Journal of Pharmacy And Bioallied Sciences

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 13  |  Issue : 5  |  Page : 748--750

Assessment of c-reactive protein level in oral submucous fibrosis and oral squamous cell carcinoma patient


Geeta Sharma1, Randhir Kumar2, Sharib Abdus Salam2, Prashant Bhasin3, Nishant Kumar Tewari4, Suman Yadav5,  
1 Department of Oral Pathology, Sarjug Dental College, Darbhanga, India
2 Department of Periodontics and Oral Implantology, Patna Dental College and Hospital, Bihar, India
3 Department of Conservative Dentistry and Endodontics, Shree Bankey Bihari Dental College, Ghaziabad, Uttar Pradesh, India
4 Department of Dentistry, Nalanda Medical College and Hospital, Patna, Bihar, India
5 Department of Oral and Maxillofacial Surgery, I.T.S Dental College, Ghaziabad, Uttar Pradesh, India

Correspondence Address:
Geeta Sharma
Department of Oral Pathology, Sarjug Dental College, Darbhanga, Bihar
India

Abstract

Background: Potentially malignant disorders are highly prevalent in India. In this study, we assessed C-reactive protein (CRP) levels in patients with oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC). Methodology: Sixty-four patients (OSMF and OSCC) were undertaken and were classified into 3 groups, OSMF patients (Group I, 34), OSCC (Group II, 30), and healthy controls (Group III, 26). Immunoturbidimetry method was used for the estimation of CRP levels. Results: Maximum cases in Group I was seen in the age group 40–60 years (males-10, females-3), Group II in the age group 40–60 years (males-11, females-5) and Group III (males-5, females-6). The mean CRP level in Group I was 6.12 ± 4.5 mg/l, in Group II was 28.4 ± 21.5 mg/l, and in Group III was 3.15 ± 2.19 mg/l. The difference was significant (P < 0.05). Conclusion: Authors found that OSMF and oral cancer patients had increased CRP levels as compared to healthy subjects.



How to cite this article:
Sharma G, Kumar R, Salam SA, Bhasin P, Tewari NK, Yadav S. Assessment of c-reactive protein level in oral submucous fibrosis and oral squamous cell carcinoma patient.J Pharm Bioall Sci 2021;13:748-750


How to cite this URL:
Sharma G, Kumar R, Salam SA, Bhasin P, Tewari NK, Yadav S. Assessment of c-reactive protein level in oral submucous fibrosis and oral squamous cell carcinoma patient. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Sep 19 ];13:748-750
Available from: https://www.jpbsonline.org/text.asp?2021/13/5/748/317580


Full Text



 Introduction



Potentially malignant disorders (PMDs) are highly prevalent in India. The high consumption of areca nut and tobacco among South Indians raises the alarm to control its use.[1] Nowadays, the cases of oral submucous fibrosis (OSMF) and oral cancer are increasing among females. Earlier, there had been a high prevalence of PMDs among males due to the rapid use of tobacco and their products. However, in the last few years, consumption among females has enhanced due to many reasons.[2]

OSMF leads to stiffness of mucosa and difficult mouth opening due to the formation of collagen bands in the buccal mucosa, labial mucosa, soft palate, etc. OSMF is associated with malignant transformation if timely intervention is not performed. Prompt identification and prevention of these PMDs may decrease the incidence and subsequently help in achieving better survival of patients who develop oral squamous cell carcinoma (OSCC).[3]

Oral cancer accounts significantly for head and neck region cancer. The incidence was found to be 300,000 universally. It is the foremost reason of deaths. It has <50% survival rate in 5 years. C-reactive protein (CRP), fibrinogen, and serum amyloid A protein are few examples of acute-phase proteins whose values alter in the presence of inflammation. CRP found to show an elevated level in malignancy is considered to be a prognostic factor.[4] Various inflammatory cytokines like interleukin (IL)-1 and IL-6 etc., encourage the production of CRP by hepatocytes. Tumor necrosis factor-α also contribute significantly. Studies have been done in the past showing alteration in CRP level in patients with PMDs.[5] Considering this, we attempted to assess CRP level in OSMF and OSCC patients.

