The Clinical Value Of HPV,TCT,SCC-Ag Detection After Cervical Cancer Chemotherapy And Follow-up

Objective:To explore the relationship with sruviliance methods HPV,TCT,SCC-Ag results and the progress of cervical cancer patients who accepted chemoradiotherapy,and analyze the clinical significance of the combined or single detection in the surveillance of these patients.Methods:A total of 399 cervical cancer patients with stage IIb to IVa(FIGO 2009)undergoing radical chemoradiothe-rapy from March 2014 to March 2016 in Jiangxi Province Maternal and Child Health Hospital were selected.All the patients were primary cevical cancer and initial treated in the hospital.The treatment plan was radical radiotherapy(pelvic external beam irradiation therapy and brachytherapy)plus platinum-based chemotherapy concurrent.HPV,TCT,and SCC-Ag tests were performed at 0~3、4~6、7~9、10~12、13~18、19~24 months after treatment in all patients.During the follow-up time,twice consecutive HPV positive cases(two times in intervals of more than three months),any cytological abnormality(≥ ASC-US)and consecutive twice or more SCC-Ag positive patients all checked by colposcopy.Patients with abnormal colposcopy results were performed by cervical biopsy or endocervical curettage(ECC).Patients with consecutive SCC-Ag positive more than twice were undergo imaging examinations(MRI,CT or PET-CT)in addition to colposcopy.The follow-up during 2 years after the treatment(patient was excluded if any recurrence).Results:1.The positive rate of HPV virus during follow-up was significantly lower than that before treatment.The HPV positive rate of 0-3mth was higher than other periods,and the 4-6mth was higher than 10-12 mth with statistical differences(P<0.001).There was no significant difference in the HPV positive rate among other periods,and also the multiple HPV positive rate of all periods(P>0.05).The persistent infection rate of multiple HPV infection group was higher than that of single HPV infection group(P<0.05).The HPV positive rate in the recurrence-free group was lower than recurrence group with statistical difference(P<0.05).2.22.73%(505/2222)patients with TCT abnormal were examined by colposcopy,and 166 of them were performed biopsy or endocervical curettage for colposcope abnormal.The abnormal TCT rate of 0-3mth was higher than other periods,and also the rate of 4-6 months higher than 13-18 mth and 19-24 mth with statistically significant(P<0.005),the rate was no statistical difference among other period(P>0.05).The negative TCT after ehemoradiotherapy mainly consisted of post-chemotherapy response,inflammatory response,and cells in the normal range,There was a correlation between the change ratio of the three components and the interval from the end of radiotherapy(P<0.05),With the prolongation of the interval,the proportion of local inflammatory responsive cells gradually decreased,while the proportion of responsive cells after chemoradiotherapy and the normal range of cells increased instead.The abnormal cytology was no statistically significant difference between the relapse group and the relapse-free group of 0-3mth(P>0.05);however,TCT abnormal rate in the recurrence group was significant difference in all of the periods compared with no recurrence group(P<0.05).3.With the extension of treatment time,the of SCC-Ag positive rate declined gradually,and the SCC-Ag positive rate of 0-3mth was higher than the subsequent follow-up periods with Statistical significance(P=0.000),and There was no significant difference among the other periodsl(P>0.05).56 patients in this group were recurrence with 50 patients SCC-Ag positive before diagnosis,,while the positive rate was 89.29%.31 patients from the recurrence group were diagnosised by imageology and symptom related to recurrence,,however,21 patients of them SCC-Ag positve before the diagnosis which was 2.5mths versus 7.5 mths,and the remaining 10 patients SCC-Ag values increase after imageology or symptoms occur.Although the measurement of SCC-Ag level is not a sensitive cervical cancer screening method(sensitivity 55.36%),but the specificity is 92.2%.During the follow-up period,the rate of negative conversion of SCC-Ag was 60% in the relapse group while the rate was 68% in the 0-3 months after treatment,and it was decreased gradually after 3 mths of treatment.In each follow-up period,the SCC-Ag negative rate of the recurrent group was lower than the relapse-free group with statistically significant(P=0.000).To predicted uncontrolled and recurrence,the cutoff value of SCC-Ag was 2.1 ug/L.4.Calculate the sensitivity and specificity of TCT、HPV、SCC-Ag、HPV+TCT and HPV+TCT+SCC-Ag for the surveillance of cervical cancer after treatment,and plot the ROC curve.The largest area under the curve is the conbination of the three.The sensitivity of TCT,HPV,SCC-Ag,HPV+TCT in the detection of distant metastasis and local recurrence were significantly different(P<0.05).The sensitivity of TCT and HPV combined with SCC-Ag detection was very high for distant metastasis and local recurrence(P>0.05).Conclusion:1.Consistent HPV after chemoradiation of cervical cancer may be closely related to local recurrence;patients may require HPV detection for at least two years.2.In the absence of visible lesions situation,ASC-US or LSIL within 6 months is high likely to consider reactive cellular changes caused by treatment(chemora dio-therapy),and can be observed.cytological manifestations ASC-US or LSIL colposcopy is necessary when the time from treatment is 6moths or more.ASC-US Cytology was selected shunts by HPV detection which with higher sensitivity and specificity for finding CIN or relapse,and women with ASC-H,HSIL,and higher cytological abnormalities should proceed colposcopy.3.Increased SCC-Ag values should be further examined to exclud relapse absence of clinical symptoms,After 3 months of chemoradiation Patient persistently positive of SCC-Ag should be alert to the possibility of relapse,and its cutoff value is greater than 2.1 ng/ml in this study.4.The combination detection by HPV,TCT and SCC-Ag has higher sensitivity and negative predictive value,and can be more sensitive to the recurrence of cervical cancer.And it has high sensitivity for the detection of distant metastasis and local recurrence.