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Antasouras G, Papadopoulou SK, Tolia M, Pandi AL, Spanoudaki M, Tsoukalas N, Tsourouflis G, Psara E, Mentzelou M, Giaginis C. May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Esophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies. Med Sci (Basel) 2023; 11:64. [PMID: 37873749 PMCID: PMC10594480 DOI: 10.3390/medsci11040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Malnutrition in esophageal and pharyngeal cancer patients constitutes a common and serious concern, which significantly reduces patients' prognoses. Cancers of the esophagus and the pharynx can considerably impair feeding in patients, resulting in severe undernutrition. This is a scoping review that intends to critically analyze the most well-designed clinical studies investigating the potential beneficial impact of diverse nutritional assessment tools on the prognosis of patients with esophageal and pharyngeal cancers. METHODS The most accurate and remarkable scientific databases were comprehensively explored utilizing relative keywords to detect clinical studies that investigate whether nutritional status may affect disease prognosis. RESULTS Several assessment tools have evaluated and highlighted the potential beneficial impact of nutritional status on disease progression and patients' prognosis in both esophageal and pharyngeal cancers. Regarding esophageal cancer, CONUT, PNI, PG-SGA, and NRS-2002 are more commonly used, while albumin is also frequently evaluated. Regarding pharyngeal cancers, fewer studies are currently available. PNI has been evaluated, and its significance as a factor for shorter survival' times has been highlighted. The Comprehensive Nutritional Index has also been evaluated with positive results, as well as NRS 2002, GPS, and body-weight status. However, there is currently a lack of studies with an adequate number of women with cancer. An international literature gap was identified concerning follow-up studies with adequate methodology. CONCLUSIONS Nutritional status may significantly affect disease progression and patients' survival, highlighting the significance of a great nutritional status in individuals with esophageal and pharyngeal cancers. Further large-scale and well-designed prospective surveys should be performed to verify the potential beneficial effects of adequate nourishment in people suffering from cancer of the esophagus and pharynx.
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Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Crete, 71110 Heraklion, Crete, Greece;
| | - Aimilia-Lynn Pandi
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece; (S.K.P.); (M.S.)
| | - Nikolaos Tsoukalas
- Department of Oncology, 401 General Army Hospital of Athens (401 Geniko Stratiotiko Nosokomeio Athenon), 11525 Athens, Greece;
| | - Gerasimos Tsourouflis
- Second Department of Propedeutic Surgery, Medical School, University of Athens, 11527 Athens, Greece;
| | - Evmorfia Psara
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Maria Mentzelou
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of the Environment, University of the Aegean, 81400 Lemnos, Greece; (G.A.); (A.-L.P.); (E.P.); (M.M.)
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Ran Z, Chen W, Shang J, Li X. The prognostic implication of pre-treatment hemoglobin levels in esophageal cancer patients: A systematic review and meta-analysis. Meta Gene 2020. [DOI: 10.1016/j.mgene.2020.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Zhao CC, Chen J, Niu RF, Liu Y, Zhang CG. Increased resistin suggests poor prognosis and promotes development of lung adenocarcinoma. Oncol Rep 2018; 40:3392-3404. [PMID: 30272365 PMCID: PMC6196645 DOI: 10.3892/or.2018.6736] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/17/2018] [Indexed: 12/27/2022] Open
Abstract
Resistin is considered to be a risk factor for several types of cancer, but its functions are controversial and not well studied in lung cancer. The present study is aimed to investigate the expression of resistin in lung adenocarcinoma tissues, in order to evaluate its association with the clinicopathological characteristics of cancer patients and to investigate the effects of resistin in lung adenocarcinoma cells. A total of 70 pairs of lung adenocarcinoma tissues and normal tissues were collected and immunohistochemistry was performed to examine resistin expression. Resistin overexpressed cells were established by plasmid transfection in A549 or H1975 cells. Alterations in cell proliferation, apoptosis, migration and invasion were analyzed in vitro. A nude mouse tumorigenicity assay was used to test the effect of resistin in vivo. High expression of resistin was predominantly observed in lung adenocarcinoma tissues but not in adjacent normal lung tissues. Resistin expression was significantly associated with increased tumor size, clinical stage as well as lymph node metastasis while negatively associated with progression-free survival (PFS) and overall survival (OS). Expression of resistin was an independent risk factor for PFS and OS. Overexpression of resistin promoted significant proliferation, migration and invasion, while also inhibited apoptosis in vitro. Resistin also promoted tumor formation in nude mice. The potential molecular mechanism was also investigated by in vitro experiments. In conclusion, the present study revealed that a high level of resistin expression in lung adenocarcinoma tissues is associated with poor clinicopathological status and survival. Resistin, which promotes the development of lung adenocarcinoma in vitro and in vivo may be a novel target for lung adenocarcinoma.
