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 c an be predicted by pretreatment squamous cell carcinoma antigen (SCC-Ag) le vels in early stage squamous cervical carcinoma. Materials and methods. Between 1994 and 1998, 284 patients with stage Ib an d IIa cervical squamous cell carcinoma undergoing radical hysterectomy had preoperative SCC-Ag determination. The correlation between clinicopathologi cal findings on SCC-Ag levels were examined. The Mann-Whitney U test was us ed to statistically analyze differences between node positive and negative patients, Multiple regression analysis and a multiple logistic model were e mployed to examine the effect of clinicopathological findings on SCC-Ag lev els. Results. Of the 284 patients, 56 patients were found to have nodal metastas is. 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 no dal 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 pati ents with SCC-Ag levels below 8 mu g/l showed no nodal metastasis, while ab out 65% of the patients with serum levels above 8 mu g/l exhibited nodal me tastasis. Multivariate analyses confirmed that only lymph node metastasis h ad a significant impact on the SCC-Ag levels exceeding 8 mu g/l. Conclusion. For predicting nodal metastasis preoperatively, SCC-Ag levels g reater than 8 mu g/l 1 can be considered a high-risk zone for nodal metasta sis.