Department of Oral and Maxillofacial Surgery, Plastic Operations, General Hospital, Breslauer Strasse 201, 90471 Nuremberg, Germany.
Med Oncol. 2012 Sep;29(3):1435-47. doi: 10.1007/s12032-011-0045-3. Epub 2011 Aug 19.
The purpose of this retrospective study was to develop a pre-treatment laboratory prognostic index (LPI) based on laboratory results that might serve as an extension to clinicopathological parameters for prognosis and treatment in patients with oral squamous cell carcinoma (OSCC). Pre-treatment LPI was calculated from C-reactive protein (CRP), hemoglobin (Hb) levels, and count of white blood cells (WBCs) due to significant (P < 0.05) association with locoregional recurrence measured for each parameter by receiver operating characteristic (ROC) curves in 187 patients with OSCC. Positive predictive values (+PV, precision rate) and negative predictive values (-PV) of LPI were measured. Likelihood ratios (LRs) were used to assess how good the pre-treatment LPI diagnostic test is to determine locoregional recurrence of the disease. CRP expression by cancer cells was confirmed by immunocytochemistry and FACS analysis. ROC analysis determined cutoff values for CRP levels, Hb levels, and WBC count and showed significant differences between nonrecurrent and recurrent group of OSCC. On univariate analysis, patients with high pre-treatment LPI (LPI ≥ 2, hazard ratio (HR) = 3.8670, 95% confidence interval (CI) = 2.2518-6.6407, P < 0.0001) had a significant poorer prognosis. Multivariate analysis showed that the most important independent prognostic factor was high pre-treatment LPI (LPI ≥ 2, HR = 3.6450, 95% CI = 2.3964-5.5441, P < 0.0001). Moreover, pre-treatment LPI ≥ 2 showed high probability that locoregional recurrence will be present later (+PV, LPI ≥ 2, 86.4%, 95% CI = 65.1-97.1). High +LR gave an excellent indication for a good quality of the test (LR+, LPI ≥ 2, 12.77, 95% CI = 8.8-18.6). Immunohistochemistry and FACS analysis confirmed inflammatory CRP expression by cancer cells. This study highlights the combination of inflammatory CRP levels, Hb levels, and WBC count as the most important independent prognostic factor in predicting disease recurrence of patients with OSCC. LPI can be used as a pre-treatment inflammatory biomarker that may identify OSCC with a more aggressive biological phenotype of the disease and might be helpful for guiding further post-operative treatment in OSCC.
本回顾性研究旨在建立一种基于实验室结果的治疗前实验室预后指数（LPI），以补充口腔鳞状细胞癌（OSCC）患者的临床病理参数，作为预后和治疗的补充指标。通过对 187 例 OSCC 患者的每个参数进行接收者操作特征（ROC）曲线分析，发现 C 反应蛋白（CRP）、血红蛋白（Hb）水平和白细胞计数（WBC）与局部区域复发显著相关（P<0.05），据此计算治疗前 LPI。测量 LPI 的阳性预测值（+PV，精密度率）和阴性预测值（-PV）。使用似然比（LR）评估治疗前 LPI 诊断试验对确定疾病局部区域复发的好坏。通过免疫细胞化学和 FACS 分析证实了癌细胞中 CRP 的表达。ROC 分析确定了 CRP 水平、Hb 水平和 WBC 计数的截断值，并显示了非复发性和复发性 OSCC 组之间的显著差异。单因素分析显示，治疗前 LPI 较高的患者（LPI≥2，危险比（HR）=3.8670，95%置信区间（CI）=2.2518-6.6407，P<0.0001）预后显著较差。多因素分析显示，最重要的独立预后因素是治疗前 LPI 较高（LPI≥2，HR=3.6450，95%CI=2.3964-5.5441，P<0.0001）。此外，治疗前 LPI≥2 显示局部区域复发的可能性较高（+PV，LPI≥2，86.4%，95%CI=65.1-97.1）。高+LR 为试验质量提供了极好的指示（LR+，LPI≥2，12.77，95%CI=8.8-18.6）。免疫组化和 FACS 分析证实了癌细胞中炎症性 CRP 的表达。本研究强调了将炎症性 CRP 水平、Hb 水平和 WBC 计数相结合作为预测 OSCC 患者疾病复发的最重要独立预后因素。LPI 可作为一种治疗前炎症生物标志物，可识别具有更具侵袭性生物学表型的 OSCC，并可能有助于指导 OSCC 的术后进一步治疗。
