鳞状细胞癌抗原与子宫颈鳞状细胞癌的临床病理特征及预后的关系

目的 探讨治疗前血清鳞状细胞癌抗原（SCCAg）滴度与宫颈鳞状细胞癌（鳞癌）临床病理特征的关系,以及作为预测预后的因素的意义。方法 选择114例治疗前检测过血清SCCAg并经治疗后长期随访的Ⅰb1～Ⅱa期宫颈鳞癌患者,结合临床资料对SCCAg与临床病理特征及预后的关系进行单因素和多因素分析。结果 单因素分析显示,治疗前血清SCCAg滴度升高（正常值≤1．5mg／L）与肿瘤直径、深肌层浸润及盆腔淋巴结转移相关（P〈0．05）;多因素分析显示,SCCAg滴度升高与深肌层浸润（P=0．029）、盆腔淋巴结转移（P=0．049）相关。114例患者的5年累积无瘤生存率为78．6％,总复发率为27．2％。单因素分析显示,SCCAg滴度升高、盆腔淋巴结转移与5年累积无瘤生存率及复发相关（P〈0．05）;多因素分析显示,影响预后的独立因素为SCCAg滴度升高（P=0．030）和盆腔淋巴结转移（P=0．003）,影响复发的显著相关因素为盆腔淋巴结转移（P=0．006）。盆腔淋巴结转移且SCCAg滴度正常者与盆腔淋巴结转移且SCCAg滴度升高者,5年累积无瘤生存率（分别为50．0％、50．9％）、复发率[分别为60．0％（6／10）、47．1％（8／17）]、局部复发率[分别为3／8、20．0％（3／15）]和远处复发率[分别为1／8、20．0％（3／15）]分别比较,差异均无统计学意义（P〉0．05）。盆腔淋巴结无转移且SCCAg滴度正常者与盆腔淋巴结无转移且SCCAg滴度升高者,5年累积无瘤生存率（分别为98．0％、71．8％,P=0．003）、复发率[分别为9．8％（5／51）、33．3％（12／36）,P=0．006]、局部复发率[分别为2．1％（1／47）、26．5％（9／34）,P=0．001]分别比较,差异均有统计学意义。结论 治疗前血清SCCAg滴度升高和盆腔淋巴结转移是影响Ⅰb1～Ⅱa期宫颈鳞癌患者预后的独立因素。治疗前血清SCCAg滴度升高且盆腔淋巴结无转移患者的局部复发风险显著升高。     

血清鳞状细胞癌抗原检测对宫颈鳞癌的诊断价值

目的:探讨检测血清鳞状细胞癌抗原(SCCAg)在宫颈鳞癌诊断中的价值。方法:用化学发光法测定32例宫颈鳞癌(宫颈鳞癌组)、21例宫颈上皮内瘤变(CIN组)和30例慢性宫颈炎(慢性宫颈炎组)患者治疗前血清SCCAg值(以≥2.5ng/ml为阳性参考值),并根据最大约登指数计算最佳诊断界值及计算曲线下面积(AUC)。结果:宫颈鳞癌组术前血清SCCAg水平(5.516±1.523ng/ml)明显高于CIN组(0.806±0.152ng/ml)和慢性宫颈炎组(0.412±0.053ng/ml),差异均有统计学意义(t=2.492,P=0.001;t=4.715,P=0.000)。宫颈鳞癌组术前血清SC-CAg阳性率(43.75%)明显高于CIN组(4.76%)和慢性宫颈炎组(0),差异均有统计学意义(χ2=9.498,P=0.000;χ2=35.497,P=0.000);宫颈鳞癌组ⅠB期、ⅡA期、ⅡB期、Ⅳ期术前血清SCCAg阳性率分别是31.25%、40.00%、75.00%、100.00%,但4组比较,差异无统计学意义(χ2=3.2,P=0.362)。血清SCCAg对宫颈鳞癌最佳诊断界值、灵敏度、特异度和ROC曲线下面积分别为1.48ng/ml、44.00%、99.00%、0.727。结论:血清SCCAg是宫颈鳞癌特异度较高的肿瘤标志物,可作为辅助诊断指标,而降低SCCAg诊断界值可能有助于提高诊断率。     

