Serum ferritin as a tumor marker in patients with squamous cell carcinoma of the head and neck

Iron Overload in Children with Acute Lymphoblastic and Acute Myeloblastic Leukemia-Experience of One Center

Transfusions of packed red blood cells (PRBCs), given due to an oncological disease and its acute complications, are an indispensable part of anticancer therapy. However, they can lead to post-transfusion iron overload. The study aim was to evaluate the role of ferritin as a nonspecific marker of leukemic growth and marker of transfusion-related iron overload. We performed a longitudinal study of PRBC transfusions and changes in ferritin concentrations during the oncological treatment of 135 patients with childhood acute lymphoblastic and acute myeloblastic leukemia (ALL and AML, median age 5.62 years). At the diagnosis, 41% of patients had a ferritin level over 500 ng/mL, and 14% of patients had a ferritin level over 1000 ng/mL. At the cessation of the treatment, 80% of the children had serum ferritin (SF) over 500 ng/mL, and 31% had SF over 1000 ng/mL. There was no significant difference between SF at the beginning of the treatment between ALL and AML patients, but children with AML finished treatment with statistically higher SF. AML patients had also statistically higher number of transfusions. We found statistically significant positive correlations between ferritin and age, and weight and units of transfused blood. Serum ferritin at the moment of diagnosis can be a useful marker of leukemic growth, but high levels of SF are connected with iron overload in both AML and ALL.

FTH1 indicates poor prognosis and promotes metastasis in head and neck squamous cell carcinoma

Background

Currently, ferritin heavy chain (FTH1) has been increasingly found to play a crucial role in cancer as a core regulator of ferroptosis, while its role of non-ferroptosis in head and neck squamous cell carcinoma (HNSCC) is still unclear.

Methods

Herein, we analyzed the expression level of FTH1 in HNSCC using TCGA database, and FTH1 protein in HNSCC tissues and cell lines was determined by immunohistochemistry (IHC) and western blotting, respectively. Then, its prognostic value and relationship with clinical parameters were investigated in HNSCC patients. Additionally, the biological function of FTH1 in HNSCC was explored.

Results

The current study showed that FTH1 is significantly overexpressed in HNSCC tissues and related to poor prognosis and lymph node metastasis of HNSCC. FTH1 knockdown could suppress the metastasis and epithelial-mesenchymal transition (EMT) process of HNSCC.

Conclusion

Our findings indicate that FTH1 plays a critical role in the progression and metastasis of HNSCC and can serve as a promising prognostic factor and therapeutic target in HNSCC.

Preliminary Evaluation Salivary Biomarkers in Patients with Oral Potentially Malignant Disorders (OPMD): A Case-Control Study

INTRODUCTION

Oral potentially malignant disorders (OPMD) are lesions associated with an increased risk of transformation (MT) into cancer.

OBJECTIVE

A study was made of the salivary levels of adenosine deaminase (ADA), ferritin (FRR) and total proteins (TP) in healthy individuals and in patients with oral potentially malignant disorders (OPMD), assessing the potential role of saliva as a diagnostic tool.

METHODS

A total of 91 subjects participated in the study, divided into two groups-59 patients with OPMD (oral leukoplakia or oral lichen planus) and 32 healthy controls-with measurements being made of salivary ADA, ferritin (FRR) and total proteins (TP).

RESULTS

There were no significant differences in salivary mean ADA between the OPMD group 0.85 ± 2.18 UI/I and the controls 0.71 ± 1.72 UI/I (p = 0.934), though the levels of both FRR mean OPMD, 12.66 ± 10.50 (µg/L), versus control, 7.19 ± 4.44 (p = 0.001), and TP, 23.41 ± 17, versus control, 14.15 ± 15.19, were significantly higher in the OPMD group (p = 0.001). Patients with oral lichen planus showed significant differences in terms of FRR (p = 0.009) and TP (p = 0.003). The ferritin in LPO with a cut-off point of 8.5C showed a sensitivity and specificity of 54.3% and 82.3, respectively. The area under the curve (AUC) was 0.69 (95% confidence interval (95% CI): 0.58-0.82; p = 0.003).

CONCLUSIONS

Ferritin and total proteins may constitute potential salivary biomarkers for oral lichen planus, though further studies are still needed in this field. In addition, saliva testing is a reliable and noninvasive diagnostic tool and appears to be a reliable strategy offering an interesting alternative for the screening of large populations.

