Evaluation of tumor markers in patients with squamous cell carcinoma in the oral cavity

Is Systemic Immunosuppression a Risk Factor for Oral Cancer? A Systematic Review and Meta-Analysis

Even if the relationship between immunosuppression and increased incidence of systemic cancers is well known, there is less awareness about the risk of developing oral cancer in immunosuppressed patients. The aim of this review was to evaluate the association between immunosuppression and the development of oral cancer. Two authors independently and, in duplicate, conducted a systematic literature review of international journals and electronic databases (MEDLINE via OVID, Scopus, and Web of Science) from their inception to 28 April 2023. The assessment of risk of bias and overall quality of evidence was performed using the Newcastle-Ottawa Scale and GRADE system. A total of 2843 articles was identified, of which 44 met the inclusion criteria and were included in either the qualitative or quantitative analysis. The methodological quality of the included studies was generally high or moderate. The quantitative analysis of the studies revealed that immunosuppression should be considered a risk factor for the development of oral cancer, with a percentage of increased risk ranging from 0.2% to 1% (95% CI: 0.2% to 1.4%). In conclusion, the results suggest that a constant and accurate follow-up should be reserved for all immunosuppressed patients as a crucial strategy to intercept lesions that have an increased potential to evolve into oral cancer.

Fucoidan/hyaluronic acid cross-linked zein nanoparticles loaded with fisetin as a novel targeted nanotherapy for oral cancer

Fisetin (FS) is an anticancer drug having potential role in oral tumors management. However, its clinical application is limited due to its hydrophobicity and instability. Bioactive polymers-based nanosystems have a great potential in cancer therapy. Herein, different biopolymers were selected for their anticancer activity and targeting ability for nanoparticles preparation namely; fucoidan (FU), zein (Zn) and hyaluronic acid (HA). The selected FS-loaded cross-linked Zn nanoparticles (ZFH) which contains HA& FU for Zn nanoparticles stabilization showed the most suitable particle size (196 ± 6.53 nm), mean surface net charge (-38.8 ± 1.47 mV) and entrapment efficiency (98 ± 1.2 %). This is the first study to utilize both HA &FU not only for stabilization but also for dual targeting effect due to their targeting ability to multiple tumor targets. In-vitro anticancer activity of ZHF revealed remarkable uptake by SCC-4 cells with significant cytotoxic action. Further, ZHF was appraised using 4-nitroquinoline 1-oxide (4-NQO)-induced oral cancer in-vivo; ZHF significantly reduced OSCC-specific serum biomarkers levels, histologic tumor grade and increased caspase-3 level. Moreover, potential of destroying two key tumor regulatory cells; TECs and CSCs, was evaluated using their specific markers. The elaborated ZFH nanoparticles could be considered as promising targeted nanotherapy for oral cancer treatment with enhanced efficacy and survival rate.

Liquid Biopsy for Oral Cancer Diagnosis: Recent Advances and Challenges

"Liquid biopsy" is an efficient diagnostic tool used to analyse biomaterials in human body fluids, such as blood, saliva, breast milk, and urine. Various biomaterials derived from a tumour and its microenvironment are released into such body fluids and contain important information for cancer diagnosis. Biomaterial detection can provide "real-time" information about individual tumours, is non-invasive, and is more repeatable than conventional histological analysis. Therefore, over the past two decades, liquid biopsy has been considered an attractive diagnostic tool for malignant tumours. Although biomarkers for oral cancer have not yet been adopted in clinical practice, many molecular candidates have been investigated for liquid biopsies in oral cancer diagnosis, such as the proteome, metabolome, microRNAome, extracellular vesicles, cell-free DNAs, and circulating tumour cells. This review will present recent advances and challenges in liquid biopsy for oral cancer diagnosis.

