Risk Stratification System for Oral Cancer Screening

Abstract

Oral cavity and oropharyngeal cancer (oral cancer) is a deadly disease that is increasing in incidence. World-wide 5-year survival is only 50% due to delayed intervention with more than half of diagnoses at stage III and IV, whereas earlier detection (stage I and II) yields survival rates up to 80%–90%. Salivary soluble CD44 (CD44), a tumor-initiating marker, and total protein levels may facilitate oral cancer risk assessment and early intervention. This study used a hospital-based design with 150 cases and 150 frequency-matched controls to determine whether CD44 and total protein levels in oral rinses were associated with oral cancer independent of age, gender, race, ethnicity, tobacco and alcohol use, and socioeconomic status (SES). High-risk subjects receiving oral cancer prevention interventions as part of a community- based program (n=150) were followed over 1 year to determine marker specificity and variation. CD44 ≥5.33 ng/ml was highly associated with case status (adjusted OR 14.489, 95%CI: 5.973, 35.145; p<.0001, versus reference group CD44 <2.22 ng/ml and protein <1.23 mg/ml). Total protein aided prediction above CD44 alone. Sensitivity and specificity in the frequency-matched study was 80% and 48.7%, respectively. However, controls were not representative of the target screening population due, in part, to a high rate of prior cancer. In contrast, specificity in the high-risk community was 74% and reached 95% after annual retesting. Simple and inexpensive salivary CD44 and total protein measurements may help identify individuals at heightened risk for oral cancer from the millions who partake in risky behaviors.

Green Salad Intake Is Associated with Improved Oral Cancer Survival and Lower Soluble CD44 Levels

“…Of the 79 cases that underwent p16 staining, 39.2% were positive. Further definitions of included variables are in the Table 1 footnote and are consistent with stratification from a previous publication [ 28 ].…”

“…Continuous variables were analyzed using Student t-test or analysis of variance (ANOVA) followed by Fisher’s least-significant-difference test for pairwise mean comparison. Data on solCD44 were log2-base transformed (Log 2 [solCD44]) to better approximation to normal distribution, as was done in previous publications [ 27 , 28 ]. Progression-free survival (PFS), which was defined as the elapsed time from date of diagnosis to progression or death, was evaluated in 137 cases.…”

“Search less, verify more”—Reviewing salivary biomarkers in oral cancer detection

“…Abnormal expression is common in dysplastic epithelia, and overexpression of its soluble counterpart released by MMP‐aided lysis is observed during tumour progression and metastasis . Promising diagnostic validity and specificity have been reported for OSCC, with SolCD44 applied prospectively to screen high‐risk individuals . Combinations with CD44 gene hypermethylation, cancer risk factor profiling and total protein levels have been found to enhance marker sensitivity, with possible roles suggested for predicting malignant transformation and identifying occult malignancy …”

A Review on Current Scenario of Oral Cancer in India With Special Emphasis on Modern Detection Systems and Biomarkers

“…Soluble CD44 (solCD44) and total protein levels are significantly associated with the development of oral cancer in high-risk individuals. ELISA analysis of CD44 and total protein assay from oral rinses can be a predictive biomarker in the development of oral cancer [102].…”