血清鳞状上皮细胞癌抗原对子宫颈癌及CINⅢ的诊断价值

目的：探讨血清鳞状上皮细胞癌抗原（SCCAg）在宫颈癌诊断、疗效评估等方面的应用价值。方法：本研究选择了2011年9月—2012年3月天津市中心妇产科医院妇瘤科的住院患者145例,全部为可疑宫颈癌患者,经病理组织学确诊分为宫颈上皮内瘤变（CIN）Ⅲ组55例和宫颈癌组90例。采用化学发光的方法检测患者术前血清SCCAg的浓度,结合临床资料和病理组织学诊断,分析评价SCCAg与临床分期、组织分化程度的相关性及其对宫颈癌的诊断价值,通过术前与术后SCCAg检测值的比较评价其在疗效评估方面的价值。结果：血清SCCAg浓度在CIN组和宫颈癌组中的差异有统计学意义（P=0.000）,治疗后SCCAg水平较治疗前显著下降（P=0.000）;按国际妇产科联盟（FIGO）分期分组讨论,随疾病的进展,临床分期的加重,SCCAg的数值增高,阳性率亦增高,两者具有正相关性;SCCAg在可疑宫颈癌人群的检测敏感度为71.1%,特异度72.7%,准确度71.7%,阴性预测值60.6%,阳性预测值81.0%;CINⅢ的检测阳性率为27.3%,宫颈鳞癌Ⅰ期患者的检测阳性率为66.7%。结论：SCCAg对宫颈鳞状上皮细胞癌具有诊断价值,对疗效监测及预后判断也有重要临床意义,但在早期诊断方面仍有局限性,与宫颈癌的病理类型、临床分期有关,与组织分化程度无关。     

癌基因c－erbB2与子宫颈鳞状上皮细胞癌生物学行为的关系

目的：探讨癌基因ｃ－ｅｒｂＢ２在人宫颈鳞状上皮细胞癌（鳞癌）中的表达及其与生物学行为及预后的关系。方法：采用免疫组织化学方法，检测宫颈鳞癌６２例、宫颈上皮内瘤变（ＣＩＮ）９例及正常宫颈（１０例）的宫颈上皮组织中ｃ－ｅｒｂＢ２的表达。结果：６２例鳞癌中，１９例细胞呈阳性染色，９例ＣＩＮ中１例呈阳性染色，正常宫颈上皮无一例呈阳性染色。细胞学１、２和３级阳性率分别为１２．５％、２７．６％和５２．９％，１级及２级与３级比较，差异有显著意义（Ｐ＝０．０１９）。手术治疗的２０例患者中，６例阳性染色者，３例有盆腔淋巴结转移，１４例例阴性染色者，仅１例淋巴结转移，两者比较，差异有显著意义（Ｐ＝０．０３２）。ｃ－ｅｒｂＢ２阳性表达者，５年生存率（３１．５％）明显低于阴性者（７４．４％，Ｐ＜０．００１）。结论：癌基因ｃ－ｅｒｂＢ２表达与宫颈鳞癌生物学行为及预后相关，检测其表达可能作为宫颈鳞癌预后判断的参考指标     

血清SCCAg及CA125在诊断宫颈鳞癌及评价预后中作用的研究

目的:探讨血清SCCAg及CA125用于宫颈鳞癌诊断、手术治疗及预后的价值。方法:选取ⅠA2～ⅡA期宫颈鳞状细胞癌为研究组,20例CIN及20例慢性宫颈炎分别为对照组1和对照组2。采用固相夹心法酶联免疫吸附实验(ELISA)检测血清SCCAg的数值,采用化学发光免疫分析法(CLIA)检测血清CA125数值。比较分析血清SCCAg及CA125与宫颈鳞癌临床病理特征、手术疗效及预后的关系。结果:宫颈鳞癌组术前血清SCCAg及CA125水平均高于慢性宫颈炎组,差异均具有统计学意义(P<0.01)。宫颈鳞癌组术前SCCAg水平高于CIN组,差异有统计学意义(P<0.001);宫颈鳞癌组术前CA125水平与CIN组的差异无统计学意义(P=0.049,P>0.0167)。血清SCCAg、CA125诊断宫颈鳞癌的临界值分别为1.03ng/ml、8.16U/ml。血清SCCAg、CA125及两项联合诊断宫颈癌的ROC曲线下面积分别为0.954、0.718、0.960,两项联合后诊断性能无明显增加。宫颈鳞癌术前血清SCCAg随临床分期增加具有线性增加的趋势。脉管有否癌栓、盆腔淋巴结有否转移也与术前血清SCCA水平有关,差异有统计学意义(P=0.011,P=0.043)。宫颈鳞癌组手术治疗后的血清SCCAg及CA125水平均有逐渐降低趋势,差异有统计学意义(P均<0.001)。结论:血清SCCAg对宫颈鳞癌有较高的诊断价值,可考虑作为诊断及手术疗效评估指标之一,有助于初步判断脉管及盆腔淋巴结转移。血清CA125对于宫颈鳞癌诊断、手术评估及随访的价值均低于SCCAg,与SCCAg联合不能增加诊断的敏感度和特异度。     