The Addition of Ferritin Enhanced the Prognostic Value of International Prognostic Index in Diffuse Large B‐Cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) is a highly heterogeneous non-Hodgkin lymphoma, and the prognosis of DLBCL patients is widely affected by multivariables. Clinical-factors-based prognostic systems stratify the prognosis of DLBCL with certain limitations, and the value of ferritin on the prognosis of DLBCL is unclear. In this study, 225 cases were retrieved from 4 centers of Huaihai Lymphoma Working Group (HHLWG) as the derivation cohort, and 66 cases were from the other 6 centers of HHLWG as external validation cohort. X-Tile program divided ferritin into three groups when applying 175.00 and 391.90 μg/L as the optimal cutoff points. Based on multivariable analysis, ferritin appeared to be a stronger predictor. A total of three variables (ferritin, age, and lactate dehydrogenase) were included for the development of the nomogram. The C-indexes were 0.73 and 0.70 in the derivation and validation cohort, and the calibration curve showed the consistency between the nomogram prediction and the actual observation. In conclusion, Ferritin-based nomogram enhanced the prognostic value of IPI in DLBCL.

Are Serum Ferritin Levels a Reliable Cancer Biomarker? A Systematic Review and Meta-Analysis

Although serum ferritin (SF) has been shown in several studies to be a potential cancer biomarker, the results are inconsistent. Herein, a systematic review was performed to investigate the clinical SF levels in different types of tumors in order to verify the role of SF levels as a biomarker for cancer diagnosis. The search was performed using the PubMed/Medline, Cochrane Library, and Scopus databases. Observational studies comparing SF levels between healthy adults and patients with cancer were included. The meta-analysis was carried out according to the inverse variance and random effects model. The standardized mean differences (SMDs) were assessed at 95% confidence intervals (CIs). We found that SF was higher in patients with cancer (SMD 3.07; CI 1.96,4.17), especially for head and neck cancer (SMD 3.88; CI 0.42,7.34), lung cancer (SMD 1.72; CI 0.67,2.78), pancreatic cancer (SMD 6.79; CI 5.66,7.91), and renal cell carcinoma (SMD 1.77; CI 0.48,3.05). Moreover, in the advanced stages (Stages III and IV), ferritin levels were higher than in healthy adults (SMD 4.89; CI 2.72,7.06, and SMD 8.40; CI 6.99,9.82, respectively). SF acts as a biomarker for pancreatic cancer, renal cell carcinoma, lung cancer, and head and neck cancer and is a sensitive biomarker for the detection of advanced stages of tumors.

Significance of Ferritin as a Marker in Head and Neck Malignancies

The efficiency of the combination of two tumor-associated antigens in recognising head and neck cancer was evaluated. The markers studied were CEA and ferritin by radioimmunoassay. CEA was estimated in 22 controls and 41 head and neck cancer patients. There was no difference in CEA values of controls and head and neck cancer patients, suggesting that CEA was not specific for head and neck malignancies. We measured serum ferritin in 27 controls and 58 patients with head and neck cancer. The mean ferritin level was significantly higher in patients (P < 0.001) than in normal subjects. The ferritin level in patients with no evidence of clinical disease 8 months after treatment showed approximately normal levels, whereas the levels showed a tendency to increase or remain at high levels in patients with a poor prognosis, giving support to the contention that ferritin may prove to be a valuable adjunct in head and neck cancer.

Detection of Five Circulating Antigens in Patients with Head and Neck Squamous Cell Carcinoma

Five tumor markers (CEA, Ferritin, CA-50, TPA and SCC) were assayed in 54 patients with ear, nose and throat (ENT) cancers in early and advanced stages. The specificity of these markers always exceeded 95%. Their sensitivity ranged from 13 to 43%, and reached 72% as a combination of all five markers.

No distinction was found between early and advanced stage of illness. These markers seem to have no distinct function in ENT oncological diagnosis and follow-up because objective data is easily available even in early tumors.

Use of Tumor Markers in the Management of Head and Neck Cancer

Serologic tumor markers have been evaluated in the diagnosis, management and follow-up of patients with head and neck cancer. However, to the authors’ knowledge no tumor marker has yet been shown to be useful for monitoring the response to chemotherapy in this type of disease, in particular for undifferentiated tumors. The pretreatment levels of CEA, TPA, SCC and ferritin were evaluated in 98 patients with advanced head and neck cancer. Of this group 64 patients were studied sequentially every month during planned chemotherapy and three weeks after treatment using standard commercial kits. The results showed the following sensitivity values: TPA 50%, CEA 36%, SCC 34% and ferritin 19%. The incidence and magnitude of the marker elevations were correlated with the extent of disease. In patients with squamous cell cancer SCC and CEA were elevated (by 68% and 54%, respectively) in tumors with good differentiation (G1), but only by 13% (both markers) in tumors classified as poorly differentiated (G3). CEA, SCC and ferritin serum levels were not correlated with response to chemotherapy, while TPA values correlated with the clinical response to treatment in 100% of patients with undifferentiated cancer and in 75% of those with squamous cell cancer. Our data indicate that in patients with head and neck cancer TPA appears to be a sensitive marker, followed in decreasing order of sensitivity by CEA, SCC and ferritin. However, SCC and CEA seem to be the most suitable markers for squamous cell cancer and in particular for more differentiated tumors (G1). Finally, TPA has proved to be a useful marker for monitoring the response to chemotherapy in patients with head and neck cancer, in particular for undifferentiated tumors.

