Diagnostic and prognostic significance of squamous cell carcinoma antigen in non-small cell lung cancer
Introduction
Squamous cell carcinoma (SCC) antigen, a subfraction of the TA-4 antigen, is a glycoprotein secreted by various tumours, including those of the lung [8]. Studies conducted to investigate the usefulness of the SCC antigen in the diagnosis and prognosis of lung cancer, have produced contradictory results [1], [2], [3], [5], [7], [8], [9], [10], [11]. Most of these studies have used arbitrarily defined cut-off values of the SCC antigen serum level to discriminate lung cancer patients from control subjects, which might have adversely affected the performance of this tumour marker. Furthermore, the results obtained from these studies were not prospectively validated [6].
To circumvent this problem we have used receiver operator characteristic (ROC) curve analysis to test the diagnostic performance of the SCC antigen and determine the optimal threshold value in a group of non-small cell lung cancer (NSCLC) patients undergoing curative surgery and age matched controls (derivation group). This threshold value was afterwards prospectively validated in another group of NSCLC patients and controls (validation group) [6].
The prognostic significance of preoperative SCC antigen level in lung cancer patients is rather limited [2], [10]. Nevertheless, the SCC antigen level decreases after surgery. The prognostic significance of this decrease in SCC antigen level after surgery has not been adequately tested. We, therefore, also studied the prognostic significance of the decrease in SCC antigen level after surgery, and compared it with other predictors of survival of NSCLC patients.
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Materials and methods
We have measured SCC antigen in the serum of 153 patients with primary NSCLC (149 males, 62±10 years old), before and 1 month after surgery, and in 99 age matched healthy controls (97 males), using a commercially available ELISA kit (Abbot Laboratories, USA). Patients (77) had SCC, 45 had adenocarcinoma (ADC) and 31 patients had large cell carcinoma (LCC). The inclusion period was from May 1994 to August 1996.
Patients had been considered as candidates for surgery based on clinical and
Results
The preoperative serum SCC-Ag level of the lung cancer patients was 1.4 ng/ml (0.9–2.9 ng/ml) in the derivation group (median, 25–75% percentiles) and 1.5 ng/ml (0.9–2.4 ng/ml) in the validation group, whereas the respective values of the healthy controls were 1 (0.6–1.3 ng/ml) and 0.8 ng/ml (0.6–1 ng/ml) (P<0.05). As expected, the serum SCC-Ag level decreased postoperatively to 0.65 (0.3–1 ng/ml) and 0.6 ng/ml (0.4–1 ng/ml) in the derivation and validation groups, respectively (P<0.05).
Discussion
The major findings of this study are, (1) SCC Ag serum level has moderate diagnostic role in NSCLC; (2) both the preoperative SCC-Ag serum level and its postoperative decrease have prognostic significance, yet inferior to the one provided by the disease stage and the patient's age.
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