Green salad intake is associated with improved oral cancer survival and lower soluble CD44 levels

Deficiencies in fruit and vegetable intake have been associated with oral cancer (oral cavity and oropharyngeal). Salivary rinses contain measurable biomarkers including soluble CD44 (solCD44) and total protein, which are known markers of oral cancer risk. This study investigates the effect of nutritional factors on solCD44 and protein levels to evaluate oral cancer risk and survival. We evaluated solCD44 and protein levels from 150 patients with oral and oropharyngeal squamous cell carcinoma and 150 frequency-matched controls. We subsequently characterized the effect of food group consumption and these biomarkers on progression-free survival (PFS) and overall survival (OS). Patients reported eating fewer servings of salad (p = 0.015), while controls reported eating fewer servings of potatoes (p \u3c 0.001). Oral cancer patients who consumed at least one serving per week of green salad were found to have significantly lower CD44 levels than those who ate salad less frequently (mean of log2[solCD44]1.73 versus 2.25, p = 0.014). Patients who consumed at least one serving per week of “salad or other vegetables” had significantly longer PFS (median 43.5 versus 9.1 months, p = 0.003, adjusted hazard ratio (HR) = 0.39 p = 0.014) and OS (median 83.6 versus 10 months, p = 0.008, adjusted HR = 0.04 p = 0.029). These findings suggest that dietary factors, namely greater green salad and vegetable intake, may be associated with lower CD44 levels and better prognosis in oral cancer patients

Abstract LB-269: Nutritional effect on CD44 in head and neck cancer

Abstract Head and neck (HN) cancer incidence accounts for more than 550,000 cases annually worldwide, with an estimated of 55,000 Americans developing head and neck cancer each year. There are multiple risk factors associated with HN cancer including smoking, alcohol consumption, human papillomavirus (HPV) infection, genetic predisposition, poor oral hygiene, periodontal disease and poor diet. According to World Health Organization (WHO), 35 - 55% of human cancers and approximately 15% of oropharyngeal cancers can be attributed to dietary deficiencies or imbalances. There is convincing evidence that we can reduce the risk of cancer, including that of oral cancer through improved nutrition. CD44 is a cancer stem cell marker associated with HN cancer and poor prognosis. Protein levels in saliva are also associated with HN cancer risk. This study will investigate the relationship between nutritional effect of a balanced diet which includes fruits and vegetables and levels of CD44 and salivary protein. 150 participants diagnosed with HN cancer and 150 controls were frequency matched for tobacco use, alcohol, age, gender, race and socioeconomic status. Participants completed a lifestyle questionnaire which included questions about fruit and vegetable consumption. Oral rinse CD44 and protein levels were measured in both groups. We did a preliminary investigation on the number of servings of juice, salad, fruits, carrots, potato and other vegetables within the cancer case and control groups to determine whether there was an association between these dietary variables and CD44 and protein levels. HN cancer cases who ate salad one or more times per week were found to have significantly lower CD44 levels than those who ate salad less frequently (4.22ng/ml verses 7.09 ng/ml p = 0. 004). Since high CD44 levels are associated with worse prognosis, these findings suggest that dietary factors such as greater salad intake may be associated with better HN cancer prognosis. Citation Format: Turki M. Almuhaimid, Faisal F. Alotaibi, Erika Rearegue, William Goodwin, Elizabeth Franzmann. Nutritional effect on CD44 in head and neck cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-269. doi:10.1158/1538-7445.AM2015-LB-269</jats:p

Multinodular goiter with a retropharyngeal extension: A report of two cases and literature review

Multinodular goiter (MNG) is a chronic benign nodular enlargement of the thyroid gland. It presents as an anterior painless neck mass, potentially progressing to exert pressure on the trachea and esophagus and giving rise to compressive symptoms. MNG is a common thyroid gland disorder; however, retropharyngeal goiter is considered rare with few reported cases. We report the cases of two patients who presented to our institution with MNG with retropharyngeal extension: a 62-year-old female patient who presented with a progressive anterior neck mass with dilated neck veins; and a 49-year-old male who presented with a painless anterior neck mass. Both patients successfully underwent total thyroidectomy with an uneventful postoperative recovery. The clinical presentation of MNG with retropharyngeal extension varies with patients; hence, a high index of suspicion is of the utmost significance. While the retropharyngeal extension does not cause compressive symptoms, it should raise the suspicion of a large retrosternal component

