preoperative computed tomography (CT) images and serum level of squamous cell carcinoma antigen (SCC-Ag) were analyzed, and the diagnostic efficiencies of the minimum axial diameter (MAD) of lymph node on CT≥0.5 cm, ≥1.0 cm, serum level of SCC-Ag alone or combined to predict the extraperitoneal lymph node metastases were compared. The high-risk factors of common iliac lymph node (CILN) and para-aortic lymph node (PALN) metastases were also analyzed. Results: The lymph node metastasis rate of 81 patients who received the laparoscopic extraperitoneal lymphadenectomy was 59.3% (48/81). The CILN and/or PALN metastasis rate was 24.7%(20/81), and among them, the MAD of CILN and/or PALN ≥0.5 cm on CT images were in only 7 patients. The threshold of SCC-Ag for evaluating lymph node metastasis was 4.8 ng/ml. The accuracy, specificity and Youden index of SCC-Ag≥4.8+ MAD≥1.0 cm group for predicting lymph node metastasis were 78.3%, 100% and 0.6, respectively, and were significantly higher than 57.9%, 12.1% and 0.1 of MAD≥0.5 cm group, 71.1%, 75.8% and 0.4 of MAD≥1.0 cm group, 65.0%, 57.7% and 0.3 of SCC-Ag≥4.8 ng/ml group and 68.3%, 65.4% and 0.4 of SCC-Ag≥4.8 ng/ml+ MAD≥0.5 cm group (P<0.05). All of the 21 patients in SCC-Ag≥4.8 ng/ml+ MAD≥1.0 cm group were detected to occur lymph node metastases, and the metastasis rate of CILN and/or PALN was 38.1%. While only 4 cases of 17 patients in SCC-Ag<4.8 ng/ml+ MAD<1 cm group were confirmed to occur CILN metastases. The difference of lymph node metastasis rate between these two groups was statistically significant (P<0.001). The pathological type, the number of PLN with MAD≥1.0 cm, at least one of the PLN MAD≥1.0 cm and/or MAD of CILN and/or PALN was 0.5~1.0 cm were associated with the CILN and/or PALN metastases (all P<0.05). Conclusions: Those patients with MAD≥1.0 cm+ SCC-Ag≥4.8 ng/ml and with high-risk factors of CILN and/or PALN metastases should undergo laparoscopic extraperitoneal lymphadenectomy to provide explicit guidance for the subsequent therapy. However, the incidence of lymph node metastasis of patients with SCC-Ag<4.8 ng/ml combined with MAD<1.0 cm is low, therefore these patients can accept concurrent chemoradiotherapy directly.

MiR-152 may function as an early diagnostic and prognostic biomarker in patients with cervical intraepithelial neoplasia and patients with cervical cancer.

Previous studies have demonstrated that circulating miRNAs are effective biomarkers of various types of cancer. It has also been indicated that miR-152 is upregulated in cervical cancer. However, whether miR-152 may be used as an early detection method for patients with cervical cancer is yet to be elucidated. The results of the current study demonstrated that miR-152 levels were the lowest in healthy controls, high in patients with cervical intraepithelial neoplasia (CIN), and the highest in patients with cervical cancer. Furthermore, miR-152 levels in peripheral blood were higher in patients with high-grade CIN compared with those with low-grade CIN. It was also demonstrated that miR-152 levels increased as the clinical stage of cervical cancer advanced. Compared with healthy controls, squamous cell carcinoma antigen (SSC-Ag) levels were significantly higher in patients with cervical cancer. However, no significant differences were identified in patients with CIN, indicating that SCC-Ag could not be used for the early detection of CIN. In contrast, miR-152 was elevated along with SCC-Ag in patients with CIN and cervical cancer. Receiver operating characteristic (ROC) analysis demonstrated that miR-152 preferentially distinguished patients with CIN (95% confidence interval, 0.688-0.973; P<0.001) and patients with cervical cancer (95% confidence interval, 0.817-0.996; P<0.001) from healthy controls. Additionally, miR-152 levels were markedly reduced in patients with cervical cancer who received chemotherapy (28 patients) or chemotherapy and radiation therapy (22 patients). In conclusion, the level of miR-153 in peripheral blood may be utilized as an effective biomarker for the early detection of cervical cancer, thus decreasing the requirement for invasive cervical biopsies. Furthermore, it may be utilized to predict the most effective form of treatment for patients with cervical cancer.

Prognostic Roles of SCC Antigen, CRP and CYFRA 21-1 in Oral Cavity Squamous Cell Carcinoma.

Tumor-related and inflammation-related markers were reported to be prognostic in cancer patients. In this study, we evaluated squamous cell carcinoma antigen (SCC-Ag), cytokeratin 19 fragment (CYFRA 21-1) and C-reactive protein (CRP) simultaneously in oral cavity squamous cell carcinoma (OSCC) patients. Two hundred and forty-six newly diagnosed OSCC patients were retrospectively recruited between December 2010 and December 2016. The elevation of CRP levels (≥5.0 mg/l) and SCC-Ag levels (≥2.0 ng/ml) were significantly related with tumor invasion parameters and metastatic factors. In contrast, the elevation of CYFRA 21-1 levels (≥3.3 ng/ml) was related with extranodal extension alone. For patients with all three markers being elevated before surgery, their overall survival and disease-free survival were significantly worse than others. Concurrent elevation of preoperative SCC-Ag, CYFRA 21-1 and CRP serum levels can be correlated with worse survival rates in OSCC.