腹腔镜下广泛子宫颈切除术治疗早期子宫颈鳞状细胞癌的初步研究

目的：探讨完全腹腔镜下广泛宫颈切除术治疗早期宫颈鳞癌的远期肿瘤结局及妊娠结局。方法：以2005年1月—2009年12月于首都医科大学附属北京朝阳医院妇产科经完全性腹腔镜下广泛宫颈切除术治疗的12例早期宫颈鳞癌患者为研究对象,收集临床资料及随访结果,对数据进行分析。结果：12例患者平均年龄27（22~34）岁。国际妇产科联盟（FIGO）分期为IA2期7例,IB1期5例。12例患者的组织学类型均为鳞癌。平均手术时间233（200～320）min,平均出血量153（50～200 ）mL。12例均为接受完全腹腔镜下宫颈广泛切除术的患者,在58个月的中位随访时间中,均无肿瘤复发。4例患者术后长期避孕,4例患者自然妊娠,2例在妊娠早期自然流产,1例于妊娠29周时因胎膜早破行剖宫产,1例于妊娠37周时行剖宫产终止妊娠。结论：完全腹腔镜下广泛宫颈切除术治疗早期宫颈鳞癌是安全可行的,但仍需大样本的前瞻性研究对妊娠结局进行评估。     

宫颈非鳞状细胞恶性肿瘤35例临床病例分析

目的 讨论宫颈非鳞状细胞恶性肿瘤(以下简称非鳞癌)的临床特征、诊断、卵巢转移情况及预后。方法 对中国人民解放军陆军总医院2010年1月至2016年5月收治的35例宫颈非鳞癌患者与同期228例宫颈鳞癌患者的临床及病理资料进行回顾性分析。结果 非鳞癌患者占同期宫颈恶性肿瘤的13.3%。非鳞癌的宫颈细胞学检测阳性率较低(60%)。绝经前与绝经后非鳞癌发病的组织病理类型差异有统计学意义(P0.05)。非鳞癌患者以阴道排液症状就诊的比例及宫颈肉眼观呈内生型的比例明显高于同期鳞癌组(P0.05)。非鳞癌中保留卵巢组与未保留卵巢组5年生存率差异无统计学意义(P0.05)。宫颈非鳞癌的5年生存率明显低于同期鳞癌(P0.05)。结论 临床医生对于宫颈非鳞癌的早期诊断需要提高警惕,减少漏诊及误诊率。非鳞癌的预后较鳞癌差,临床分期、淋巴结转移、局部大病灶、宫颈深间质浸润是影响预后的因素。对于早期非鳞癌的年轻患者,仍可考虑保留一侧正常卵巢。     

鳞状细胞癌抗原在宫颈鳞癌中的研究进展

鳞状细胞癌抗原(SCC-Ag)是鳞状上皮细胞膜产生的一种肿瘤相关蛋白,又名TA-4抗原,由SC-CA1和SCCA2抗原组成。目前,SCC-Ag作为临床最早应用于鳞状细胞癌诊断的肿瘤标记物,与鳞癌的发生发展密切相关,其血清水平检测已广泛应用于全身各系统鳞状细胞癌,尤其是宫颈鳞癌的诊断、病情监测、治疗效果评价及预后判断的辅助指标。就SCC-Ag的生物学特点及近年来有关SCC-Ag在宫颈鳞癌中的研究进展简要综述。     

癌基因—c—erbB2与子宫颈鳞状上皮细胞癌生物学行为的关系

目的：探讨癌基因ｃ－ｅｒｂＢ２在人宫颈鳞癌中的表达及其与生物行为及预后的关系。方法：采用免疫组织化学方法，检测宫颈鳞癌６２例、宫颈上皮内瘤变（ＣＩＮ）９例及正常宫颈（１０例）的宫颈上皮组织中ｃ－ｅｒｂＢ２的表达。结果：６２例鳞癌中，１９例细胞呈阳生染色，９例ＣＩＮ中１例呈一染色，下沉宫颈上皮无一例阳性染色。细胞学１、２和３有阳性率分别为１２．５％、２７．６和５２．９％，１级及２级与３级比较，差异有     

冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变患者的预后影响因素分析

目的探讨冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变（HSIL）患者的预后影响因素。方法回顾分析1999年1月至2004年1月间,卫生部北京医院妇产科266例冷刀锥切手术切缘阴性的HSIL患者的临床资料,分析影响预后的因素,并随访治疗结局。其中宫颈上皮内瘤变（CIN）II20例,CIN11246例（包括原位癌82例）;腺体累及者40例,无腺体累及者226例;257例检测高危型人乳头状瘤病毒（HPV）患者中,高危型HPV阳性244例,阴性13例。结果中位数随访时间46个月,总复发率为8．6％（23／266）,无浸润癌发生。CINⅡ患者中1例（5．0％,1／20）复发,CINⅢ患者（不包括原位癌）中9例（5．5％,9／164）复发,而82例原位癌中13例（15．8％,13／82）复发,原位癌与CINⅡ及CINⅢ（不包括原位癌）患者复发率比较,差异均有统计学意义（P〈0．05）。腺体累及者中7例（17．5％,7／40）复发,无腺体累及者中16例（6．0％,16／226）复发,两者比较,差异有统计学意义（P〈0．05）。高危型HPV阳性者中21例（8．6％,21／244）复发,而13例高危型HPV阴性者中无一例复发,两者比较,差异有统计学意义（P〈0．05）。结论冷刀锥切术切缘阴性的HSIL复发率低;病理分级高和腺体受累是影响疗效及预后的因素。     

Post-treatment serial serum squamous cell carcinoma antigen (SCC) in the monitoring of squamous cell carcinoma of the cervix

Serum squamous cell carcinoma antigen (SCC) was raised in 62% of 308 patients with squamous cell carcinoma of the cervix before treatment. Post-treatment SCC levels were raised in 69 patients (22.4%). Retrospective review showed that persistently raised SCC level after treatment was significantly associated with persistent or recurrent disease in squamous cell carcinoma of the cervix. The specificity of persistently raised SCC level in association with recurrent disease was 98.2%. The sensitivity in association with recurrent disease was 74.7%. The positive predictive values was 94.2%. The median lead time for recurrence was 4 months. SCC was raised in 38% of patients with clinical evidence of disease in the vagina. One patient had raised SCC one month prior to clinical detection of vaginal metastasis and was salvaged by an exenterative procedure. SCC was raised in 71–91% of patients with metastatic disease in the lung, lymph nodes or other distant sites. Thus, persistently raised SCC level after treatment of squamous cell carcinoma should alert the clinician to look for recurrent disease especially in distant metastatic sites. Post-treatment raised SCC level was associated with less than 5% 5-year survival rate whereas in patients with normal SCC level, the 5-year survival rate was 87%.     

Scalp metastasis from squamous cell carcinoma of the cervix

Abstract. Maheshwari GK, Baboo HA, Ashwathkumar R, Dave KS, Wadhwa MK. Scalp metastasis from squamous cell carcinoma of the cervix.
We describe a 45-year-old woman with squamous cell carcinoma of the cervix stage IIB, who was initially treated with radical radiotherapy. The patient developed multiple scalp metastases 8 months following her treatment. The scalp was involved in the disease as the sole anatomic site of distant cutaneous metastasis. The scalp lesions were treated with palliative radiotherapy. A search of the literature revealed only two cases of such distant metastatic involvement of the scalp from cervical cancer.     

Concurrent radiotherapy with paclitaxel/carboplatin chemotherapy as a definitive treatment for squamous cell carcinoma of the uterine cervix

