Assessment of Serum Cortisol Levels in Patients with Oral Squamous Cell Carcinoma and Its Correlation with Clinical Staging, Histopathological Grading and Nodal Metastasis: A Prospective Study

Abstract

Aims and objectives: To assess the serum cortisol level in patients with oral squamous cell carcinoma and correlate this value with clinical staging of tumor using TNM staging, histopathological grading of the tumor using BRYNE'S (1992) invasive tumor front grading system and nodal metastasis using histopathology.

Materials and methods: In this prospective study a total of 25 patients who reported with biopsy proven oral squamous cell carcinoma from Dec 2012-Nov 2014 were included. Patient's clinical parameters were recorded. Clinical staging was assessed using TNM staging. Blood sample was collected from the patient in the early morning and was sent to department of biochemistry, SDM Medical College to assess the serum cortisol levels. The obtained results of serum cortisol levels was correlated with TNM staging, histopathologic grading of the excised tumor (using BRYNE'S grading system) and nodal metastasis (which was confirmed using histopathology of neck specimen). The data was then analyzed statistically.

Results: Patients with oral SCC showed morning serum cortisol levels higher. Cortisol levels increased as the stage of the cancer advanced. There was a statistical significance between TNM and cortisol (p = 0.0001) but no significant correlation between TMS and PN status with cortisol.

Conclusion: Patients with advanced stage oral SCC showed significantly higher levels of cortisol than those in an initial stage. This study provides strong evidence that OSSS cells are influenced by neurohormonal mediators and cortisol estimation can be used a biomarker associated with the disease clinical status.

Keywords: Brynes histological grading; Oral squmous cell carcinoma; Serum cortisol level; TNM staging.

Fig. 1

Patient with carcinoma of buccal mucosa

Fig. 2

Plain bulb with blood

Fig. 3

Blood for centrifugation

Fig. 4

Serum for cortisol estimation

Fig. 5

ADVIA centaur immunoassay system

Fig. 6

Lite reagent for cortisol estimation

Fig. 7

Comparison of T stages with cortisol levels (μg/dl)

Fig. 8

Comparison of N stages with cortisol levels (μg/dl)

Fig. 9

Comparison of TNM stages with cortisol levels (μg/dl)

Fig. 10

TMS groups wise distribution

Fig. 11

Comparison of groups of TMS scores with cortisol levels (μg/dl)

Fig. 12

PN distribution of patients

Fig. 13

Comparison of PN status after HPR with cortisol levels (μg/dl)