Serum ferritin level is a prognostic marker in patients with peripheral T-cell lymphoma

INTRODUCTION

The prognostic value of serum ferritin level in patients with peripheral T-cell lymphoma (PTCL) remains unknown.

METHODS

We retrospectively analyzed clinical data from 78 consecutive patients with newly diagnosed PTCL that were treated with anthracycline-containing regimens between 1998 and 2011.

RESULTS

The patients consisted of 50 males and 28 females with a median age of 64 years (range, 16-83 years). The subtypes of PTCL were 39 PTCL, not otherwise specified and 39 angioimmunoblastic T-cell lymphoma (AITL). The median observation period for the surviving patients was 50 months. The overall survival (OS) was poorer in patients with serum ferritin level above the upper normal limit (n = 28), compared with patients with serum ferritin level within normal range (n = 50; 4-year OS: 23% vs. 72%; P < 0.001). In the multivariate analysis, poor performance status (P = 0.006) and elevated serum ferritin level (P = 0.018) were independent risk factors for poor OS.

CONCLUSION

Serum ferritin level is a useful prognostic marker for PTCL.

Acrokeratosis Paraneoplastica (Bazex Syndrome) Presenting in a Patient with Metastatic Breast Carcinoma: Possible Etiologic Role of Zinc

Background:

Bazex syndrome (acrokeratosis paraneoplastica) is a rare paraneoplastic syndrome that usually occurs in males over 40 years old and is particularly associated with squamous cell carcinoma of the upper aerodigestive tract and adenopathy above the diaphragm.

Objective:

The objectives of our article are (1) to describe a unique case of acrokeratosis paraneoplastica and (2) to review the current literature regarding skin findings, commonly associated neoplasms, and treatment options relative to this condition.

Patient:

We describe a 68-year-old female with lobular breast carcinoma, complicated by local and distant recurrences, who presented with a 1-year history of prominent acral skin and nail changes.

Results:

Our patient's clinical skin findings improved significantly following treatment and partial remission of her underlying malignancy.

Conclusions:

Our patient represents one of few females described with this syndrome, which is especially rare in association with lobular breast carcinoma. Further, the patient's presentation is unique as she was discovered to demonstrate laboratory findings consistent with coexistent porphyria cutanea tarda and relative zinc deficiency.

The prognostic significance of elevated levels of serum ferritin before chemotherapy in patients with non-Hodgkin lymphoma

BACKGROUND

Elevated levels of serum ferritin have been documented to be an adverse prognostic factor in patients with hematologic malignancies undergoing hematopoietic stem cell transplantation. The purpose of this study was to estimate the correlation between elevated levels of serum ferritin and survival outcomes in patients with non-Hodgkin lymphoma (NHL).

PATIENTS AND METHODS

A total of 267 patients who were newly diagnosed with NHL and who received chemotherapy between September 1999 and April 2012 were retrospectively analyzed.

RESULTS

In multivariate analysis, other chemotherapy regimens excluding CHOP-like chemotherapy regimens (cyclophosphamide, adriamycin, vincristine, prednisolone) and RCHOP (rituximab plus CHOP), a high level of β2-microglobulin, a high-intermediate/high risk according to the international prognostic index (IPI), and elevated levels of serum ferritin were all significant independent prognostic factors for 5-year progression-free survival rates. RCHOP and other chemotherapy regimens, a high level of β2-microglobulin, a high-intermediate/high IPI risk, and high levels of serum ferritin were significant independent prognostic factors for 5-year overall survival rates.

CONCLUSION

Elevated levels of serum ferritin of 500 ng/mL or more as well as the use of chemotherapy regimens besides CHOP-like or RCHOP, a high-intermediate/high risk IPI, and a high level of beta2-microglobulin in NHL may be an important marker for predicting poor survival outcomes.

The significance of ferritin in cancer: anti-oxidation, inflammation and tumorigenesis

The iron storage protein ferritin has been continuously studied for over 70years and its function as the primary iron storage protein in cells is well established. Although the intracellular functions of ferritin are for the most part well-characterized, the significance of serum (extracellular) ferritin in human biology is poorly understood. Recently, several lines of evidence have demonstrated that ferritin is a multi-functional protein with possible roles in proliferation, angiogenesis, immunosuppression, and iron delivery. In the context of cancer, ferritin is detected at higher levels in the sera of many cancer patients, and the higher levels correlate with aggressive disease and poor clinical outcome. Furthermore, ferritin is highly expressed in tumor-associated macrophages which have been recently recognized as having critical roles in tumor progression and therapy resistance. These characteristics suggest ferritin could be an attractive target for cancer therapy because its down-regulation could disrupt the supportive tumor microenvironment, kill cancer cells, and increase sensitivity to chemotherapy. In this review, we provide an overview of the current knowledge on the function and regulation of ferritin. Moreover, we examine the literature on ferritin's contributions to tumor progression and therapy resistance, in addition to its therapeutic potential.

