J Cancer 2018; 9(9):1660-1666. doi:10.7150/jca.24049

Research Paper

Preoperative SCC-Ag and thrombocytosis as predictive markers for pelvic lymphatic metastasis of squamous cervical cancer in early FIGO stage

Fan Xu1,2*, Yanfang Li3*, Liangsheng Fan4*, Jing Ma1,5, Lan Yu4, Hongyan Yi1, Xiaojing Chen1, Wenfei Wei1, Peng Wu6, Li Liang7, Huiquan Hu2, Hui Xing8✉, Wei Wang1,4✉

1. Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
2. Department of Obstetrics and Gynecology, Nanchong Central Hospital, North Sichuan Medical University, Nanchong, Sichuan 637000, PR China
3. Department of Gynecologic Oncology, Sun Yat-sen University Cancer Center; Sun Yat-sen University, Guangzhou, Guangdong 510060, PR China
4. Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 511436, PR China
5. Department of Obstetrics and Gynecology, People's Hospital of Three Gorges University, Yichang, Hubei 443000, PR China
6. Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, PR China
7. Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
8. Department of Obstetrics and Gynecology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, Hubei 441021, PR China
* These authors contributed equally to this work

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Citation:
Xu F, Li Y, Fan L, Ma J, Yu L, Yi H, Chen X, Wei W, Wu P, Liang L, Hu H, Xing H, Wang W. Preoperative SCC-Ag and thrombocytosis as predictive markers for pelvic lymphatic metastasis of squamous cervical cancer in early FIGO stage. J Cancer 2018; 9(9):1660-1666. doi:10.7150/jca.24049. Available from http://www.jcancer.org/v09p1660.htm

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Abstract

Objectives: To explore the clinical significance of squamous cell carcinoma antigen (SCC-Ag) and thrombocytosis to predict pelvic lymphatic metastasis (PLM) of squamous cervical cancer (SCC) in International Federation of Gynecology and Obstetrics (FIGO) stages IA-IIA.

Methods: A retrospective clinicopathologic review of 782 patients of a primary cohort in three Chinese hospitals from 2010 to 2015, and 407 patients of a validation cohort in another institution from 2015 to 2017. A receiver operating characteristic curve was used to determine the optimal SCC-Ag threshold to predict PLM in the groups. Univariate and multivariate logistic analyses for PLM were performed to assess differences in outcome.

Results: In the primary and validation cohort, 15.6% (122/782) and 25.3% (103/407) patients were classified into the thrombocytosis group (platelet count >300 × 109/L), respectively. Optimal cutoff values of SCC-Ag for predicting PLM of the thrombocytosis group and the normal group were 3.26 ng/mL (AUC 0.754; sensitivity 73.08%; specificity 72.92%; P = 0.000) and 4.58 ng/mL (AUC 0.706; sensitivity 53.26%; specificity 83.98%; P = 0.000), respectively, in the primary cohort, and 1.55 ng/mL (AUC 0.705; sensitivity 79.31%; specificity 55.41%; P = 0.000) and 1.75 ng/mL (AUC 0.655; sensitivity 69.57%; specificity 64.26%; P = 0.000), respectively, in the validation cohort. In multivariate logistic analysis, preoperative SCC-Ag over 3.26 ng/mL and lymphovascular space involvement were the significant predictors of PLM for SCC in FIGO stages IA-IIA.

Conclusions: Preoperative SCC-Ag alone or combined with thrombocytosis might be used as predictive markers for PLM before initial treatment in early stage SCC.

Keywords: cervical cancer, pelvic lymphatic metastasis, squamous cell carcinoma antigen, thrombocytosis