Using SCC Antigen and CRP Levels as Prognostic Biomarkers in Recurrent Oral Cavity Squamous Cell Carcinoma

Abstract

Squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) levels have been successfully used to stratify risk groups in primary oral squamous cell carcinoma (OSCC) patients; however, related biomarkers have rarely been investigated in recurrent OSCC. The purpose of the present study was to analyze the relationships of SCC-Ag and CRP levels at the time of recurrence with clinical factors and prognosis. We retrospectively recruited patients with recurrence in a cohort of 534 OSCC patients between March 2001 and July 2013. One hundred patients had recurrence. The serum SCC-Ag and CRP levels were measured at the time of cancer diagnosis, 3 to 6 months after treatment with clinical disease-free, and at the time of recurrence. The SCC-Ag levels were significantly lowered after treatment (paired t-test: p = 0.001) and re-elevated at the time of recurrence (paired t-test: p = 0.027). An SCC-Ag level ≥2.0 ng/ml and a CRP level ≥5.0 mg/L at the time of recurrence were significantly associated with recurrent tumor status (P<0.001), recurrent nodal metastasis (χ2 trend test: P = 0.020), distant metastasis (P<0.001), and overall survival (P<0.001). Moreover, the influence of both elevated SCC-Ag and CRP levels on overall survival (P<0.001, H.R. [95% CI]: 5.406 [2.210–13.222]) still existed after adjusting for the recurrent tumor stage and patient age. The present study demonstrates that concurrent high levels of both SCC-Ag and CRP at the diagnosis of recurrence acts as a predictor of recurrent tumor status, recurrent advanced tumor stage, distant metastasis, and survival after the diagnosis of recurrence. This study expands the applicability of these two markers in the risk stratification in recurrent OSCC.

Correlation between Serum Squamous Cell Carcinoma Antigen Level and Tumor Volume in Head and Neck Cancer

“…This study made use of an SCC-Ag reference cutoff value of 2 ng/mL, established previously [6,10,[16][17][18] to analyze the correlation with tumor volume. In the group of patients with an SCC-Ag level < 2 ng/mL, the mean tumor volume was 7.90 mL.…”

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

“…This protein is member of the serine protease inhibitors family (serpin) located at chromosome 18q21.3 and transcribed by two highly homologous genes, SCCA1 and SCCA2 . Interestingly, serum SCC‐Ag levels frequently decreases after tumor resection and increases when clinical relapses are observed . 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 .…”

C‐reactive protein is an independent prognostic marker in patients with tongue carcinoma ‐ A retrospective study

“…Khandavilli et al demonstrated also an association between CRP and overall survival in a European cohort of 60 patients with OSCC undergoing surgical therapy. A group from Taiwan published several studies about CRP and OSCC and could consistently show an association between elevated CRP (cut‐off 5 mg/L) and survival . In a more recent work, they provided separate results for buccal and tongue cancer, showing significant results for buccal but not for tongue cancer .…”

“…In a more graded analysis with CRP divided into quartiles, results were significant. This raises the question if the cut‐off of 5 mg/L is appropriate; however, it has been used in most studies in the field …”