Proteins with altered levels in plasma from glioblastoma patients as revealed by iTRAQ-based quantitative proteomic analysis

Glioblastomas (GBMs) are the most common and lethal primary tumors of the central nervous system with high level of recurrence despite aggressive therapy. Tumor-associated proteins/peptides may appear in the plasma of these patients as a result of disruption of the blood-brain barrier in them, raising the scope for development of plasma-based tests for diagnosis and monitoring the disease. With this objective, we analyzed the levels of proteins present in the plasma from GBM patients using an iTRAQ based LC-MS/MS approach. Analysis with pooled plasma specimens from the patient and healthy control samples revealed high confidence identification of 296 proteins, of which 61 exhibited a fold-change ≥1.5 in the patient group. Forty-eight of them contained signal sequence. A majority have been reported in the differentially expressed transcript or protein profile of GBM tissues; 6 have been previously studied as plasma biomarkers for GBM and 16 for other types of cancers. Altered levels of three representative proteins–ferritin light chain (FTL), S100A9, and carnosinase 1 (CNDP1)–were verified by ELISA in a test set of ten individual plasma specimens. FTL is an inflammation marker also implicated in cancer, S100A9 is an important member of the Ca²⁺ signaling cascade reported to be altered in GBM tissue, and CNDP1 has been reported for its role in the regulation of the levels of carnosine, implicated as a potential drug for GBM. These and other proteins in the dataset may form useful starting points for further clinical investigations for the development of plasma-based biomarker panels for GBM.

Ferritin and ferritin isoforms II: protection against uncontrolled cellular proliferation, oxidative damage and inflammatory processes

Ferritin is a major iron storage protein involved in the regulation of iron availability. Each ferritin molecule comprises 24 subunits. Various combinations of H-subunits and L-subunits make up the 24-subunit protein structure and these ferritin isoforms differ in their H-subunit to L-subunit ratio, as well as in their metabolic properties. Ferritin is an acute-phase protein and its expression is up-regulated in conditions such as uncontrolled cellular proliferation, in any condition marked by excessive production of toxic oxygen radicals, and by infectious and inflammatory processes. Under such conditions ferritin up-regulation is predominantly stimulated by increased reactive oxygen radical production and by cytokines. The major function of ferritin in these conditions is to reduce the bio-availability of iron in order to stem uncontrolled cellular proliferation and excessive production of reactive oxygen radicals. Ferritin is not, however, indiscriminately up-regulated in these conditions as a marked shift towards a predominance in H-subunit rich ferritins occurs. Preliminary indications are that, while the L-subunit primarily fulfils the conventional iron storage role, the H-subunit functions primarily as rapid regulator of iron availability, and perhaps indirectly as regulator of other cellular processes. It is suggested that the optimum differential expression of the two subunits differ for different cells and under different conditions and that the expression of appropriate isoferritins offers protection against uncontrolled cellular proliferation, oxidative stress and against side effects of infectious and inflammatory conditions.

Soluble Tie-2 receptor levels independently predict locoregional recurrence in head and neck squamous cell carcinoma

BACKGROUND

This study assessed two circulating angiogenic receptors as tumor markers in patients with head and neck squamous cell carcinoma (HNSCC): soluble vascular endothelial factor growth receptor-1 (sVEGFR1) and soluble Tie-2 receptor (sTie2R).

METHODS

Sera from 79 newly presenting patients with HNSCC and from 22 controls were assayed using sandwich ELISA. Median follow-up was 35 months after curative treatment. Analysis was carried out to compare levels between HNSCC patients and controls and to ascertain relationships with clinicopathologic and outcome variables.

RESULTS

Soluble VEGFR1 was not elevated in the HNSCC group and was not related to any of the clinicopathologic or outcome variables. Soluble Tie2R was also not elevated in HNSCC patients or related to the clinicopathologic variables but was associated with locoregional recurrence (p =.009). Raised sTie2R (>64 ng/mL) independently predicted recurrence (p =.007) with a relative risk of 3.0 (95% CI, 1.7-5.0).

CONCLUSIONS

Soluble Tie2R is an independent predictor of locoregional recurrence in HNSCC.

