Squamous cell carcinoma antigen as a prognostic marker and its correlation with clinicopathological features in head and neck squamous cell carcinoma: Systematic review and meta‐analysis

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Head and neck cancer is the sixth most common type of cancer worldwide, and more of 90% accounts for squamous cell carcinoma (SCC).1 Despite improvement in diagnosis and local disease management, long‐term survival rates in patients with head and neck squamous cell carcinoma (HNSCC) have not increased significantly over last years.3 Clinical stage and regional lymph node metastasis are direct related to prognosis in HNSCC, however, not usually represent the real evolution of the disease.5
Thus, tumor markers have been identified to determine clinical stage, prognosis, treatment evaluation, predict relapses, and overall survival (OS).6 Squamous cell carcinoma antigen (SCC‐Ag), originally purified from human uterine cervix SCC, is one of the first biomarkers measured in HNSCC.7 This protein is member of the serine protease inhibitors family (serpin) located at chromosome 18q21.39 and transcribed by two highly homologous genes, SCCA1 and SCCA2.11 Interestingly, serum SCC‐Ag levels frequently decreases after tumor resection and increases when clinical relapses are observed.12 Furthermore, several studies have recently been conducted to address the relationship between pretreatment serum levels of SCC‐Ag with clinicopathological features and prognosis in HNSCC patients.8 The elevated SCC‐Ag level has been found to be associated with advanced tumor stage, lymph node metastasis, tumor thickness, tumor recurrence, and survival in HNSCC patients.5 However, the role of pretreatment serum levels of SCC‐Ag in these patients remains controversial,6 and a comprehensive meta‐analysis is warranted.
To the best of our knowledge, no study has systematically evaluated the prognostic value of pretreatment SCC‐Ag levels or its correlation with clinicopathological features in HNSCC patients. We designed a protocol providing guidelines for search strategy, data extraction, quality assessment, and statistical analysis. This research followed the Preferred Reporting Items for Systematic Reviews and Meta‐analysis PRISMA checklist.
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