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Affiliation(s)
- Cui-Cui Zhao
- Department of VIP Ward, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Jing Chen
- Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Rui-Fang Niu
- Department of Public Laboratory, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Yan Liu
- Department of VIP Ward, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Chuan-Gui Zhang
- Department of VIP Ward, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
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Mantzorou M, Koutelidakis A, Theocharis S, Giaginis C. Clinical Value of Nutritional Status in Cancer: What is its Impact and how it Affects Disease Progression and Prognosis? Nutr Cancer 2017; 69:1151-1176. [PMID: 29083236 DOI: 10.1080/01635581.2017.1367947] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Malnutrition is a common finding in cancer patients, which can affect disease progression and survival. This review aims to critically summarize the prognostic role of nutritional status, from Body Mass Index (BMI) and weight loss to nutrition screening tools and biochemical indices, in cancer patients. According to the currently available data, Prognostic Nutritional Index (PNI) was a significant prognostic factor of patients' survival, both in univariate and multivariate analyses. Pre-operative albumin was also correlated with worse outcomes, being an independent prognostic factor of survival in several studies. BMI was also well-studied, with contradictory results. Although, lower BMI was found to be an independent prognostic factor of shorter survival in some studies, in others it did not have an impact on survival. In this aspect, this review highlights the significant prognostic role of nutritional status in the disease progression and survival of cancer patients. Further, good-quality prospective studies are needed in order to draw precise conclusions on the prognostic role of specific nutritional assessment tools, and biochemical indices associated with the nutritional status in more cancer types, such as liver, breast and prostate cancer, and hematological malignancies.
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Affiliation(s)
- Maria Mantzorou
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
| | - Antonios Koutelidakis
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
| | - Stamatios Theocharis
- b First Department of Pathology , Medical School, University of Athens , Athens , Greece
| | - Constantinos Giaginis
- a Department of Food Science and Nutrition , University of the Aegean , Lemnos , Greece
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Słomian G, Świętochowska E, Nowak G, Pawlas K, Żelazko A, Nowak P. Chemotherapy and plasma adipokines level in patients with colorectal cancer. POSTEP HIG MED DOSW 2017; 71:281-290. [PMID: 28402255 DOI: 10.5604/01.3001.0010.3813] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Adipokines are molecules produced and secreted by adipose tissue and are linked to multiple malignancies. Adipokines can suppress or promote particular cell behaviors in different types of cancer. The aim of this study was to investigate the impact of chemotherapy on select adipokines in patients with colorectal cancer (CRC). Blood samples were collected from 42 patients with pathologically documented advanced CRC, who required palliative chemotherapy. Leptin, adiponectin, resistin and visfatin levels were measured by ELISA before and 3 months after the administration of chemotherapy. Among the 42 patients evaluated, 18 achieved a partial response (PR), 16 achieved stable disease (SD) and 8 patients experienced disease progression (PD). We found that 5-fluorouracil-based chemotherapy regimens significantly increased plasma levels of leptin and adiponectin and decreased plasma levels of resistin and visfatin in PR and SD patients, whereas the plasma levels of these molecules were not affected in PD patients. Furthermore, the mean plasma levels of leptin were significantly lower, and the mean plasma levels of resistin and visfatin were significantly greater in patients with PD compared with PR and SD both before and after chemotherapy treatment. We conclude that palliative chemotherapy in CRC patients, in addition to providing clinical benefits, positively affects cytokine production and secretion in PR and SD patients. Specifically, we found that palliative chemotherapy increased plasma levels of the anti-inflammatory adipokine adiponectin and decreased the plasma levels of visfatin and resistin, molecules known to promote angiogenesis and cancer cell proliferation in PR and SD patients. Moreover, the baseline values of leptin, visfatin and resistin might serve as prognostic indicators of a poor response to chemotherapy.
