Risk Stratification System for Oral Cancer Screening
Menée sur 150 patients atteints d'un cancer oropharyngé ou d'un cancer de la cavité buccale et sur 150 témoins, cette étude évalue l'association entre les niveaux des protéines CD44 ou des protéines totales dans les rinçages buccaux et le risque de cancer de la gorge ou de la bouche
Oral cavity and oropharyngeal cancer (oral cancer) is a deadly disease that is increasing in incidence. Worldwide 5year 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 tumorinitiating marker, and total protein levels may facilitate oral cancer risk assessment and early intervention. This study used a hospitalbased design with 150 cases and 150 frequencymatched 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). Highrisk 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 {greater than or equal to}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. -
Cancer Prevention Research , résumé, 2016