Pre-Treatment Levels of C-Reactive Protein and Squamous Cell Carcinoma Antigen for Predicting the Aggressiveness of Pharyngolaryngeal Carcinoma

<div><p>The levels of squamous cell carcinoma antigen (SCC-Ag) and C-reactive protein (CRP) can be used to predict tumor invasion, lymph node metastasis, staging and survival in patients with oral cavity cancer. The present study analyzed the relationship between pre-treatment levels of SCC-Ag and CRP in relation to clinicopathological factors in patients with pharyngolaryngeal cancer (PLC) and determined whether elevated levels of CRP and SCC-Ag were associated with tumor metabolic activity via [18F] fluorodeoxyglucose positron emission tomography (FDG-PET). We retrospectively recruited one hundred and six PLC patients between June 2008 and December 2011. All patients received computed tomography (CT)/magnetic resonance imaging (MRI) and FDG-PET staging analyses, and the serum levels of SCC-Ag and CRP in these patients were measured prior to treatment. A SCC-Ag level ≥2.0 ng/ml and a CRP level ≥5.0 mg/L were significantly associated with clinical stage (P<0.001), clinical tumor status (P<0.001), and clinical nodal status (P<0.001). The elevation of both SCC-Ag and CRP levels was correlated with the standardized uptake value (SUV) max of the tumor (≥8.6 mg/L) and lymph nodes (≥5.7 ng/ml) (P = 0.019). The present study demonstrated that the presence of high levels of both pre-treatment SCC-Ag and CRP acts as a predictor of clinical stage, clinical tumor status, and clinical nodal status in patients with PLC. Moreover, elevated levels of SCC-Ag and CRP were associated with a high metabolic rate as well as the proliferative activity measured according to the SUVmax of the tumor and lymph nodes. Therefore, elevated levels of these two factors have the potential to serve as biomarkers for the prediction of tumor aggressiveness in cases of PLC.</p> </div

Characteristics of the 106 pharyngolaryngeal carcinoma patients.

*<p>SD: Standard deviation.</p

The associations between preoperative SUVtumor-max/SUVnodal-max and CRP/SCC-Ag (n = 106).

<p>Abbreviation: CRP: C-reactive protein;SCC-Ag: squamous cell carcinoma antigen; SUVtumor-max: maximum standardized uptake valve in tumor; SUVnodal-max: maximum standardized uptake valve in lymph nodes.</p><p>CRP (−): CRP level <5.0 mg/L; CRP (+): CRP level ≥5.0 mg/L; SCC-Ag (−): SCC-Ag <2.0 ng/ml; SCC-Ag (+): SCC-Ag ≥2.0 ng/ml.</p><p>SUVtumor-max (−): SUVtumor-max level <8.6 mg/L; SUVtumor-max (+): SUVtumor-max level ≥8.6 mg/L; SUVnodal-max (−): SUVnodal-max <5.7 ng/ml; SUVnodal-max (+): SUVnodal-max ≥5.7 ng/ml.</p>*<p>Chi-square test.</p

Univariate Log-rank test of prognostic covariates in 103 patients with pharyngolaryngeal squamous cell carcinoma regarding 4-year disease-free and overall survival.

<p>Abbreviation: CRP: C-reactive protein;SCC-Ag: squamous cell carcinoma antigen.</p><p>CRP (−): CRP level <5.0 mg/L; CRP (+): CRP level ≥5.0 mg/L; SCC-Ag (−): SCC-Ag <2.0 ng/ml; SCC-Ag (+): SCC-Ag ≥2.0 ng/ml.</p>†<p>differentiation: 8 cases the differentiation could not be identified.</p

The associations between preoperative CRP, SCC-Ag, SUVtumor-max, SUVnodal-max and clinicopathologic parameters (n = 106).

<p>Abbreviation: CRP: C-reactive protein;SCC-Ag: squamous cell carcinoma antigen; SUVtumor-max: maximum standardized uptake valve in tumor; SUVnodal-max: maximum standardized uptake valve in lymph nodes.</p><p>CRP (−): CRP level <5.0 mg/L; CRP (+): CRP level ≥5.0 mg/L; SCC-Ag (−): SCC-Ag <2.0 ng/ml; SCC-Ag (+): SCC-Ag ≥2.0 ng/ml;</p><p>SUVtumor-max (−): SUVtumor-max level <8.6 mg/L; SUVtumor-max (+): SUVtumor-max level ≥8.6 mg/L; SUVnodal-max (−): SUVnodal-max <5.7 ng/ml; SUVnodal-max (+): SUVnodal-max ≥5.7 ng/ml.</p>*<p>Chi-square test; **Chi-square trend test; †differentiation: 8 cases the differentiation could not be identified.</p

The associations between preoperative CRP, SCC-Ag and clinicopathologic parameters (N = 106).

<p>Abbreviation: CRP: C-reactive protein;SCC-Ag: squamous cell carcinoma antigen; SUVtumor-max: maximum standardized uptake valve in tumor; SUVnodal-max: maximum standardized uptake valve in lymph nodes.</p><p>CRP (−): CRP level <5.0 mg/L; CRP (+): CRP level ≥5.0 mg/L; SCC-Ag (−): SCC-Ag <2.0 ng/ml; SCC-Ag (+): SCC-Ag ≥2.0 ng/ml.</p>*<p>Chi-square trend test;</p>†<p>differentiation: 8 cases the differentiation could not be identified.</p

Additional file 1: of Roles of preoperative C-reactive protein are more relevant in buccal cancer than other subsites

Clinical information of 343 OSCC patients. (SAV 100 kb

Fairness and the Architecture of Responsibility

This essay explores a conception of responsibility at work in moral and criminal responsibility. Our conception draws on work in the compatibilist tradition that focuses on the choices of agents who are reasons-responsive and work in criminal jurisprudence that understands responsibility in terms of the choices of agents who have capacities for practical reason and whose situation affords them the fair opportunity to avoid wrongdoing. Our conception brings together the dimensions of normative competence and situational control, and we factor normative competence into cognitive and volitional capacities, which we treat as equally important to normative competence and responsibility. Normative competence and situational control can and should be understood as expressing a common concern that blame and punishment presuppose that the agent had a fair opportunity to avoid wrongdoing. This fair opportunity is the umbrella concept in our understanding of responsibility, one that explains it distinctive architecture

Characteristics of all patients.

a<p>Significant difference, <i>p</i> – value <0.05.</p

OS and RFS for patients treated with or without CCRT stratified based on different factors.

<p>OS and RFS for patients treated with or without CCRT stratified based on different factors.</p