原文題目(出處)： C-reactive protein levels: a prognostic marker for patients with head and neck cancer ? Head & Neck Oncology 2010;2:21
原文作者姓名： Kruse AL, Luebbers H, Grätz KW
通訊作者學校： Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich, Zurich, Switzerland
報告者姓名： R2 吳欣倩
報告日期： 99/11/26
內文：
Introduction
C-reactive protein (CRP)
Acute-phase protein
Marker for inflammation
Synthesis in the hepatocytes
May be regulated by pro-inflammatory cytokines which are also influencing factors in various types of tumors
Interleukin-1
Interleukin-6
Tumor-necrosis factor
Disease progression depends on
Tumor stage
Host’s inflammatory response
In 1863, Rudolf Virchow postulated the induction hypothesis
Cancer originated at site of chronic inflammation
Human immunodeficiency virus
Viral hepatitis B
Human papilloma virus
Long-term use of aspirin and other nonsteroidal anti-inflammatory drugs reduced risk for colorectal cancer
Chronic inflammation is associated with the increased risk of cancer
Increased CRP levels associated with cancer
Two hypotheses:
Induction hypothesis: chronic inflammation results in excessive cell proliferation and activation of a cascade of cellular actions, leading to induction of irreversible DNA damage
Response hypothesis: the immune response of the host as a consequence of tumor growth itself could be the reason for the elevation in CRP levels
Findings from the studies have been inconsistent:
Elevated serum CRP levels are associated with colorectal and lung cancer
Doubt that CRP can be regarded as a prognostic marker
In patients with combined esophageal cancer and squamous cell carcinoma
Raised CRP concentrations have been regarded as an indicator of a poorer prognosis for squamous cell carcinoma
However, it is still unclear whether an elevated CRP level is a risk factor for the development of cancer or CRP levels are elevated before the biological onset of cancer
Only a very few studies have dealt with association between oral SCC and preoperative CRP levels (Table 1).
All of these data are consistent with the hypothesis that CRP levels increase after onset of oral cancer.
Aim of the current study: investigate the significance of preoperative CRP levels as a parameter for development of lymph node metastases or recurrence.
Materials and methods
278 patients with oral SCC (119 female,159 male)
Treated at a single center (Department of Craniomaxillofacial and Oral Surgery, University Hospital Zurich) between 1999 and 2008.
Minimum follow-up time:12 months
Exclusion criteria: inadequate information, less than 12 months of follow-up time
Serum CRP levels were obtained between 1 and 5 days prior to surgical treatment.
According to the preoperative measure of CRP concentration, divided into two groups:
Normal CRP values: ≦ 5.0 mg/L
Elevated CRP levels: > 5.0 mg/L
P < 0.05 was considered to be statistically significant
Kaplan-Meier analysis with log-rank testing was used for univariate analysis.
Results
Mean CRP: 7.36 mg/L
193 patients (69.4%): CRP level ≦ 5 mg/L
85 patients (30.6%): CRP level > 5 mg/L
The distribution was independent of age
Local recurrence
48 patients (17.3%): local recurrence, mean time of 24.31 months (range: 7-84 months)
24 patients (8.6%): 2cd tumors
206 patients (74.1%): no recurrence
Lymph node metastases
46 patients (16.5%): cervical lymph node metastases, mean time of 18.27 months (range:
4-71 months)
14 patients (5%): distant metastases
218 patients (78.5%): no metastases
In the elevated CRP group:
Recurrence appeared earlier (Fig. 2)
No differences in the time of metastases (Fig. 3)
> 5 mg/L
> 5 mg/L ≦5 mg/L
≦5 mg/L
Lymph node metastases:
Normal CRP group: 37 patients /193
Elevated CRP group: 9 patients /85
No significant correlation was found for development of metastasis (p = 0.468)
Local recurrence:
Normal CRP group: 27 patients /193
Elevated CRP group: 21 patients /85
No significant correlation was found for development of recurrence (p = 0.137)
≦5 mg/L ≦5 mg/L
> 5 mg/L
> 5 mg/L
Discussion
The purpose of our study was to find a simple and cost effective indicator for oral SCC.
Mean follow-up time: 35.97 months (range: 12-107 months)
Elevated CRP levels:
The proportion of lymph node metastasis was smaller
No significant association with development of recurrence or metastases
This study does not confirm the results from other studies (Table 1) and disagree with Zingg U et al.
In patients who have undergone neoadjuvant treatment for esophageal cancer
Suggested CRP-measurements in the re-staging process before surgery
Select patients who are likely to benefit from surgery
There seems to be inconsistency concerning the CRP levels:
Khandavilli et al., Komai et al. : > 5 mg/L (raised CRP levels)
Other authors : < 1.0 mg/L (low), 1.0 - 3.0 mg/L (average), > 3.0 mg/L (high)
In our study : > 5 mg/L (raised CRP levels)
(> 50 mg/L seen in infectious disease in 6 patients)
CRP levels can be reduced with weight loss and smoking cessation
For esophageal cancer, a correlation has been shown between
Malnutrition with impaired immunity
Elevated serum CRP concentration
Smoking and alcohol abuse can lead to chronic inflammation in the oral mucosa
Investigate CRP levels in precancerous lesions (ex: erosive lichen)
Ki et al.
40 patients with primary laryngo-pharyngeal cancer
During radiotherapy
Significant correlation between the presence of radiation-induced mucositis and CRP level
In our study
Advantages: high number of patients
Limitations:
CRP was measured at one point in time, therefore intra-individual variations were not considered
General diseases associated with possible higher inflammation markers like diabetes mellitus or Morbus Crohn were not taken into consideration
Conclusion
Our findings do not appear to support a positive association between preoperative CRP levels and oral SCC.
Further studies should examine CRP levels in precancerous lesions and in HPV positive patients with oral SCC.
CRP is a nonspecific marker of inflammation, and additional studies of specific cytokines that regulate acute-phase response are necessary to elucidate the mechanisms by which inflammation influences the risk of cancer.
題號 題目
1 下列何者關於erosive lichen planus的敘述錯誤?
(A) Confined to the gingival mucosa, producing the desquamative gingivitis (B) Periphery of the atrophic region is usually bordered by white radiating
striae
(C) Usually symptomatic
(D) More common than the reticular type
答案(D) 出處：Oral and Maxillofacial PATHOLOGY, second edition, P680-681
題號 題目
2 下列何者不是可能引起SCC的因素之一?
(A) Iron deficiency (B) Syphilis
(C) Vitamin B deficiency (D) Phenols
答案(C) 出處：Oral and Maxillofacial PATHOLOGY, second edition, P358