Novel mucoadhesive celecoxib-loaded cubosomal sponges: Anticancer potential and regulation of myeloid-derived suppressor cells in oral squamous cell carcinoma

Oral squamous-cell carcinoma (OSCC) is a widespread health problem. Myeloid-derived suppressor cells (MDSCs) are major tumor microenvironment (TME) population that govern many carcinogenesis aspects by establishing immunosuppressive milieu favoring tumor aggressiveness and treatment resistance. Cyclooxygenase-2 (COX-2) regulates MDSCs activity, hence, COX-2-selective inhibition by celecoxib (CXB) showed good anticancer effect at relatively high doses with possible subsequent cardiovascular complications. Therefore, targeted CXB delivery to MDSCs may represent a promising OSCC treatment strategy. Novel mucoadhesive-cubosomal buccal sponges were prepared for MDSCs targeting and were evaluated for their in-vitro quality attributes, ex-vivo mucoadhesion using buccal chicken-mucosa. Optimally-selected formulation showed considerable uptake by CD33⁺/11b⁺MDSCs in human OSCC cell-line (SCC-4) when quantitatively analyzed by flow-cytometry and examined using confocal-laser microscope. Optimum formulations loaded with low CXB doses (12 mg) were promoted to in-vivo studies via local application, using 4-nitroquinoline-1-oxide-induced OSCC in rats, and compared to their corresponding CXB gels. SP16 revealed the highest ability to decrease MDSC activation, recruitment and TME-immunosuppression in the isolated tumors. Consequently, SP16 exerted the greatest capacity to reduce histologic tumor grade, the OSCC-specific serum tumor markers levels, cancer hallmarks and stemness markers. CXB-loaded cubosomal sponges preferentially target MDSCs with noticeable anticancer potential and may exemplify novel mucoadhesive nanocarriers for OSCC treatment.

Higher serum homocysteine level and frequency of hyperhomocysteinemia in carcinoembryonic antigen-positive or squamous cell carcinoma-antigen-positive oral leukoplakia patients

BACKGROUND/PURPOSE

Our previous study found significantly lower serum hematinic levels and higher serum homocysteine level as well as higher frequencies of serum hematinic deficiencies and hyperhomocysteinemia in oral leukoplakia (OL) patients than in healthy control subjects. This study evaluated whether carcinoembryonic antigen (CEA)-positive or squamous cell carcinoma-antigen (SCC-Ag)-positive OL patients had significantly lower serum hematinic levels and higher serum homocysteine level as well as significantly higher frequencies of hematinic deficiencies and hyperhomocysteinemia than CEA-negative or SCC-Ag-negative OL patients or healthy control subjects.

METHODS

The complete blood count, serum iron, vitamin B12, folic acid, and homocysteine levels in 184 OL patients including 85 CEA-positive, 99 CEA-negative, 25 SCC-Ag-positive, and 159 SCC-Ag-negative OL patients and in 184 age- and sex-matched healthy control subjects were measured and compared.

RESULTS

We found that the 85 CEA-positive or 25 SCC-Ag-positive OL patients had a significantly lower mean serum folic acid level and a significantly higher mean serum homocysteine level as well as significantly higher frequencies of serum folic acid deficiency and hyperhomocysteinemia than 184 healthy control subjects. Moreover, the 25 SCC-Ag-positive OL patients had a significantly higher mean serum homocysteine level than the 159 SCC-Ag-negative OL patients. The 85 CEA-positive OL patients had a higher mean serum homocysteine level and a higher frequency of hyperhomocysteinemia than 99 CEA-negative OL patients (marginally significant, P = 0.060).

CONCLUSION

CEA-positive or SCC-Ag-positive OL patients tend to have a higher mean serum homocysteine level and a higher frequency of hyperhomocysteinemia than CEA-negative or SCC-Ag-negative OL patients, respectively.

Salivary melatonin in oral squamous cell carcinoma patients

Melatonin’s role in circadian rhythm is well documented, as are its’ anti-oxidant, oncostatic and anti-inflammatory properties. Poor sleep quality has been associated as a potential risk factor for several malignancies, including head and neck cancers. The purpose of this study is to determine salivary melatonin (MLT) levels in oral squamous cell carcinoma (OSCC) patients, compare the salivary MLT levels with those in healthy individuals and compare the salivary and serum levels in OSCC patients. Furthermore, the aim is to investigate the potential relationship between sleep quality and salivary MLT levels in OSCC patients. Unstimulated (UWS) and stimulated (SWS) whole saliva was sampled from patients with T1N0M0 and T2N0M0 OSCC (N = 34) and 33 sex and age matched healthy subjects. Serum samples were taken from 11 OSCC patients. Sleep quality was measured using Pittsburgh Sleep Quality Index (PSQI) questionnaire. Melatonin levels in UWS and SWS were significantly higher in the OSCC group. Sleep quality was significantly lower in patients with OSCC (P = 0.0001). ROC analysis was found to be significant (P < 0.001) in evaluating MLT concentration limit in diagnosing OSCC. The expected relationship between sleep quality and salivary MLT levels in OSCC patients was not observed. Our results suggest salivary MLT as a potential biomarker that might facilitate non-invasive detection of early stage OSCC.