Abstract LB-272: Effect of smoking cessation on soluble CD44 levels in head and neck cancer

Abstract In the past year, an estimated 55,070 individuals were diagnosed with head and neck cancer and approximately 12,000 related deaths occurred. This disease is devastating to the patients and families it affects due to its significant impact on swallowing, speech and appearance. Tobacco, the single largest risk factor for head and neck cancer, accounts for an estimated 85% of head and neck cancers. Carcinogens found in tobacco smoke induce damage to DNA leading to mutations and DNA strand breaks. When not correctly repaired, overexpression of gene products including CD44, a cancer stem cell marker, occurs. CD44 can be cleaved into a soluble form (solCD44) that is found in body fluids. CD44 levels in oral rinses distinguish head and neck cancer patients from controls with around 62% sensitivity and 88% specificity. CD44 becomes abnormally expressed in dysplasia and elevated levels of solCD44 have been found prior to clinical evidence of disease, in some cases. In this study we investigate changes in solCD44 levels with smoking cessation. 150 smokers from a South Florida community known to be at high-risk for oral cancer were recruited and enrolled in smoking cessation programs. At baseline, questions on smoking status, frequency and history were administered to participants. Oral rinses and saliva samples were also collected to determine levels of solCD44 and cotinine, which was used to confirm quit status, using ELISA assays. One year after enrollment (± 3 weeks), samples and questionnaires were taken again from participants to identify quitters and measure their CD44 levels. Results were then computed and analyzed by paired t-test using SAS University Edition. So far, thirty-seven participants (24.6%) reported quitting smoking but only half of them (n = 13) were confirmed by cotinine (&amp;lt;21). For confirmed quitters, the mean solCD44 dropped from 1.81 (SD = 1.29) prior to quitting to 1.65 (SD = 1.12) one year after enrollment. This association between solCD44 level and smoking cessation was not statistically significant (p = 0.65). Four out of 13 quitters had elevated CD44 levels prior to quitting. Three of 4 with elevated levels experienced drops in their CD44 levels following smoking cessation, including 2 subjects whose CD44 level returned to the normal range. Based on this data, a larger number of quitters and/or an additional time points post quitting are needed as it might reveal more profound results. Such results would be critical, offering smoking cessation as a means for subjects with high levels of CD44 to decrease their risk of progression. Citation Format: Faisal F. Alotaibi, Turki M. Almuhaimid, Erika Reategui, Elizabeth Franzmann, Jarrard Goodwin. Effect of smoking cessation on soluble CD44 levels in head and neck cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-272. doi:10.1158/1538-7445.AM2015-LB-272</jats:p

Green Salad Intake Is Associated with Improved Oral Cancer Survival and Lower Soluble CD44 Levels

Deficiencies in fruit and vegetable intake have been associated with oral cancer (oral cavity and oropharyngeal). Salivary rinses contain measurable biomarkers including soluble CD44 (solCD44) and total protein, which are known markers of oral cancer risk. This study investigates the effect of nutritional factors on solCD44 and protein levels to evaluate oral cancer risk and survival. We evaluated solCD44 and protein levels from 150 patients with oral and oropharyngeal squamous cell carcinoma and 150 frequency-matched controls. We subsequently characterized the effect of food group consumption and these biomarkers on progression-free survival (PFS) and overall survival (OS). Patients reported eating fewer servings of salad (p = 0.015), while controls reported eating fewer servings of potatoes (p &lt; 0.001). Oral cancer patients who consumed at least one serving per week of green salad were found to have significantly lower CD44 levels than those who ate salad less frequently (mean of log2[solCD44]1.73 versus 2.25, p = 0.014). Patients who consumed at least one serving per week of &ldquo;salad or other vegetables&rdquo; had significantly longer PFS (median 43.5 versus 9.1 months, p = 0.003, adjusted hazard ratio (HR) = 0.39 p = 0.014) and OS (median 83.6 versus 10 months, p = 0.008, adjusted HR = 0.04 p = 0.029). These findings suggest that dietary factors, namely greater green salad and vegetable intake, may be associated with lower CD44 levels and better prognosis in oral cancer patients