 Methodology



We recruited 64 cases of OSMF and OSCC disorders of both genders reported to the Department of Oral Medicine and Radiology. The diagnosis of PMDs and OSCC was made clinically as well as histopathologically. We included 26 healthy subjects as control. Ethical approval for the study was taken before starting it, followed by written consent in vernacular language from all subjects.

The demographic profile of all subjects was recorded in case history pro forma. Patients were divided into three groups. Group I comprised OSMF patients (34), group II had cases of OSCC (30), and Group III had healthy controls (26).

All patients underwent collection of 2-ml venous blood samples using the standard venipuncture technique. Serum from blood was separated with centrifugation technique. Immunoturbidimetry method was used for the estimation of CRP levels. Results of the study were entered in MS excel sheet for statistical inference using Statistical Package of Social Sciences (SPSS) version 21 (IBM, Armonk, NY, USA). Data were expressed as mean ± standard deviation, maximum and minimum values using Kruskal–Wallis test and analysis of variance. 0.05 value was set as significance.

 Results



[Table 1] shows distribution of subjects in different groups.{Table 1}

[Table 2] shows that maximum cases in Group I was seen in the age group 40–60 years (males-10, females-3), Group II in the age group 40–60 years (males-11, females-5), and Group III (males-5, females-6).{Table 2}

[Table 3] and [Graph 1] shows that the mean CRP level in Group I was 6.12 ± 4.5 mg/l, in Group II was 28.4 ± 21.5 mg/l, and in Group III was 3.15 ± 2.19 mg/l. The difference was significant (P < 0.05).{Table 3}[INLINE:1]

 Discussion



Tobacco is the leading cause of PMDs and OSCC. Tobacco is consumed as smoking form and smokeless form.[6] Various forms of smoking tobacco is cigarette, bidi, hookah, hookli, etc. Smokeless form of tobacco comprised of chaini khaini, zarda, pan masala, mawa, mishri, etc. Tobacco contains carcinogen products polycyclic hydrocarbon, nitrosamine, etc.[7]

The onset of OSMF is sudden. Patients experience multiple symptoms for which they report to the dental surgeon. The foremost complaint of the patients is the burning sensation on eating spicy and hot beverages. With the passage of time, multiple blisters and ulceration start appearing on the palate. Recurrent stomatitis and excessive salivation occur within few days, and ultimately xerostomia occurs.[8] The composition of areca nut is arecoline, arecadine, guvacoline, guvacine, and isoguvacine. Research reveals that there is nitrosation of arecoline with use resulting in the formation of arecanut specific nitrasamine.[9] These compounds are potential carcinogens and cause alkylation of. In this study, we assessed CRP level in OSMF and OSCC patients.

We found that there were 34 cases of OSMF, 30 cases of OSCC, and 26 controls. Age group 20–40 years had 7 males and 8 females in Group I, 6 males and 4 females in Group II, and 5 males and 5 females in Group III, Age group 40–60 years had 10 males and 3 females, Group II had 11 males and 5 females in Group II, and 5 males and 6 females in Group III. Age >60 comprised of 5 males and 1 female in Group I, 3 males and 1 female in Group II and 3 males and 2 females. Vankadara et al.[10] recruited 30 healthy controls (Group I), while Group II had 30 patients of leukoplakia, OSMF and OLP and Group III had 30 cases of squamous cell carcinoma. The result showed that mean CRP levels in Group I was 3.88 ± 4.50 mg/l with range from 0.1 to 18.3 mg/l. In Group II, mean CRP level was 5.59 ± 9.86 mg/l with rang from 0.8 to 53.9 mg/l. In Group III, mean CRP level was 31.72 ± 31.01 mg/l, which rang from 3.3 to 96 mg/l.

We found that mean CRP level in Group I was 6.12 ± 4.5 mg/l, in Group II was 28.4 ± 21.5 mg/l and in Group III was 3.15 ± 2.19 mg/l. Gosavi and Torkadi[11] conducted a study with 50 healthy, 50 OSMF and 50 OSCC individuals who were divided into Group I, Group II and Group III, respectively. The mean value of serum CRP in Group I was 2.20 ± 1.74 mg/L; in Group II, it was 5.40 ± 4.79 mg/L and in Group III, it was 12.17 ± 11.38 mg/L.