OBJECTIVES: To evaluate the toxicity and the efficacy of paclitaxel/carboplatin chemoradiotherapy as a definitive treatment for squamous cell cancer of the uterine cervix. METHODS: From March 2000 to January 2004, 33 patients with squamous cell cancer of the uterine cervix were treated with concurrent chemoradiotherapy including 2 cycles of paclitaxel (135 mg/m(2)) and carboplatin (area under the time-concentration curve 4.5 mg min/ml) at 4-week interval. Seven patients received adjuvant chemotherapy with the same chemotherapeutic regimen. All patients received external beam radiotherapy with 41.4-51.4 Gy (median 50.4 Gy) to the whole pelvis. Twenty-eight patients received boost irradiation to the cervix by brachytherapy with 25.6-43.3 Gy (median 34.6 Gy) and 5 patients by external beam radiotherapy with 10.8-14.4 Gy (median 14.4 Gy). RESULTS: A median follow-up period was 27 months (range: 6-53 months). Acute hematological toxicity of grade 3 or 4 developed in 20 patients (61%), and acute gastrointestinal toxicity of grade 3 developed in 1 patient (3%). Vesicovaginal fistula occurred in 2 patients (6%). All patients achieved objective response (CR 70%, PR 30%) in 2 months after termination of treatment. One patient had a local progression in cervix, and 4 patients developed distant metastases. The 3-year estimated disease-free survival rates for stages I-IIA, IIB, III and IV were 67%, 91%, 88% and 50%, respectively. The 3-year estimated survival rates for stages I-IIA, IIB, III and IV were 89%, 91%, 88% and 50%, respectively. CONCLUSION: Concurrent chemoradiotherapy with paclitaxel and carboplatin is effective to achieve an excellent pelvic control.     

Changes of Ki-67 index in squamous cell carcinoma of the cervix during the early course of radiotherapy and prediction of prognosis

PURPOSE: To determine whether changes in the Ki-67 index during the early course of radiotherapy could predict the prognosis in squamous cell carcinoma of the uterine cervix and be of value in clinical practice. MATERIALS AND METHODS: Biopsy specimens from 23 cases of histologically confirmed squamous cell carcinoma of the cervix were stained with anti-Ki-67 monoclonal antibody prior to radiotherapy and after 9 Gy. The correlation between the Ki-67 index, local control and distant metastasis was determined by Spearman's correlation test. RESULTS: Median age of the patients was 49. According to the FIGO staging system four patients had Stage IIA, 16 had Stage IIB, one had Stage IIIA and two had Stage IIIB disease. Among the whole group brachytherapy was applied to 17 patients (17/23) and weekly cisplatin (40 mg/m2) was applied to 15 patients (15/23). The mean Ki-67 index prior to radiotherapy and after 9 Gy for the entire group were 58.5% and 46.0%, respectively. The Ki-67 index after 9 Gy decreased in most of the patients (74%). During a median follow-up of 23 months four patients developed local recurrence and four patients developed distant metastasis. No significant correlation was detected among the local control and changes in Ki-67 index after 9 Gy, whereas there was a moderate correlation between distant metastasis and changes in Ki-67 index after 9 Gy (r = 0.51, p = 0.01). CONCLUSION: The Ki-67 index can be used safely as a proliferation marker in cervical carcinomas, and changes in the Ki-67 index during the early course of radiotherapy may predict the metastatic potential. However prospective studies including a large number of patients with long-term follow-up are necessary to confirm the clinical utility of this marker in cervical cancer.     

Effectiveness of definitive radiotherapy for squamous cell carcinoma of the vulva with gross inguinal lymphadenopathy

Objective

To evaluate the effectiveness and long-term side effects of definitive groin radiotherapy for vulvar cancer with grossly involved inguinal lymph nodes.

A Phase II study of topotecan in patients with squamous cell carcinoma of the cervix: a gynecologic oncology group study

OBJECTIVE: The toxicity and activity of intravenous topotecan were assessed in a multicenter Phase II study (GOG 76-U) in patients with advanced, recurrent, or persistent squamous cell carcinoma of the uterine cervix. METHODS: Intravenous topotecan was administered at 1.5 mg/m2 per day for 5 consecutive days every 4 weeks in patients without prior chemotherapy, aside from chemosensitizing agents used in conjunction with radiotherapy. The study required histologic confirmation of primary diagnosis, adequate performance status, and measurable disease to assess response. A two-stage design for accrual was used to allow for early termination of the study should inadequate response or excessive toxicity be an issue. Modifications of dose were based on hematologic toxicity. Treatment was continued until progression of disease was documented or adverse effects prohibited further therapy. RESULTS: A total of 49 patients were entered on study: of these 5 were never treated, and 1 was not evaluable for response. More than 88% (38 of 43 patients) had received prior radiotherapy. A median of two courses were administered per patient with a range of 1 to 14 cycles. Grade 4 neutropenia occurred in 68% and grade 4 thrombocytopenia in 18% of patients. Nonhematologic toxic effects were infrequent and not dose-limiting. The overall response rate (complete and partial) was 18.6%. The median progression-free survival was 2.4 months. CONCLUSIONS: Topotecan administered at this dose and schedule demonstrated moderate activity albeit at a cost of substantial hematologic toxicity in patients with advanced, recurrent, or persistent squamous cell carcinoma of the cervix.     