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Affiliation(s)
- Grzegorz Słomian
- Oncological Ward, Independent Public Health Care Unit, Voivodeship Specialized Hospital No. 3, Rybnik, Poland
| | | | - Grzegorz Nowak
- Department of Hygiene, Wroclaw Medical University, Poland
| | | | - Aleksandra Żelazko
- Department of Toxicology and Health Protection, Medical University of Silesia, Poland
| | - Przemysław Nowak
- Department of Toxicology and Health Protection, Medical University of Silesia, Poland
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Zemanova M, Vecka M, Petruželka L, Staňková B, Žák A, Zeman M. Plasma Phosphatidylcholines Fatty Acids in Men with Squamous Cell Esophageal Cancer: Chemoradiotherapy Improves Abnormal Profile. Med Sci Monit 2016; 22:4092-4099. [PMID: 27794582 PMCID: PMC5091214 DOI: 10.12659/msm.896799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Abnormal metabolism of fatty acids (FA) is considered to play a role in human cancers, including esophageal cancer (EC). Nevertheless, there have been only a few studies dealing with the influence of the chemotherapy or radiotherapy on the plasma FA profiles. In this work we compared FA in plasma phosphatidylcholine (PC) of the patients with squamous EC and healthy subjects and investigated changes in the FA spectrum during neoadjuvant chemoradiotherapy (CRT). MATERIAL AND METHODS Forty-two men with squamous EC were compared with age-matched healthy controls. The EC group was subjected to concurrent neoadjuvant CRT. We analyzed FA in plasma PC before and after CRT. RESULTS The EC group was characterized by increased levels of both saturated and monounsaturated FA, associated with an increased index of SCD1 (stearoyl-CoA desaturase-1). Moreover, decreased levels of linoleic acid and total polyunsaturated FA (PUFA) n-6 were found in EC patients. The CRT was accompanied by increased docosahexaenoic acid and total PUFA n-3 content in plasma PC, concurrently with the decrease of estimated activity of SCD1. CONCLUSIONS We found that patients with EC had altered FA profile in plasma PC, which could be related to abnormal FA metabolism in cancer (e.g., altered synthesis de novo, b-oxidation, desaturation, and elongation). The described changes in FA profiles during CRT could be involved in favorable functioning of CRT. Further studies investigating the plasma FA compositions and their changes due to CRT in EC patients are warranted.
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Affiliation(s)
- Milada Zemanova
- Department of Oncology, 1st Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Marek Vecka
- 4th Department of Internal Medicine, 1st Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Luboš Petruželka
- Department of Oncology, 1st Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Barbora Staňková
- 4th Department of Internal Medicine, 1st Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Aleš Žák
- 4th Department of Internal Medicine, 1st Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Miroslav Zeman
- 4th Department of Internal Medicine, 1st Faculty of Medicine of Charles University in Prague and General University Hospital, Prague, Czech Republic
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Zhang Y, Liao R, Li H, Liu L, Chen X, Chen H. Expression of Cofilin-1 and Transgelin in Esophageal Squamous Cell Carcinoma. Med Sci Monit 2015; 21:2659-65. [PMID: 26344167 PMCID: PMC4576925 DOI: 10.12659/msm.895242] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) has attracted much research attention around the world, and the number of ESCC cases has increased gradually in recent years. Identifying the specific biomarkers of ESCC is an effective approach for the early diagnosis of tumors. MATERIAL AND METHODS Immunohistochemical streptavidin-peroxidase method was used to determine the expressions of Cofilin-1 and transgelin in 68 patients with esophageal squamous cell carcinoma (ESCC) and 48 individuals with normal esophageal tissues. In addition to the relationships between the expression of Cofilin-1 and transgelin, the clinicopathologic features of ESCC were also discussed. The correlation between Cofilin-1 and transgelin protein expression in ESCC was analyzed. RESULTS (1) The positive expression rates of Cofilin-1 and transgelin were 60.3% (41/68) and 54.4% (37/68) in esophageal carcinoma tissue, respectively. The positive expression rates of Cofilin-1 and transgelin in normal esophageal tissue were 27.1% (13/48) and 29.1% (14/48), respectively. The differences were statistically significant (P<0.05). (2) The positive expression rate of Cofilin-1 did not differ significantly (P>0.05) with sex, age, ethnicity, tumor size, or infiltration depth; but did have a statistically significant (P<0.05) difference with various degrees of tumor differentiation, lymph node metastasis, and clinical stages. (3) The positive expression rate of transgelin did not differ significantly (P>0.05) with sex, age, ethnicity, tumor size, infiltration depth, and clinical stage, but did significantly (P<0.05) differ with degree of tumor differentiation and lymph node metastasis. CONCLUSIONS Cofilin-1 and transgelin may play roles in the carcinogenesis and development of esophageal squamous cell carcinoma. Cofilin-1 may be useful as an important biomarker for indicating the degree of malignancy of esophageal squamous cell carcinoma, and the detection of transgelin is valuable in early diagnosis of esophageal squamous cell carcinoma.
