Abstract
BACKGROUND: Early detection of recurrence in carcinoma cervix can be challenging but has the potential to improve survival in a subset of patients. Squamous cell carcinoma antigen (SCC-Ag) has been tested in multiple roles in the management of cervical cancer but the evidence from India is limited. METHODS: This was a prospective, cohort pilot study conducted in a tertiary care hospital in central India. Study subjects were patients with locally advanced carcinoma cervix treated with concurrent chemoradiotherapy between June 2017 and May 2018. All patients underwent pre and post-treatment SCC-Ag testing which was continued serially every 3 months for a total follow-up of 24 months. A cut-off value of 1.5 ng/ml or more was used to define a positive test. Chi-Square tests, Pearson's correlation testing and Kaplan Meier plots were used to study the association of different patient and tumour variables with the SCC-Ag levels. Test validity of serial measurements of SCC-Ag was also measured for detection of recurrence. RESULTS: A total of 45 patients were included. SCC-Ag levels were strongly correlated with tumour stage and presence of lymph nodal metastases. Post-treatment abnormal SCC-Ag levels were significantly associated with a poorer recurrence-free survival (RFS). Serial measurement of SCC-Ag levels proved to be a good screening tool for early detection of recurrences even before clinical symptoms or signs developed with a sensitivity of 90% and specificity of 91.8%. CONCLUSION: Our study has highlighted the benefits of the use of this tumour marker in the management of cervical cancer and has generated useful evidence supporting its use in prognosticating patients, guiding investigations, determining risk for recurrence, assessing tumour response and for early detection of recurrences.