宫颈鳞癌与腺癌生物学行为的回顾性对比分析

目的探讨宫颈鳞癌(SCC)和宫颈腺癌(AC)在生物学行为方面存在的差异,为宫颈癌的合理诊治提供更多的临床依据。方法回顾分析山东大学齐鲁医院妇产科1997年1月至2006年3月收治的273例宫颈癌初治患者的临床资料,对比分析SCC和AC在发病相关因素、临床病理特征、5年生存率等生物学行为方面的不同。结果SCC和AC两组病例中有吸烟史者分别占22%和10%、宫颈涂片阳性率分别为80%和46%,体重指数(body mass index,BMI)≥24kg/m2者分别占15%和34%,确诊时FIGOⅠ期、Ⅱ期、Ⅲ期、Ⅳ期患者分别占SCC患者的42%、46%、11%、1%和AC患者的31%、47%、12%、10%,卵巢转移率分别为0.5%和6.7%,5年生存率分别为69.9%和50.6%,以上差异均有统计学意义(P<0.05)。结论SCC和AC在发病相关因素、临床病理特征和预后等方面均有统计学差异,SCC组有吸烟史者的比例及宫颈涂片阳性率更高,AC患者中则体重超重或肥胖者占较高比例,AC患者确诊时晚期患者较多而且更容易发生卵巢转移,预后较SCC差。     

Radiation therapy for elderly patient with squamous cell carcinoma of the uterine cervix

OBJECTIVE: The purpose of this study was to profile cervical squamous cell carcinoma in elderly patients undergoing radiation therapy and to study the treatment outcome and side effects of therapy. MATERIALS AND METHODS: A retrospective analysis was carried out from the records of 380 patients with squamous cell carcinoma of the uterine cervix who had been given radiation therapy between 1970 and 1994. The patients were divided into three age groups: under 70 years (youngest group; n = 215), 70 to 79 years (intermediate group; n = 124), and 80 years or older (oldest group; n = 41). Radiation therapy was performed by a combination of external beam therapy and three brachytherapy fractions using low-dose-rate sources. RESULTS: The 5-year overall survival rates in the youngest, intermediate, and oldest groups were 58, 50, and 33%, respectively, while cause-specific survival rates were 68, 70, and 65%, respectively. For the patients with stage III, the 5-year overall survival rates in the youngest, intermediate, and oldest groups were 59, 48, and 36%, respectively, while cause-specific survival rates were 72, 70, and 70%, respectively. There was no statistical significance in the 5-year intrapelvic recurrence rates among the three groups. Grade 3 or 4 complications occurred in 6.5% of the youngest, 11.3% of the intermediate, and 7.3% of the oldest groups. CONCLUSION: Radiation therapy with external beam combined with three fractions of low-dose-rate brachytherapy proved both highly effective and safe for senior patients with cervical squamous cell carcinoma.     

Monitoring of serum squamous cell carcinoma antigen levels in invasive cervical cancer: is it cost-effective?

OBJECTIVE: The aim of this study was to assess the cost-effectiveness of serial squamous cell carcinoma antigen (SCC) monitoring in the clinical setting. METHODS: All patients with squamous cell carcinoma of the cervix and SCC measurement from 1994 to 1999 were reviewed. The cost of the investigations, including blood tests, X rays, and computer tomography; and clinic visits were adjusted to 2001 dollars for all cases over the 6-year study period. The effectiveness measure was the number of cases detected by SCC monitoring before the onset of clinical symptoms or abnormal physical examination findings. Altered clinical management due to early detection was considered successful. RESULTS: Two thousand eight hundred fifty-one SCC antigen assays were performed from 384 patients. An elevated pretreatment SCC level was associated with poorer cumulative survival over time (P < 0.05). Fifty-five patients had recurrences, with 10 local and 45 distant recurrences. SCC levels were elevated in 47 patients (85%). The median lead time was 7.8 months. The cost of finding 1 recurrence was US$4750. SCC monitoring does not alter clinical management and has no advantage over clinical examination in detecting local recurrence. Most of the recurrent diseases were detected too late for curative treatment. Only 1 patient, in whom the diagnosis could have been made by clinical examination without SCC monitoring, may have potentially benefited from exenteration. CONCLUSION: Posttreatment SCC monitoring is not cost-effective in the absence of curative treatment for distant spread of disease.