Circulating angiogenic cytokines as tumour markers and prognostic factors in head and neck squamous cell carcinoma

This pilot study investigated the potential use of three circulating angiogenesis-related cytokines, basic fibroblast growth factor (bFGF), angiogenin (ANG) and endostatin, as tumour markers and prognostic factors in patients with head and neck squamous cell carcinoma (HNSCC). A total of 30 patients with HNSCC treated with curative intent and 15 healthy controls were studied. Serum (bFGF and ANG) and plasma (endostatin) was assayed by enzyme-linked immunoabsorbance assay (ELISA). None of the cytokines was raised in HNSCC patients when compared with controls. Serum bFGF was not associated with any clinico-pathological or outcome parameters, although there was a trend towards higher levels in more advanced and aggressive tumours. Lower serum angiogenin (sANG) levels were associated with loco-regional disease recurrence (P = 0.036). Using a cut-off level of 400 pg/mL, a low level of sANG predicted tumour recurrence with a relative risk of 4.0 (95% CI: 0.7-24.0). Plasma endostatin was associated with higher histological grade (P = 0.01) and with both disease recurrence (P = 0.045) and death from disease (P = 0.021). Plasma endostatin above a cut-off point of 70 ng/mL could predict tumour recurrence with a relative risk of 4.7 (95% CI: 1.1-19.7). These data suggest that plasma endostatin and sANG have potential roles as prognostic factors and require further investigation.

Conventional tumor markers are prognostic indicators in patients with head and neck squamous cell carcinoma

We tested for squamous cell carcinoma-related antigen (SCC), carcinoembryonic antigen (CEA), ferritin, immunosuppressive acid protein (IAP) and sialic acid in the serum from 247 patients with head and neck squamous cell carcinoma prior to therapy. Significant correlations were found between IAP and tumor size, lymph node metastasis, and clinical stage (P<0.0001, P<0.001, and P<0.0001). Also, sialic acid and SCC were also correlated with tumor size, lymph node metastasis, and clinical stage. Moreover IAP, sialic acid and SCC were strongly associated with survival rate (P<0.0001, P = 0.0230 and P = 0.0159). A multivariate Cox proportional hazard model demonstrated that being positive for IAP was an independent predictor for patients with H&NSCC (P = 0.0115). The results indicate that IAP, sialic acid and SCC are useful as prognostic factors.

Development of an automated immunoturbidimetric ferritin assay

We have developed a new procedure for turbidimetric measurement of ferritin concentration in human serum, based on latex microparticle agglutination technology. The procedure has been automated using the Falcor 300 analyzer. Carboxilated latex particles (336 nm in diameter) were covalently coupled with immunopurified F(ab')2 fragments of anti-ferritin IgG antibodies. Coated microparticles were automatically mixed with undiluted sample and the resulting absorbance due to agglutination was measured at 550 nm. The procedure generated a calibration curve with a measuring range of 0 to 558 microg/l, showing a day-to-day imprecision lower than 5.7%. The detection limit was 4 microg/l. There were no interferences from bilirubin, hemoglobin or rheumatoid factors. Turbid and lipemic samples caused an important interference which could be avoided by pretreating those samples prior to measurement. A prozone effect was provisionally obtained with ferritin concentrations over 1800 microg/l. The results suggested a hook-like effect due to a rapid microparticle precipitation in the reaction media, that could be avoided by increasing the reaction medium density by adding sucrose to the buffer, up to 150 g/l concentration. This sucrose addition resulted in a displacement of the Heidelberger curve with a prozone phenomenon occuring at concentration higher than 3000 microg/l of ferritin. Results obtained with the present procedure correlated well with those obtained by a nephelometric procedure and with those obtained by an RIA. We conclude that this latex turbidimetric immunochemical procedure is simple, rapid, has a good analytical and operational performance on the Falcor 300 analyzer and is well suited for the measurement of ferritin concentration in human serum.

Serum vascular endothelial growth factor in patients with head and neck squamous cell carcinoma

Vascular endothelial growth factor (VEGF) is a key pro-angiogenic cytokine expressed by most human tumours. Two isoforms, VEGF121 and VEGF165, are soluble and can be assayed in serum. Serum VEGF has been shown to be significantly raised in patients with solid tumours and shows some promise as a potentially useful tumour marker. Serum levels of VEGF were assayed in 52 patients with untreated head and neck squamous cell carcinoma (HNSCC) and 104 healthy controls. Serum VEGF is significantly raised in patients with HNSCC (P < 0.001), but there was no association with either tumour stage or specifically the presence of nodal metastases. Sixteen patients (31%) had a higher serum VEGF than 95th centile of controls, suggesting that serum VEGF measurement is of little practical use as an initial diagnostic tool. The finding that patients with HNSCC have significantly raised serum VEGF probably relates to enhanced platelet aggregation in these patients.

Strong association between hyperferritinaemia and metastatic disease in nasopharyngeal carcinoma

We have investigated the role of serum ferritin, in relation to disease stages, in patients with nasopharyngeal carcinoma. Patients with localised disease (Ho's stage I-IV) had levels which were not significantly different from age, sex matched normal subjects and there was no relationship between mean serum ferritin levels and stage. However, in patients with metastatic disease levels were grossly elevated with mean levels increased more than 6-fold compared to normal subjects and patients with localised disease. Furthermore, among the small group of patients with localised disease but hyperferritinaemia, the subsequent development of metastatic disease within 1 year was significantly much higher (32.4%) than in those with levels falling within the reference range (10.3%). Hyperferritinaemia is strongly associated with, and may predict, metastatic disease in patients with nasopharyngeal carcinoma.