Significantly higher serum tumor marker levels in patients with oral submucous fibrosis

Background/purpose

Our previous study showed that carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and ferritin are significantly higher in patients with oral potentially malignant disorders (OPMDs including oral leukoplakia, oral erythroleukoplakia, and oral verrucous hyperplasia) than in healthy controls (HCs). Oral submucous fibrosis (OSF) is also recognized as an OPMD. This study evaluated whether these three serum tumor marker levels were also significantly higher in OSF patients than in HCs.

Materials and methods

The serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients and 164 HCs were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively.

Results

We found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients than in 164 HCs (all P-values < 0.05). Moreover, 41 OSF patients had significantly higher serum positive rates of CEA (39.0%), SCC-Ag (19.5%), and ferritin (53.7%) than 164 HCs (all P-values < 0.05). Of the 41 OSF patients, 26 (63.4%), 7 (17.1%), and 2 (4.9%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively.

Conclusion

There are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in OSF patients than in HCs. The serum CEA, SCC-Ag, and ferritin levels may be served as tumor markers for evaluation of malignant potential of OSF lesions.

Salivary biomarkers in oral squamous cell carcinoma - An insight

Oral cancer refers to the malignancies that occur in the oral cavity, lip and pharynx with 90% of oral cancers being squamous cell carcinomas (OSCC). OSCC has the highest mortality ratio compared to other carcinomas. Although oral cavity is easily accessible, most oral cancers are detected at a later stage leading to lower survival rates. Early detection of OSCC is a key factor in improving the prognosis and survival rate of the patient. Rapid advancement in the field of diagnosis has enabled early diagnosis of many potentially malignant conditions even before its clinical manifestations. One such diagnostic modality that has gained much relevance in the field of molecular biology has been the discovery of salivary biomarkers (DNA, RNA and protein markers). These salivary biomarkers have been shown to play a non-invasive role in the diagnosis and surveillance of oral cancer. The direct contact between the saliva and the oral cancer lesions makes it a most sensitive and specific, screening method in diagnosis, staging and follow-up. This review aims to discuss the effectiveness and the potential of salivary biomarkers as a screening tool in OSCC.

Diagnostic accuracy of serum biomarkers for head and neck cancer: A systematic review and meta-analysis

Serum biomarkers could be helpful to characterize head and neck squamous cell carcinoma (HNSCC). Thus, the purpose of this systematic review and meta-analysis was to determine the diagnostic capability of serum biomarkers in the assessment of HNSCC patients. Studies were gathered by searching LILACS, PubMed, Science Direct, Scopus and Web of Science up to April 10th, 2015. Studies that focused on serum biomarkers in the diagnosis of HNSCC compared with controls were considered. Sixty-five studies were identified, and the sample size included 9098 subjects. Combined biomarkers demonstrated improved accuracy than those tested individually. Therefore, 12.8% of single and 34.3% of combined indicated that serum biomarkers discriminate patients with HNSCC from controls. The combined biomarkers with better diagnostic capability included Epidermal growth factor receptor (EGFR)+Cyclin D1 and squamous cell cancer-associated antigen (SCCA)+EGFR+Cyclin D1. Beta2-microglobin may also be a promising single biomarker for future studies. Serum biomarkers can be potentially useful in the diagnosis of HNSCC. However, further research is required to validate these biomarkers.

