medwireNews: Post-treatment evaluation of salivary biomarkers could be useful for monitoring recurrence in people with oral cavity or oropharyngeal cancer, indicate findings.
As reported in JAMA Otolaryngology Head & Neck Surgery by Elizabeth Franzmann (University of Miami Health System and Jackson Memorial Hospital, Florida, USA) and associates, elevated levels of soluble CD44 and total protein as detected by a laboratory test were significantly associated with a higher relapse risk.
The researchers previously demonstrated that “soluble CD44, a tumor-initiation factor, and total protein were useful in identifying [oral and oropharyngeal squamous cell carcinoma] at all stages,” and therefore sought to evaluate whether the biomarkers could also predict recurrence.
The nonrandomized clinical trial included 172 patients (mean age 62.5 years; 70.9% men) with previously untreated nonmetastatic oral or oropharyngeal squamous cell carcinoma who were due to undergo treatment with curative intent. They provided oral rinse samples prior to initiating treatment and at 3, 6, 12, and 18 months after completing treatment.
During a median follow-up of 36.7 months, recurrence occurred in 22.9% of the 157 participants with complete disease and treatment records.
Using Cox regression models that incorporated the CD44 or total protein level as a time-varying covariate, higher CD44 levels were significantly associated with an increased risk for recurrence (hazard ratio [HR]=1.06), although this was not the case for total protein levels.
However, in multivariate analysis adjusting for study site, sex, race, smoking status, alcohol use, primary therapy, and cancer site, increased levels of both CD44 and total protein correlated significantly with a higher likelihood of recurrence, with HRs of 1.13 and 3.51, respectively.
“In terms of clinical use, a determination of elevated CD44 levels may trigger earlier diagnostic interventions such as magnetic resonance imaging or positron emission tomography, biopsies, or more frequent examinations to identify recurrence earlier and improve outcomes,” write the study authors.
They continue: “An area for future research is whether xerostomia and overall damage to mucosa from radiation may change salivary CD44 and [total protein] production counts.”
Franzmann and colleagues also evaluated a “rapid, low-cost, easy-to-use” point-of-care test for both biomarkers based on at least a 3-cc aliquot of salivary rinse, and although it “holds promise,” they believe “further development is needed for it to be useful as a monitoring or prognostic tool” in this patient population.
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JAMA Otolaryngol Head Neck Surg 2024; doi:10.1001/jamaoto.2024.2490