Adenoma-carcinoma sequence: a reappraisal with immunohistochemical expression of ferritin

To examine the biological significance of ferritin (FRN) expression, a retrospective immunohistochemical study was performed in normal colonic mucosae (n = 8), adenomas (n = 88), and colorectal carcinomas (n = 104). FRN was present in some epithelia in the crypt base of normal colonic mucosae. Significant cytoplasmic staining for FRN was revealed in 26 (29.5%) cases of adenoma and 54 cases (51.9%) of adenocarcinoma. The cancer cells had a higher proportion of FRN expression than those of adenomas or non-neoplastic mucosae (P < 0.001). Expression of FRN showed a positive association with the degree of dysplasia (P = 0.039) and the distal location of adenoma (P = 0.013). FRN expression tended to be associated with the tumor size (P = 0.083), but no substantial difference was observed among the histologic types of adenoma (P = 0.754). The results suggest that cytoplasmic FRN expression is associated with cellular proliferation. The proliferative index shows a significant difference through the adenoma-carcinoma sequence. Further investigation is necessary to clarify the clinical implication of FRN expression in tumor cells and normal-appearing mucosae.

CUSUM analysis of the SCC antigen in patients with head and neck cancer

PURPOSE

Serial postoperative serum squamous cell carcinoma antigen (SCCAg) levels in a group of head and neck cancer patients were evaluated using a cumulative sum (CUSUM) technique to determine the prognostic value of serial SCCAg levels in predicting tumor recurrence.

MATERIALS AND METHODS

A retrospective analysis of serial postoperative SCCAg measurements in 75 patients with squamous cell carcinoma of the head and neck (SCCHN) from two previous studies of SCCAg was performed. Serum SCCAg levels were determined by radioimmunoassay. A V-mask was used to detect significant deviations of greater than 1 SD of the CUSUM from the reference value.

SETTING

Oncologic head and neck practice at a tertiary referral hospital.

PATIENTS OR OTHER PARTICIPANTS

Seventy-five consecutive patients with a minimum of three postoperative SCCAg determinations were reviewed to provide equal numbers with and without recurrent disease. All patients who remained disease-free were followed for a minimum of 2 years. All patients were previously untreated and underwent surgical therapy.

MAIN OUTCOME MEASURES

CUSUM curve of postoperative SCCAg levels and 2-year disease-free survival.

RESULTS

In a group of 38 patients with 2-year disease-free survival, the CUSUM analysis did not detect any significant deviation in postoperative SCCAg levels for up to 23 months after surgery. In a group of 37 patients who subsequently died of disease, a deviation of greater than 1 SD was noted as early as 5 months postoperatively and persisted throughout the course of their monitoring for up to 36 months.

CONCLUSIONS

The CUSUM technique is more sensitive for detecting postoperative changes in serial measurements of the SCCAg and may be applicable to the monitoring of individual patients for recurrent disease.

Head and neck carcinoma--stage at presentation

A prospective study was performed during a 2-year-period. A total of 127 patients presenting with a squamous cell carcinoma of the head, neck and upper aerodigestive tract were entered into the study. Patients were classified according to the primary site, namely: larynx (n = 44), oropharynx (n = 28), hypopharynx (n = 17) and oral cavity (n = 19) and others (n = 19). Patients were staged according to the UICC TNM classification (1987) and the nature and duration of their symptoms were recorded. Sixty-one per cent of patients were found to be presenting with advanced disease (stages 3 and 4): oropharynx--71%; hypopharynx--77%; oral cavity--50%; larynx--34%. No relationship could be established between stage at presentation and duration of symptoms and 53% of patients with advanced disease had been symptomatic for less than 3 months at the time of diagnosis. Only 28% of patients presenting with stage 3 or 4 disease had symptoms for 3 months or longer. Earlier diagnosis will not make a significant impact on the overall prognosis in head and neck cancer.

Circulating markers in squamous cell carcinoma of the head and neck: a review

Biological markers of disease enhance the ability to diagnose, treat and evaluate results of therapy and are especially intriguing for their potential use in the management of malignant tumours. The serum levels of various biochemical substances have been shown to be abnormal for many cancers and are utilised in the management of affected patients. Several markers have been thoroughly investigated for potential clinical utility in head and neck carcinoma. Although no single marker has been found to be adequately sensitive and specific, combinations of markers may improve the utility for some aspects of patient management. This review highlights the literature to date in the realm of circulating markers for head and neck carcinoma. A discussion of the potential usefulness and limitations of such markers follows.