Identification of tumour-related proteins as potential screening markers by proteome analysis-protein profiles of human saliva as a predictive and prognostic tool

The analysis of biomarkers in saliva as a clinical application offers an attractive, simple and rapid diagnostic tool for the short- and long-term monitoring of pathological disorders and drug therapy. The collection of saliva, either in the pure or in its fractionated form, is a relatively easy and non-invasive procedure that is not harmful to the patients and has no complications at all. However, the fluid collection must be clearly defined due to variations in saliva composition, flow rate and day-to-day variability. In order to minimise possible variations, saliva from five patients without squamous cell carcinoma (SCC) pathology and five with suspicion of oral squamous carcinoma (OSCC) were collected and matched at different days and analysed by two-dimensional polyacrylamide gel electrophoresis (2DE-PAGE). Approximately 800 spots were identified, corresponding to 151 different gene products. The list of identified proteins includes a large number of structural proteins like keratins, keratin subunits, enzymes and enzyme inhibitors, cytokines, immunoglobulins as well as amylase and other salivary specific glycoproteins. The majority of proteins that are localised in oral epithelia cells were found as unsolved debris in saliva. One of the identified proteins was significantly overexpressed in OSCC and was selected for further validation by Western blot analysis.

PARVB overexpression increases cell migration capability and defines high risk for endophytic growth and metastasis in tongue squamous cell carcinoma

Background:

Tongue squamous cell carcinoma (TSCC) is highly diverse, even in its early stages. This cancer is classified into three subtypes (superficial, exophytic, and endophytic) based on macroscopic appearance. Of these subtypes, the endophytic tumours have the worst prognosis because of their invasiveness and higher frequency of metastasis.

Methods:

To understand the molecular mechanism underlying the endophytic subtype and to identify biomarkers, we performed a comprehensive gene expression microarray analysis of clinical biopsy samples and also confirmed the clinical relevance of differential gene expression.

Results:

Expression of the parvin-beta (PARVB) gene and its encoded protein was significantly upregulated in endophytic-type TSCC. PARVB is known to play a critical role in actin reorganization and focal adhesions. Knockdown of PARVB expression in vitro caused apparent decreases in cell migration and wound healing, implying that PARVB has a crucial role in cell motility. Moreover, metastasis-free survival was significantly lower in patients with higher tumour expression of PARVB.

Conclusions:

These findings suggest that PARVB overexpression is a candidate biomarker for endophytic tumours and metastasis. This protein may be a clinically useful target for adjuvant TSCC therapy.

Quantitative proteomic analysis of serum proteins from oral cancer patients: comparison of two analytical methods

Serum proteomic analysis can be a valuable approach for the discovery of protein biomarkers for early detection or monitoring of a disease. In this study, two analytical methods were compared for quantification of serum proteins in patients with oral cancer. In the first approach, we quantified serum proteins between oral squamous cell carcinoma (OSCC) and healthy control subjects by performing in-solution digestion of serum proteins, isobaric tags for relative and absolute quantification (iTRAQ) labeling of the resulting peptides, strong cation exchange (SCX) fractionation of labeled peptides and finally capillary liquid chromatography with tandem mass spectrometry (LC-MS/MS) analysis of the peptides. In the second approach, we first separated serum proteins with SDS-PAGE. The gel-separated proteins were then digested with trypsin and the resulting peptides were labeled with iTRAQ and analyzed with LC-MS/MS for protein quantification. A total of 319 serum proteins were quantified with the first proteomic approach whereas a total of 281 proteins were quantified by the second proteomic approach. Most of the proteins were identified and quantified by both approaches, suggesting that these methods are similarly effective for serum proteome analysis. This study provides compelling evidence that quantitative serum proteomic analysis of OSCC is a valuable approach for identifying differentially expressed proteins in cancer patients’ circulation systems that may be used as potential biomarkers for disease detection. Further validation in large oral cancer patient populations may lead to a simple and low invasive clinical tool for OSCC diagnosis or monitoring.

Salivary markers for oral cancer detection

Oral cancer refers to all malignancies that arise in the oral cavity, lips and pharynx, with 90% of all oral cancers being oral squamous cell carcinoma. Despite the recent treatment advances, oral cancer is reported as having one of the highest mortality ratios amongst other malignancies and this can much be attributed to the late diagnosis of the disease. Saliva has long been tested as a valuable tool for drug monitoring and the diagnosis systemic diseases among which oral cancer. The new emerging technologies in molecular biology have enabled the discovery of new molecular markers (DNA, RNA and protein markers) for oral cancer diagnosis and surveillance which are discussed in the current review.

