| Objective:In recent years,the incidence of laryngeal squamous carcinoma(LSC)has been increasing,which seriously endangers human health.There are currently few indicators for the assessment of the condition and prognosis of LSC.Therefore,finding suitable indicators is of great significance for improving the diagnostic performance of LSC and accurately assessing tumor development and prognosis.This study was designed to evaluate the correlation of pre-treatment serum squamous cell carcinoma antigen(SCC-Ag),keratin fragment 19(CYFA21-1)with the primary tumor stage,lymph node metastasis,clinical stage and the prognosis of patients with LSC,in order to explore their clinical value in this tumor.Method: According to the corresponding inclusion and exclusion criteria,relevant clinical data of 86 patients with LSC who were firstly diagnosed and treated in our hospital from October 2012 to December 2018 were collected.These data included gender,age,smoking history,drinking history,andpre-treatment serum SCC-Ag level,pre-treatment serum CYFRA21-1 level,tumor differentiation degree,tumor primary tumor(tumor,T)stage,lymph node(N)metastatic stage,clinical stage,postoperative radiotherapy,total survival time,tumor-free survival time,tumor recurrence and death status.The normal range of serum SCC-Ag is 0-1.5 ng/ml,and the normal range of CYFRA 21-1 is0-3.3 ng/mL.Using SPSS 21.0 statistical software,chi-square tests,spearman rank correlation tests were used to analyze the relations of level of SCC-Ag,CYFRA21-1 and their abnormal elevation rates to gender,age,presence or absence of smoking,drinking history,postoperative radiotherapy,tumor correlation of degree of differentiation,T calsssification,N classification,clinical stage,etc.Seventy-five patients with LSC who met the criteria(follow-up time ≥6 months)were followed up to obtain data of survival and recurrence status after treatment.The Kaplan-Meier analyses were used to calculate the disease-free survival(DFS)and overall survival(OS)of the patients.Log-rank tests(univariate analysis)were used to evaluated the differencies of OS and DFS between subgroups including gender(male or female),age(≤ 58 years or >58 years)smoking history(with or without),drinking history(with or without),degree of tumor differentiation(high differentiation or moderate-poor differentiation),SCC-Ag(≤1.5 ng/ml or >1.5ng/ml),CYFRA21-1(≤3.3 ng/ml or >3.3 ng/ml),postoperative radiotherapy(with or without),T classification(T1+T2 or T3+T4),N classification(N0+N1or N2+N3),clinical stage(I+II or III+IV).variables with P<0.10 in univariate analyses were included in the subsequent Cox regression models for multivariate analysis to determine independent factors affecting the prognosis of patients with LSC.Results with P < 0.05(bilateral)were considered as statistical significance.Result:All of the 86 patients with LSC who were enrolled were tested for serum SCC-Ag and CYFRA21-1 before treatment.Among these patients,83(96.5%)were male,3(3.5%)were female,and their median age was 58 years;50(58.1%)patients were T1+T2,and 36(41.9%)were T3+T4;68 cases(79.1%)were with N0,with7 cases(8.1%)in N1,11 cases(12.8%)in N2,and 0 cases(0%)in N3;47 cases(54.7%)were in early stage(stage I + stage II)),with 39patients(45.3%)in advanced stage(stage III+IV);78 patients(90.7%)were with serum SCC-Ag≤1.5ng/ml and 8 patients(9.3%)were with >1.5ng/ml;60patients(70.0%)with CYFRA21-1 ≤ 3.3ng/ml and 26 patients(30.0%)were with >3.3ng/ml.A total of 75 patients with LSC who were followed up for ≥ 6months were included in the survival analysis.At the end of follow-up,22patients(29.3%)had tumor recurrence and 13 patients died(17.3%).Statistical analysis results: 1.Chi-square test results showed that(1)there was no significant difference of the proportion of patients with abnormally elevated serum SCC-Ag(>1.5 ng / mL)between the group of the male(P =1.000)or tumor with moderate-poor differentiation(P=1.000)or N0(P=0.096)and the group of female or high differentiation,or with N1+N2+N3,respectively;however,the ratio of patients with abnormally elevated serum SCC-Ag in the T1+T2 phase(P=0.018),I+II classification(P=0.004)was significantly lower than that in the T3+T4 classification and the III+IV stage,respectively.(2)the proportion of patients with abnormally elevated serum CYFRA21-1(>3.3ng/mL)in the group of males(P=1.000),those with moderate-poor differentiation tumor(P=0.324),andthose with N0(P=0.140)was not significantly different from that of females or those with high differentiation tumor or those with N1+N2+N3,respectively.The ratio of patients with the abnormal increase CYFRA21-1 level in T1+T2 classification(P=0.015)and I+II(P=0.014).is significantly lower than that in the T3+T4 classification,III+IV stage,respectively.2.Spearman correlation test results showed:(1)serum SCC-Ag level before treatment significantly and positively correlated with T classification of LSC patients,(r=0.229,P=0.034);serum SCC-Ag level before treatment significantly and positively correlated with N classification(r=0.252,P=0.019);the serum SCC-Ag level before treatment was significantly positively correlated with the clinical stage of LSC patients,(r=0.237,P=0.028);(2)There was a significant positive correlation of pre-treatment serum CYFRA21-1 with the T classification of patients with LSC(r=0.346,P=0.001);There was a significant positive correlation between serum CYFRA21-1 and N stage of patients with LSC before treatment(r=0.245,P=0.023);pre-treatment serum CYFRA21-1 was significantly and positively correlated with clinical stage,(r=0.363,P=0.001);(3)There was a significant positive correlation between serum SCC-Ag and CYFRA21-1 levels before treatment(r=0.260,P=0.016).3.Survival analysis: survival analysis was performed on 75 eligible LSC patients,who had a 3-year OS of 83.4%,a 5-year OS of 73.5%,a 3-year DFS of 73.9%,and a 5-year DFS of 66.0%.Highly differentiated squamous cell carcinoma is an independent protective factor for OS(OR=0.097,95%CI=0.012-0.784,P=0.029);lymph node metastasis(N2 and N3)is an independent risk factor for a shorten OS(OR= 4.301,CI%=1.005-18.412,P=0.049);abnormal elevation of CYFRA21-1(> 3.3 ng/ml)was an independent risk factor for a shorten OS(OR=3.411,CI%=1.017-11.439,P= 0.047).Drinking history was an independent risk factor for DFS(OR=3.662,95%CI=1.230-10.905,P=0.020),but the abnormal increase of CYFRA21-1 before treatment was not significantly associated with DFS.Conclusion:1.In patients with LSC,abnormal elevation of serum SCC-Aglevel before treatment may be associated with T classification and clinical stage.Serum SCC-Ag level in patients with LSC significantly positively correlated with T classification,N classification,and clinical stage.2.In patients with LSC,abnormal elevation of serum CYFRA21-1 level before treatment may be related to T classification and clinical stage.There was a significant positive correlation of serum CYFRA21-1 level with T classification,N classification,and clinical stage in patients with LSC.3.There may be a significant positive correlation of pretreatment serum SCC-Ag with CYFRA21-1 level in patients with LSC.4.The abnormal increase of pretreament serum CYFRA21-1,N classification,and tumor differentiation may be independent factors affecting the risk of death in patients with LSC.A history of drinking may be an independent risk factor for the risk of recurrence in patients with LSC,but abnormal elevation of CYFRA21-1 may not be significantly associated with risk of recurrence. |
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