Kaja et al.[12] consisted of 20 cases of oral PMDs (Leukoplakia-10, Oral Sub mucous fibrosis-10). Mean CRP levels in leukoplakia was 0.33 ± 0.17, in OSMF was 0.58 ± 0.83 where as in controls it was 0.26 ± 0.05. In PMDs, CRP was slightly elevated when compared with the controls.

It is mentioned in the literature that CRP level increases significantly in tissue in active phase of disease and in cancer patients. It is a receptive marker of inflammation. It is evident stimulation by IL-6 significantly CRP levels in the liver and additional organs. CRP can be increased by both acute and chronic stimulation.[13] It is a defensive mechanism against viral and bacterial infections. Elevation of CRP has also been seen in connective tissue diseases, cardiovascular diseases, infections, inflammatory conditions, tuberculosis, rheumatoid arthritis, and women using oral contraceptives.[14] Anand Kumar and Bhateja[15] also observed that the level of serum CRP level was significantly higher in OSMF cases in comparison to the control group.

The shortcoming of the study is the small sample size.

 Conclusion



The authors found that OSMF and oral cancer patients had increased CRP level as compared to healthy subjects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Neville BW, Day TA. Oral cancer and precancerous lesions. CA Cancer J Clin 2002;52:195-215.
2Chandrashekara S. C-reactive protein: An inflammatory marker with specific role in physiology, pathology, and diagnosis. IJRCI 2014;2:SR3.
3Biswas S, Manna K, Das U, Khan A, Pradhan A, Sengupta A, et al. Smokeless tobacco consumption impedes metabolic, cellular, apoptotic and systemic stress pattern: A study on Government employees in Kolkata, India. Sci Rep 2015;5:18284.
4Oliveira KG, von Zeidler SV, Lamas AZ, Podestá JR, Sena A, Souza ED, et al. Relationship of inflammatory markers and pain in patients with head and neck cancer prior to anticancer therapy. Braz J Med Biol Res 2014;47:600-4.
5Acharya S, Kale J, Hallikeri K, Anehosur V, Arnold D. Clinical significance of preoperative serum C-reactive protein in oral squamous cell carcinoma. Int J Oral Maxillofac Surg 2018;47:16-23.
6Metgud R, Bajaj S. Altered serum and salivary C-reactive protein levels in patients with oral premalignant lesions and oral squamous cell carcinoma. Biotech Histochem 2016;91:96-101.
7Gockel I, Dirksen K, Messow CM, Junginger T. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus. World J Gastroenterol 2006;12:3746-50.
8Baxi BR, Patel PS. A report on clinical importance of serum glycoconjugates in oral cancer. Indian J Biochem 1990;5:139-44.
9Allin KH, Bojesen SE, Nordestgaard BG. Base line protein is associated with incident cancer and survival in patients with cancer. J Clin Oncol 2009;27:2217-24.
10Vankadara S, K P, Balmuri PK, G N, G VR. Evaluation of serum C-reactive protein levels in oral premalignancies and malignancies: A comparative study. J Dent (Tehran) 2018;15:358-64.
11Gosavi SR, Torkadi AA. Serum C-reactive protein in oral submucous fibrosis and oral squamous cell carcinoma: A cross-sectional study. J Oral Maxillofac Pathol 2020;24:46-51.
12Kaja S, Naga SS, Kumar KK, Dasari N, Kantheti LC, Reddy BR. Quantitative analysis of C-reactive protein in potentially malignant disorders: A pilot study. J Orofac Sci 2015;7:3-6.
13Tilakaratne WM, Klinikowski MF, Saku T, Peters TJ, Warnakulasuriya S. Oral submucous fibrosis: Review on aetiology and pathogenesis. Oral Oncol 2006;42:561-8.
14Saraswathi TR, Ranganathan K, Shanmugam S, Sowmya R, Narasimhan PD, Gunaseelan R. Prevalence of oral lesions in relation to habits: Cross-sectional study in South India. Indian J Dent Res 2006;17:121-5.
15Anand Kumar C, Bhateja S. Altered C-reactive protein levels in serum of oral pre cancer patients in comparison with healthy control. Int J Oral Maxillofac Pathol 2011;2:16-9.