Study On The Prognostic Of Serum Tumor Markers On The Early Stage Cervical Adenocarcinoma

Objective:There is currently a lack of research on preoperative prognostic analysis of earlystage cervical adenocarcinoma(ADC).The purpose of our study was to clarify whether preoperative serum tumor-marker levels were of better prognostic value in patients with early-stage ADC.Methods:This retrospective study enrolled 212 patients with early-stage ADC treated at Women's Hospital,Zhejiang University School of Medicine between January 2005 and December 2015.Demographic and clinicopathologic characteristics were collected from medical records.There were 188 patients with accurate follow-up data for at least 3 years.We analyzed the relationship between preoperative serum tumor markers and various clinicopathological factors.In addition,survival analysis was used to determine the relevant risk factors and independent prognostic predictors of preoperative overall survival and disease-free survival.The optimal cut-off point of the meaningful tumor markers was determined by the analysis of the subject operating characteristic curve,area under the curve to assess the accuracy of the results.Results:Elevated serum carcinoembryonic antigen(CEA)was significantly associated with body mass index(BMI)and the degree of myometrial invasion.Elevated serum carbohydrate antigen 125(CA125),was significantly associated with the degree of myometrial invasion and lymph node metastasis(LNM).The combination of elevated serum CEA and CA125 was significantly associated with FIGO stage,body mass index(BMI)and LNM.Kaplan-Meier analysis distinctly showed that patients with early-stage ADC had worse prognoses when they had elevated CEA or CA125 alone in their preoperative serum.When the markers were examined together as an indicator for analysis,the conclusions were more precise.Univariate and multivariate analyses further showed that the combination of elevated serum CEA and CA125 served as an independent predictor of both shorter DFS and OS.The optimal CEA cut-offs for predicting DFS and OS using the receiver operating characteristic were 2.85 ng/ml and 2.05 ng/ml,and CA125 cut-offs for predicting DFS and OS were both 32.60 U/ml.The areas under the curve(AUC)for preoperative serum CA125 or CEA in predicting DFS were 0.565(95% CI: 0.410–0.719,P=0.343)and 0.676(95% CI: 0.533–0.820,P=0.010),while the AUC for CA125 and CEA in predicting OS were 0.561(95% CI: 0.388–0.733,P=0.409)and 0.712(95% CI: 0.554–0.870,P=0.004).Conclusion:The preoperative serum levels of CEA and CA125 might have significant prognostic implications in early-stage ADC patients.Combined preoperative serum CEA and CA125 levels independently predicted DFS and OS of early-stage ADC,which defines a group of patients who are at high risk for recurrence and mortality.