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Affiliation(s)
- Yan Zhang
- Institute of International Education, College of Basic Medical Sciences, Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Ruyi Liao
- Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Hui Li
- Scientific Research and Innovation Center, Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Ling Liu
- College of Basic Medical Sciences, Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Xiao Chen
- Department of Pathology, College of Basic Medical Sciences, Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Hongming Chen
- Department of Histology and Embryology, College of Basic Medical Sciences, Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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Yang X, Li J, Cai W, Yang Q, Lu Z, Yu J, Yu H, Zhang N, Sun D, Qu Y, Guo H, Wen F, Ji Y. Adiponectin Gene Polymorphisms are Associated with Increased Risk of Colorectal Cancer. Med Sci Monit 2015; 21:2595-606. [PMID: 26329379 PMCID: PMC4562615 DOI: 10.12659/msm.893472] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background This meta-analysis investigates the associations of adiponectin (ADIPOQ) genetic polymorphisms with the susceptibility to colorectal cancer (CRC). Material/Methods 2 reviewers independently searched 6 databases – PubMed, Cochrane Library, Ovid, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang databases – to identify published studies relevant to adiponectin gene polymorphisms and CRC. Studies retrieved from database searches were screened using our stringent inclusion and exclusion criteria. Full texts of the selected studies were accessed and related data was extracted using a standardized data extraction form. Comprehensive Meta-analysis 2.0 software was used for statistical analyses. Results A total of 188 studies were initially retrieved from database search, and 6 studies were eventually selected, through a rigorous screening process, for inclusion in this meta-analysis. The 6 studies contained a total of 1897 patients (Asians: 1190; white: 707) with CRC in case group and 2475 healthy controls (Asians: 1325; white: 1150) in the control group. Results of the current meta-analysis revealed that the rs2241766 T>G single-nucleotide polymorphisms (SNP) increase the risk of CRC; rs1501299 G>T under dominant model was associated with increased risk of CRC; and rs266729 C>G SNP under allele model conferred an increased risk of CRC. Conclusions Our meta-analysis strongly suggests that the ADIPOQ rs2241766 T>G, rs1501299 G>T, and rs266729 C>G SNPs correlate with an increased risk of CRC.
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Affiliation(s)
- Xiaoyu Yang
- Department of Pathology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
| | - Jinsong Li
- Department of Pathology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
| | - Weimei Cai
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
| | - Qinghui Yang
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
| | - Zhihong Lu
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
| | - Jian Yu
- Department of Pathology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
| | - Hong Yu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Na Zhang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Deyu Sun
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yanli Qu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Hong Guo
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Fengyun Wen
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Yinghua Ji
- Department of Oncology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Xinxiang, China (mainland)
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Young MRI, Levingston C, Johnson SD. Cytokine and Adipokine Levels in Patients with Premalignant Oral Lesions or in Patients with Oral Cancer Who Did or Did Not Receive 1α,25-Dihydroxyvitamin D3 Treatment upon Cancer Diagnosis. Cancers (Basel) 2015; 7:1109-24. [PMID: 26120967 PMCID: PMC4586760 DOI: 10.3390/cancers7030827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/09/2015] [Accepted: 06/17/2015] [Indexed: 12/17/2022] Open
Abstract
Differences in levels of inflammation-modulating cytokines and adipokines in patients with premalignant oral lesions versus in patients that develop squamous cell carcinoma of the head and neck (HNSCC) were assessed. Also assessed was the impact of treating HNSCC patients with the immune regulatory mediator, 1α,25-dihydroxyvitamin D3 [1,25(OH)2D3], on modulators of inflammation. Compared to healthy controls, patients with premalignant oral lesions had increases in their systemic levels of the inflammatory cytokines IL-6 and IL-17, and increases in the adipokine, leptin. However, levels of these pro-inflammatory cytokines and adipokine were reduced in patients with HNSCC. Treatment of HNSCC patients with 1,25(OH)2D3 increased levels of each of the measured immune mediators. Levels of the anti-inflammatory adipokine, adiponectin, were shifted inversely with the levels of the pro-inflammatory cytokines and with leptin. These studies demonstrate heightened immune reactivity in patients with premalignant lesions, which wanes in patients with HNSCC, but which is restored by treatment with 1,25(OH)2D3.
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Affiliation(s)
- M Rita I Young
- Medical Research Service (151), Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA.
| | - Corinne Levingston
- Medical Research Service (151), Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | - Sara D Johnson
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC 29425, USA.
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