Sedimentation rate and serum thymidine kinase activity: prognostic factors in squamous cell head and neck cancer

Identification of prognostic factors in squamous cell head and neck cancers involves analysis of highly diverse clinical and biological parameters. This study analyzed the prognostic value of clinical variables (age, sex, tumor site, stage) and biologic parameters (squamous cell carcinoma antigen [SCC], serum thymidine kinase activity [TK], fibrin, sedimentation rate [SR]) at the time of diagnosis of squamous cell carcinoma of the head and neck (oral cavity, oropharynx, hypopharynx) in 189 patients. Among the clinical variables investigated, UICC stage III-IV disease (p < .0002), a hypopharyngeal site (p < .02), and age over 60 years (p < .01) were all associated with a poor prognosis. Similarly, analysis of biological blood variables allowed definition of cut-off values above which the prognosis was poor: SCC 2.5 ng/mL (p < .01), fibrin 3.5 g/L (p < .01), TK 7 IU/L (p < .0005), and SR 15 mm per first hour (p < .0000). Cox regression analysis of overall survival identified the UICC stage (p < .000), the SR (p < .001), and serum TK (p < .02) as the main independent prognostic factors. A separate study on a small number of head and neck cancer patients revealed higher TK levels in malignant squamous cell carcinoma tissue than in adjacent healthy tissue.

Significance of glutathione S-transferase-pi as a tumor marker in patients with oral cancer

BACKGROUND

The authors analyzed the clinical usefulness of glutathione-S-transferase-pi (GST-pi) as a tumor marker in patients with oral cancer.

METHODS

GST-pi levels in plasma of 61 patients with oral squamous cell carcinomas, 65 patients with benign oral diseases, and 78 healthy subjects were investigated with the sandwich enzyme-immunoassay (EIA) system.

RESULTS

Elevated GST-pi levels in plasma were observed in patients with oral cancer, but patients with benign oral diseases had normal GST-pi levels. More than 70% of patients with Stage III or IV oral cancer and more than 50% of those with Stage I and II disease had elevated levels of GST-pi in plasma. Elevated levels of GST-pi in plasma were also discovered in most patients with tumor recurring after surgery before recurrence was detected clinically. GST-pi also was found to be a useful marker for evaluating the response to chemotherapy, for monitoring postoperative tumor resectability or tumor burden, and for predicting the recurrence of tumor in patients with oral cancer.

CONCLUSIONS

GST-pi is considered to be a useful aid for early diagnosis, predicting tumor extent, and determining parameters of treatment efficacy and prognosis for oral cancer.

Automated quantitative nephelometric latex immunoassay for determining ferritin in human serum

We describe a rapid and sensitive latex nephelometric immunoassay for quantifying ferritin in human serum. This latex immunoassay procedure uses commercially available ready-for-use reagents [Tina-Quant (a) Ferritin, Boehringer Mannheim] that have a long shelf life. The assay consists of incubating the diluted serum sample (5-fold) for 12 min at room temperature with latex particles covalently coated with anti-ferritin antibodies, and then quantifying the change of light-scatter produced. The assay is fully automated on the Behring nephelometer analyzer with a sampling rate of 150 samples/hour. The method has an analytical range of 3 to 260 micrograms/l. Maximal intra- and inter-assay CVs were 4.0 and 6.2%, respectively. Analytical recoveries ranged from 91.3 to 103.6%. Assay detection limit was less than 3 micrograms/l. Linearity of the test is given throughout the measuring range. There was no interference from bilirubin (up to 340 mumol/l), haemoglobin (up to 7 g/l), or rheumatoid factor (up to 1,100 IU/ml). Turbid and lipemic samples interfere. This interference may be avoided by pretreating these samples prior to assay. Results correlated well with those obtained by an automated ELISA test (r = 0.995) and with those of two commercial RIA methods (r greater than 0.97). This latex nephelometric procedure is a convenient method and represents an interesting alternative to other immunoassays for measuring ferritin in human serum.

Expression of carcinoembryonic antigen and ferritin in normal, hyperplastic, and neoplastic endometrium

The distribution of carcinoembryonic antigen (CEA) and ferritin was demonstrated by immunohistochemical method in 95 patients with normal, hyperplastic, and neoplastic endometrium in order to distinguish among these conditions. Fifteen patients with normal endometrium (NE), 28 with hyperplasia (AH), 12 with atypical hyperplasia (AAH), and 40 with endometrial carcinoma (CA) were studied. Paraffin section tissues were subjected to immunostaining according to the avidin-biotin complex method. CEA was found in 33% of NE cases, 46% of AH, 75% of AAH, and 83% of CA (P less than 0.01). Ferritin was not detected in any case of NE; however, it was detected in one case (4%) of AH, in one case (8%) of AAH, and in 88% of CAs (P less than 0.001). Both tumor markers exhibited a heterogeneous staining pattern, and for a given histologic hyperplastic or malignant lesion, corresponded to several phenotypes. There was no significant correlation between clinical stage or tumor grade and CEA or ferritin expression. In conclusion, ferritin seems to be a better biological marker than CEA in distinguishing between hyperplastic and neoplastic endometrial lesions and it is also more reliable than CEA for endometrial malignancy since it was absent in normal and hyperplastic endometria.