Blood iron, glutathione, and micronutrient levels and the risk of oral cancer

The risk of oral cavity cancer was determined in relation to serological levels of iron; vitamins A, B2, C, E; zinc; thiamin; and glutathione (GSH). The study included 65 hospitalized patients with oral cancer and 85 matched controls. In comparing the highest to the lowest tertiles, the risk was odds ratio (OR) = 0.3 [95% confidence interval (CI) = 0.1-0.6] for iron; 3.2 (95% CI = 1.3-8.1) for total iron binding capacity (TIBC), which measures the concentration of the iron delivery protein transferrin; and 0.4 (95% CI = 0.2-0.9) for transferrin saturation (iron/TIBC x 100). These associations were stronger in never smokers than in ever smokers. The risk associated with the iron storage protein ferritin was significantly elevated, but this association could reflect disease-related inflammation or comorbidity. The OR for GSH was 0.4 (95% CI = 0.1-0.9), and the OR for GSH reductase activity coefficient (indicative of riboflavin deficiency) was 1.6 (95% CI = 1.3-3.7). These findings suggest that mild iron deficiency and low GSH levels, which are associated with increased oxidative stress, increase the risk of oral cavity cancer.

Concomitant analysis of salivary tumor markers--a new diagnostic tool for oral cancer

PURPOSE

Oral squamous cell carcinoma (OSCC) is a common human malignancy. Circulatory epithelial tumor markers were previously investigated in the serum of OSCC patients but almost never in their saliva, in spite of the fact that there is a direct contact between the saliva and the oral cancer lesion. The purpose of the current study was to examine tumor markers in the saliva of OSCC patients.

EXPERIMENTAL DESIGN

We measured the concentrations of the six most studied epithelial serum circulatory tumor markers in the saliva of OSCC (tongue) patients.

RESULTS

Significant increases (of 400%) in salivary concentrations of Cyfra 21-1, tissue polypeptide antigen, and CA125 were shown. Salivary concentrations of CA19-9, SCC, and carcinoembryonic antigen were increased without statistical significance. A concurrent analysis of the three significantly increased markers revealed sensitivity, specificity, and negative and positive predictive values of 71%, 75%, 71%, and 75%, respectively.

CONCLUSIONS

The increase reported in salivary tumor markers may be used as a diagnostic tool, especially when a concurrent analysis for significantly increased markers is done. Salivary testing is noninvasive, making it an attractive, effective alternative to serum testing, and the possibility of developing home testing kits would further facilitate it as a diagnostic aid, enabling patients to monitor their own health at home and is important for those who live far from their treatment centers and especially for those at risk of developing OSCC.

Expression of oncofoetal marker carcinoembryonic antigen in oral cancers in South India--a pilot study

Expression of the oncofoetal glycoprotein, carcinoembryonic antigen (CEA), has been observed in a number of malignancies and is also being pursued as a target for anti-cancer therapy. This study explored the status of this biochemical entity in the oral squamous cell carcinoma (SCC) in South India caused by extensive chewing habits. Squamous cell carcinoma in the study belonged to grade I and grade II. Tumour staging of the patients recruited in the study ranged from T2N1M0 to T4N3M0. Of the grade II cases studied, 88% (7 out of 8) showed expression of CEA. The 2 cases of grade I SCC of buccal mucosa also showed positive anti-CEA staining. If the results from this pilot study can be validated with a larger sample size, a role can be attributed to this tumour marker in oral neoplasia, thereby opening up avenues for using CEA as an additional diagnostic marker in oral SCC in this population and as a possible target for anti-cancer therapy.