Attachment-oriented endoscopic surgical management for inverted papillomas in the nasal cavity and paranasal sinuses

ObjectiveThe treatment of all forms of sinonasal inverted papilloma (IP) is a complete, wide, local resection. The main surgical purpose is to remove all diseased mucosa and mucoperiosteum, together with a cuff of normal-looking mucosa at the attachment site, followed by drilling and/or coagulation. Our aim is to present our experiences in endoscopic surgical management of IP by using attachment-oriented excision. MethodsWe present 20 cases of sinonasal IP. The data collected includes the histopathological diagnosis, staging, extension of the tumor, tumor attachment site, approach to surgery, serum squamous cell carcinoma antigen (SCCA) level, and recurrences. ResultsAll patients underwent endoscopic surgery. A Caldwell-Luc operation was required in addition to the endoscopic surgery in one case. There was one case of recurrence (5%). After the additional operation, there was no recurrence. The tumor attachment sites vary, and the case of recurrence had a wide attachment site at the primary surgery. No major intra- or post-operative complications were observed. ConclusionThe present study shows that attachment-oriented excision for IP is useful for complete resection of IP. Surgeons should choose the surgical approach according to the location of the tumor attachment site rather than the Krouse staging system.

Diagnostic value analysis of combined detection of Trx, CYFRA21-1 and SCCA in lung cancer.

The expression levels of thioredoxin (Trx), cytokeratin fragment 21–1 (CYFRA21-1) and serum squamous cell carcinoma antigen (SCCA) in patients with lung cancer and the diagnostic value of combined detection were investigated. Sixty-five patients with lung cancer in Weihai Municipal Hospital from January 2014 to June 2017 were retrospectively selected as the observation group, while 60 healthy subjects receiving physical examination were selected as the control group. The expression levels of serum Trx, CYFRA21-1 and SCCA were detected. The sensitivity and specificity of single detection and combined detection of these indexes were compared. Moreover, the diagnostic values of single detection and combined detection were analyzed using the receiver operating characteristic (ROC) curve. The levels of CYFRA21-1 and SCCA were the highest in squamous carcinoma (P<0.05). The level of Trx was the highest in small cell lung cancer compared with those in squamous carcinoma and adenocarcinoma (P<0.05). The levels of serum Trx, CYFRA21-1 and SCCA in lung cancer patients in clinical stage III–IV were obviously higher than those in patients in clinical stage I–II (P<0.001). The positive rate of Trx was the highest in small cell lung cancer, and the positive rates of CYFRA21-1 and SCCA were the highest in squamous carcinoma compared with other cancers (P<0.05). The area under the ROC curve of combined detection of the three indexes was the largest. The optimal cut-off value of combined detection of the three indexes in lung cancer was 9.952 with the sensitivity of 86.2% and specificity of 75.0%. The detection of serum Trx, CYFRA21-1 and SCCA is of great significance in the diagnosis, progression and pathological type of lung cancer, and combined detection can improve both specificity and sensitivity, which is more conducive to the positive rate of diagnosis of lung cancer.

Serum SCCA levels in patients suffering cancers or other diseases.

Increased serum squamous cell carcinoma antigen (SCCA) levels are clinically used diagnostic or prognostic biomarker for squamous cell carcinomas. According to recently published studies, increased serum SCCA levels are also observed in adenocarcinomas, hepatocarcinomas, kidney, and other inflammatory diseases, indicating squamous cell carcinoma is not the production source of serum SCCA in these diseases. However, serum SCCA levels in patients suffering different types of diseases have not been systematically measured and compared. Thus, in our current study, serum SCCA levels from 21,608 patients with 39 clinically defined diseases were collected and measured by the clinical laboratory in the Affiliated Hospital of Qingdao University over the past 5 years in addition to 232 serum samples from individuals who attend their annual physical examination as the healthy controls. According to the median, mean, and -log10p values, we found that patients with uremia, azotemia, diabetic nephropathy, and nephritic syndrome had the highest serum SCCA levels among all 39 different types of diseases including patients suffering squamous cell carcinomas. Moreover, patients suffering lung cancer, cervical cancer, esophagus cancer, or chronic pulmonary disease had lower median and interquartile range values but higher or comparable mean values and significantly higher SD values than that of the healthy controls. Furthermore, patients with endometrial cancer, pancreatitis, osteoporosis, and some other diseases had lower serum SCCA levels than that of the healthy controls. These results demonstrated that serum SCCA can not only be used in diagnosis and prognosis of squamous cell carcinomas but also as biomarkers for uremia, azotemia, diabetic nephropathy, and nephritic syndrome.