Use of serum markers in the diagnosis and management of laryngeal cancer

Many neoplastic diseases are reported to be accompanied by the presence or associated with an increase in biological substances identified as tumour markers. The most common markers implicated in head and neck cancers are CEA, TPA, LASA, SCC, CA 19-9, and ferritin. These markers (except SCC) were evaluated in 50 patients with a laryngeal carcinoma, in 20 patients with benign lesions, and in 20 healthy subjects. The results show for each marker assayed the following sensitivity values (true positives): CEA, 10%; CA 19-9, 30%; TPA, 30%; LASA, 90%; ferritin, 60%. Specificity (true negatives) was as follows: CEA, 85%; CA 19-9, 99.4%; TPA, 98%; LASA, 99.8%; ferritin, 97%. LASA and ferritin seem to be the most suitable markers for patient monitoring because of their higher sensitivity in all phases of cancer disease.

Serum tumor markers of head and neck cancer: current status

The serum level of a variety of substances shows significant changes in head and neck cancer patients. Such substances are collectively called biochemical tumor markers. To date, most markers lack a high degree of specificity and sensitivity. However, serial measurement of markers showing elevated pretreatment levels may help in monitoring response to therapy. Other potential uses of tumor markers include earlier detection of recurrence and/or metastasis, and possible prediction of prognosis. Measurement of more than one marker seems to enhance the diagnostic accuracy of the test. Some markers show significant correlations with various immune parameters in head and neck cancer patients and may have a possible role in potentiating the immunodepressed status of such patients. A review of currently reported tumor markers in head and neck cancer showing their nature, sources, uses, and limitations is presented.

The theoretical implications and experimental and clinical results of radiolabeled antiferritin

Ferritin is produced in malignant and normal tissues. It acts both as an immunosuppressant and as an iron storage protein. As a tumor associated protein, it is related to virally induced tumors, and selective tumor targeting by radiolabeled antiferritin antibodies has led to its use in clinical trials. In patients with advanced Hodgkin's disease who have failed conventional therapy, 131I antiferritin produced partial remissions, while 90Y antiferritin led to complete remissions and a demonstrable dose-response relationship. Combining the variable low-dose radiation patterns produced by radiolabeled antibody therapy with chemotherapy in the treatment of hepatocellular cancer has led to enhanced tumor cytotoxicity and, in some cases, the conversion of non-resectable hepatoma to resectable. Further, the potential for clinical and laboratory investigation of radiolabeled antibody therapy is discussed in light of new findings.

Iron nutrition in childhood malignancy

Status of iron nutrition along with demographic, anthropometric, dietary, and biochemical parameters were recorded in 98 pediatric cancer patients at the time of referral. Dietary intake in each patient was analyzed for calories, protein, and iron. Blood specimens were analyzed for hemoglobin (Hgb), hematocrit (Hct), iron, total iron-binding capacity (TIBC), transferrin, and ferritin. Dietary intake measures were assessed according to each subject's Recommended Dietary Allowance (RDA). The results were compared among three diagnostic groups, namely, benign, solid tumor, and hematopoietic. The nutrient lowest in intake was iron. The overall measures revealed significant differences between the benign and hematopoietic groups in all parameters except TIBC and transferrin. A correlation coefficient of 0.55 (p less than 10(-5) between transferrin and TIBC was generated in our patients. Significant differences were noted for ferritin in the acute lymphocytic leukemia (p = 0.0001) and lymphoma (p = 0.0007) groups when compared with the benign group. A correlation coefficient of 0.55 (p less than 10(-5) was generated in our patients. A 3-month follow-up assessment was conducted in order to document the effects of therapy. Tumor response and progression was compared to changes in ferritin levels from baseline to follow-up. Our results support the literature, that ferritin is a sensitive tumor marker in various malignancies.

Diagnosis of head and neck carcinomas by means of immunological tumour markers (Beta-2-microglobulin, immunoglobulin E, ferritin, N-acetyl-neuraminic acid, phosphohexose-isomerase)

In a great number of patients with squamous cell cancer of the head and neck, tumour markers in the serum were determined before any therapy, in order to evaluate their possible usefulness as parameters for monitoring therapy as well as for early detection of cancer. Patients with primary tumours (n = 101) were distributed to groups TI-II and TIII-IV according to the UICC classification 1978, and investigated together with a group of recurrences (n = 105). 50 age-matched healthy individuals served as controls. Substances investigated were beta 2-Microglobulin (beta 2-M), Immunoglobulin E (IgE), Ferritin, N-Acetyl-Neuraminic Acid (sialic acid; NANA), Phosphohexose-Isomerase (PHI). Not only were the mean values of the groups compared with each other, but also the percentages of the respective groups displaying increases above the upper norm limit (95. percentile) were calculated. Critical evaluation of the results led to the conclusion that in particular IgE, NANA and--with some reservations--ferritin should be further investigated as biological serum markers in serial determination with special regard to their possible relevance for cancer treatment.