• Mohamad Adel, Chung-Kan Tsao, Fu-Chan Wei, Huei-Tzu Chien, Chih-Hsiung Lai, Chun-Ta Liao, Hung-Ming Wang, Kang-Hsing Fan, Chung-Jan Kang, Joseph Tung-Chieh Chang, and Shiang-Fu Huang.
• From the Department of Surgery (MA), Division of Surgical Oncology, Al-Azhar University Hospitals, Al-Azhar Faculty of Medicine, Cairo, Egypt, Department of Otolaryngology (MA, CTL, CJK, SFH), Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University (CKT, FCW), Department of Epidemiology (HTC, CHL), Department of Medical Oncology (HMW), and Department of Radiation Oncology (KHF, JTC), Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan, China.
• Medicine (Baltimore). 2016 Apr 1; 95 (14): e3149e3149.

AbstractThe prognostic significance of squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) levels and lymph node density (LND) has been individually recognized in oral squamous cell carcinoma (OSCC). We investigated the relationship between preoperative serum markers (SCC-Ag and CRP) and postoperative prognostic marker (LND) in this study. We retrospectively analyzed 277 OSCC patients who underwent primary curative resection and neck dissection with/or without adjuvant therapy between March 2008 and November 2013. Serum SCC-Ag and CRP levels were measured preoperatively. Distant metastasis, overall survival (OS), and disease-free survival (DFS) were used to evaluate the prognostic significance of preoperative SCC-Ag and CRP levels in relation to LND. LND (cutoff point ≥0.06) correlated with the pathologic tumor status, pathologic nodal metastasis, degree of differentiation, tumor stage, tumor depth (≥10 mm vs <10 mm), and perineural invasion (all P values were <0.001). LND was significantly associated with development of distant metastasis, DFS, and OS (all P values were <0.001). Preoperative elevated CRP and SCC-Ag levels were significantly associated with LND (P = 0.006), DFS (P < 0.001), and OS (P < 0.001). LND patients were further stratified into prognostic groups according to their SCC-Ag and CRP levels (DFS: P = 0.010; OS: P = 0.003). LND correlated with the incidence of DM, DFS, and OS in patients with OSCC. Concurrent elevated preoperative SCC-Ag and CRP levels are predictors for LND. In addition, SCC-Ag and CRP are markers for classifying high-risk LND patients with OSCC into subgroups.

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