title: Association of serum and salivary tumor necrosis factor-α with histological grading in oral cancer and its role in differentiating premalignant and malignant oral disease.
abstract: BACKGROUND
  Oral squamous cell carcinoma (OSCC) is an important malignancy throughout the world; early detection is an important criterion for achieving high cure rate. Out of the many reported markers for OSCC, this study validated the efficacy of tumor necrosis factor-α (TNF- α) in differentially diagnosing premalignant oral lesions and OSCC. Also, the study aimed to correlate the levels of salivary and serum TNF- α with clinicopathologic factors.
  
  
  METHODS
  A prospective experimental laboratory study was designed. Serum and salivary samples from 100 subjects in each group of healthy control, premalignant disease (PMD) and OSCC were collected for the study following appropriate exclusion and inclusion criteria. Serum and salivary level of TNF-α was analysed by enzyme linked immunosorbent assay. The data obtained were subjected to appropriate statistical analysis.
  
  
  RESULTS
  Increased level of both serum and salivary TNF- α was observed in OSCC subjects compared to healthy control and PMD group. Receiver operator characteristic curve analysis and area under curve values showed high specificity and sensitivity for salivary TNF-α in differentiating OSCC from PMD and healthy controls. There was significant increase in TNF- α level in moderately and poorly differentiated lesion compared to well differentiated lesion and in stage IV of clinical stage. A positive correlation was observed only with histological grading of OSCC and TNF- α.
  
  
  CONCLUSIONS
  Salivary TNF-α is proved to be superior for detecting OSCC. Increase in TNF-α with histological grading and clinical staging suggests a role in prognosis.
authors.affiliation: Department of Oral and Maxillofacial Pathology, SRM Dental College, SRM University, Chennai E-mail : drrajkumaromp@gmail.com.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Krishnan
authors.forename: Dinesh Kumar
authors.initials: DK
authors.lastname: Thayalan
authors.forename: Rajashree
authors.initials: R
authors.lastname: Padmanaban
authors.forename: Ramya
authors.initials: R
authors.lastname: Ramadas
authors.forename: Ramesh Kumar
authors.initials: RK
authors.lastname: Annasamy
authors.forename: Nirmala
authors.initials: N
authors.lastname: Anandan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D060787:Neoplasm Grading; D011230:Precancerous Conditions / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D012463:Saliva / Q000737:chemistry*; D000077195:Squamous Cell Carcinoma of Head and Neck; D014409:Tumor Necrosis Factor-alpha / Q000097:blood* / Q000378:metabolism; D055815:Young Adult
chemical_list: D014409:Tumor Necrosis Factor-alpha