Effect of dendritic cell vaccine against a tongue squamous cell cancer cell line (Tca8113) in vivo and in vitro

Dendritic cells (DCs), as primary antigen-presenting cells with the capacity to activate naïve T lymphocytes, are considered to be promising adjuvants for immunity against cancer. In this study, the effect of T lymphocyte-mediated immunity induced by a DC vaccine against Tca8113 cells in vivo and in vitro was evaluated. DCs were from human peripheral blood monocytes cultured in the presence of granulocyte-macrophage colony stimulating factor, interleukin 4 and/or tumour necrosis factor alpha, and stimulated with Tca8113 cell lysate prepared by the freeze-thaw method. The autologous T cells activated by these DCs were used in an in vitro MTT assay to detect their tumouricidal activity and investigated for their anti-tumour effect in vivo by administration to nude mice with implanted tumours (Tca8113). An adequate number of DCs were successfully generated from the monocytes. The T cells activated by the DC-based vaccine killed Tca8113 cells in vitro (P<0.01), postponed tumour doubling time of the implanted tumours in nude mice (P<0.01) and inhibited the growth of the tumours (P<0.05). These results show that DCs from monocytes induce a lymphocyte-mediated immune response against tongue squamous carcinoma, and could be used as a vehicle for tumour antigens.

Follow-up of collagen crosslink excretion in patients with oral squamous cell carcinoma and analysis of tissue samples

The presence of an oral squamous cell carcinoma (OSCC) may be associated with increased urinary excretion of the markers of collagen degradation, hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP). We investigated the possibility of these markers predicting the presence of active disease. Patients from a current study on HP and LP were included as follows: Group 1a (OSCC with confirmed mandibular bony infiltration, n=12), group 1b (group 1a patients >6 months after successful treatment), group 2a (OSCC without evidence of mandibular bone infiltration, n=8), group 2b (group 2a patients >6 months after successful treatment), group 3a (recurrent OSCC, n=8), group 3b (group 3a patients >6 weeks later, symptoms unchanged) and group 4 (control group, n=74). Tissue samples from tumour tissue and adjacent healthy mucosa were additionally investigated for HP and LP concentrations (n=8). The decrease in the urinary concentrations of HP and LP was statistically significant between groups 1a and 1b (P<0.001 for HP and LP), but not between groups 2a and 2b (P=0.07 for HP and LP), while values in groups 1b and 2b were within the normal range. When comparing groups 3a and 3b, a significant increase was observed for LP (P=0.050), but not HP (P=0.208). In conclusion, successful treatment of OSCC with bony involvement may be associated with a reduction of urinary HP and LP, whereas ongoing disease may result in an increase of LP. HP and LP may both be useful markers of tumour progression in patients with OSCC.

Squamous cell carcinoma antigen, circulating immune complexes, and immunoglobulins in monitoring squamous cell carcinoma of head and neck: a study of the hellenic co-operative oncology group (HeCOG)

This study investigates the clinical utility of squamous cell carcinoma antigen (SCC-Ag), circulating immune complexes (CIC), and immunoglobulins (IgA, IgG, IgM) in the diagnosis, monitoring, and prognosis of 117 squamous cell carcinoma of the head and neck (SCC-HN) patients having local and/or systemic treatment. Serum marker levels were measured in a prospective study. SCC-Ag was positive in 28.2% of patients, the CIC in 63.2%, the IgA in 11.1%, the IgG in 15.4%, and the IgM in 9.44%. Statistically significant correlation was found between the initial SCC-Ag levels and tumor localization, whereas the CIC levels were increasing significantly with progressing disease stages. It was also found that the significant decrease of SCC-Ag, IgA, and CIC levels at the end of treatment was correlated with an increased incidence of disease-free status. The initial values of IgG and the disease stage were significantly correlated with a favorable treatment outcome. The pretreatment elevated SCC-Ag and IgM serum values showed a significant trend to predict a disease progression. Using a Cox proportional hazards model the IgG serum values, the primary site, and the disease stage were significant predictors for time to progression. The significant decrease of SCC-Ag, IgA, and CIC values at the completion of treatment was correlated with an increased incidence of disease-free status. This study indicates that only the estimation of SCC-Ag and in some degree the IgM and/or IgG is a potential tool for monitoring the efficacy of treatment or disease recurrence in SCC-HN.

Intraoperative and postoperative kinetics of serum tumor markers in patients with oral carcinoma

PURPOSE

There are no reliable laboratory procedures to monitor intraoperative tumor antigen dispersal in patients with squamous cell carcinoma of the head and neck. This study evaluated the use of serologic parameters as perioperative indicators of systemic manifestations.

PATIENTS AND METHODS

In 28 patients, serial measurements of different tumor markers (squamous cell carcinoma antigen, carcinoembryonic antigen, carbohydrate antigen 19.9, carcinoma antigen 125) were made preoperatively, intraoperatively, and postoperatively at short intervals to determine the influence of tumor ablation on the antigen concentration in the serum. A microparticle enzyme immunoassay was used for the serologic analysis.

RESULTS

Squamous cell carcinoma antigen showed elevated serum levels preoperatively, which increased intraoperatively and decreased significantly postoperatively. The serologic examinations in the control group and the other tumor markers showed no correlation with the clinical situation.

CONCLUSIONS

The results suggest that the titer of squamous cell carcinoma antigen in serum has a positive correlation with the tumor burden and the operative trauma in the case of surgery. These results support the value of intraoperative and postoperative serum antigen monitoring.

Maspin is an intracellular serpin that partitions into secretory vesicles and is present at the cell surface

The tumor suppressor maspin (mammary serpin) was originally identified as a component of human mammary epithelial cells that is downregulated as mammary tumor cells progress from the benign to the invasive and metastatic states. Maspin inhibits cellular invasion, motility, and proliferation, but its mechanism of action is currently unknown. Because the cellular machinery responsible for these processes is cytoplasmic, we have reexamined the tissue distribution and subcellular localization of maspin. We find that maspin, or a maspin-like protein, is present in many human organs, in which it localizes to epithelia. In cultured human mammary myoepithelial cells, maspin is predominantly a soluble cytoplasmic protein that associates with secretory vesicles and is present at the cell surface. In vitro assays show that the vesicle association is due to the existence of an uncleaved facultative secretion signal that allows small amounts of maspin to partition into the endoplasmic reticulum. These results demonstrate that maspin is more widespread than previously believed. The subcellular localization studies indicate that soluble intracellular and vesicle-associated maspin probably play an important role in controlling the invasion, motility, and proliferation of cells expressing it, whereas extracellular maspin may also regulate these processes in adjacent cells.

Combination assay for tumor markers in oral squamous cell carcinoma

PURPOSE

This study evaluated use of a combination assay of tumor markers in the diagnosis of oral squamous cell carcinoma.

PATIENTS AND METHODS

Serum levels of four tumor markers (carcinoembryonic antigen [CEA], squamous cell carcinoma antigen [SCCA], immunosuppressive acidic protein [IAP], and cytokeratin 19 fragment [Cyfra]) were simultaneously measured in 42 patients with oral squamous cell carcinoma (O-SCC) and in 12 patients with oral benign diseases.

RESULTS

The positive rates were 31.0% for CEA, 38.1% for SCCA, 52.4% for IAP, and 38.1% for Cyfra in patients with O-SCC. These rates were significantly different (P < .01) from those of control patients with oral benign diseases. The sensitivity (81.0%) and accuracy (77.8%) of the combination assay uses higher than that obtained with individual markers.

CONCLUSION

A combination assay with CEA, SCCA, IAP, and Cyfra may be useful for the screening of patients with suspected oral squamous cell carcinoma.

A serpin from human tumor cells with direct lymphoid immunomodulatory activity: mitogenic stimulation of human tumor-infiltrating lymphocytes

A serum-free supernatant from an epidermal carcinoma cell line has previously been shown to contain mitogenic activity for human tumor infiltrating lymphocytes in culture [1]. From this conditioned medium we have now purified to homogeneity, as determined by SDS-PAGE analysis, a ca. 45 kDa protein which stimulates [3H]thymidine incorporation into the DNA of these human T-lymphocytes. Amino acid composition data and immunoreactivity of the purified protein as well as sequence analyses of 7 tryptic fragments obtained therefrom suggest a strong similarity with human monocyte/neutrophil elastase inhibitor, which is a member of the serine protease inhibitor (serpin) superfamily. We have previously identified and purified from the same conditioned medium a 36 kDa protein with myeloid immunomodulatory activity [2]. Taken together, these two reports support the role of tumor-derived soluble factors in tumor immunosurveillance.