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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 2  |  Page : 53-60

Serum l-fucose levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions and oral squamous cell carcinoma: An original research article


1 Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Oral Medicine and Radiology, Saraswati Dhanwantari Dental College and Hospital and Post-graduate Research Institute, Parbhani, Maharashtra, India
3 Department of Oral and Maxillofacial Surgery, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
4 Department of Oral and Maxillofacial Surgery, Malla Reddy Dental College for Women, Hyderabad, Telangana, India

Date of Web Publication30-Dec-2019

Correspondence Address:
Dr. Abhishek Singh Nayyar
Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College and Hospital, Post Graduate Research Institute, Parbhani, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jco.jco_9_19

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  Abstract 

Context and Aim: Tumor markers are specific substances released either by the tumor or, the host while combating the tumor into the serum. Altered concentration of these biomarkers in the serum or, saliva of an individual, then, gives the signal of the future alarming condition pertaining to the process of frank malignant transformations. l-Fucose is one such tumor marker detectable in serum which can be used as an important biomarker for the detection, monitoring and for prognostic assessment of the potentially malignant disorders. The purpose of the present study was to estimate and evaluate the efficacy of serum l-Fucose levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions (PMELs) including leukoplakia, OSMF and OSCC patients. Materials and Methods: The present observational study was conducted over a period of 2 years wherein a total of 100 subjects aged between 18 to 60 years clinically diagnosed and histopathologically confirmed as patients with oral leukoplakia, OSMF and OSCC between the age range of 20-60 years were included. The patients were subjected to incisional biopsy after routine hematological investigation. The same sera samples were, then, used for the analysis of serum l-Fucose levels. Statistical Analysis Used: The statistical analysis was done using the Statistical Package for Social Sciences (SPSS version 17.0, EPI-INFO 6.0 version) and Graph Pad Prism version 5.0 (Chicago, USA). Comparison of serum L-Fucose levels with the control group was performed using one way Analysis of Variance (one way ANOVA) test (F-Test) while frequencies were compared with the help of chi-square test. Inter-group comparisons and multiple comparisons were done with the help of Tukey’s Test. P < 0.05 was considered statistically significant. Results: On comparing serum l-Fucose levels in the patients of the four groups, a statistically significant difference was found in the values of the mean serum l-Fucose levels in all the four groups (p < 0.05). Conclusion: The observations of the present study revealed that serum l-Fucose levels were found to be raised in all the three groups and showcased an increasing trend with the progression of the severity of the disease from the potentially malignant to the malignant stages.

Keywords: serum and salivary biomarkers, serum l-fucose, early detection, oral potentially malignant epithelial lesions, oral squamous cell carcinoma


How to cite this article:
Khan FA, Chandak R, Nayyar AS, Chandran A, Nachiappan S, Reddy G S. Serum l-fucose levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions and oral squamous cell carcinoma: An original research article. J Curr Oncol 2019;2:53-60

How to cite this URL:
Khan FA, Chandak R, Nayyar AS, Chandran A, Nachiappan S, Reddy G S. Serum l-fucose levels as a potential biomarker in the early detection of oral potentially malignant epithelial lesions and oral squamous cell carcinoma: An original research article. J Curr Oncol [serial online] 2019 [cited 2020 Feb 17];2:53-60. Available from: http://www.journalofcurrentoncology.org/text.asp?2019/2/2/53/274306




  Introduction Top


Oral potentially malignant epithelial lesions (PMELs) are defined as those lesions and/or conditions of the oral mucosa that are dysplastic but not frankly malignant but are more prone to turning into frank malignant degenerations.[1] The term “precancerous lesion/condition” has been discarded as not all these lesions/conditions turn into malignancies.[2],[3] The most common among these PMELs is leukoplakia, which is a tobacco-related PMEL seen as a white patch or plaque that cannot be characterized clinically or histopathologically as any other disease. The definition indicates that the term “leukoplakia” does not carry a histological connotation and should be used only in descriptive clinical context.[4] The rate of malignant transformation of leukoplakia has been rated as around 0.13%34%.[5] Likewise, erythroplakia is nothing apart from an advanced stage or variant of leukoplakia, which has predominant red elements in it, indicating even higher chances of dysplasia and being more prone for malignant transformation. To add to this list, oral submucous fibrosis (OSMF) is described as an insidious chronic disease process affecting any part of the oral mucosa and sometimes, even involving the pharyngeal and laryngeal mucosa associated with juxta-epithelial inflammatory reaction followed by fibroelastic changes in the lamina propria with epithelial atrophy, leading to stiffness of the oral mucosa causing trismus and inability to eat.[6] The condition is characterized by burning sensation of the oral mucosa assisted with ulceration and pain, blanching of the mucosa, depapillation of the tongue, depigmentation of the mucosa, and progressive reduction of mouth opening.[2] The overall prevalence of OSMF in India is estimated to be approximately 0.2%–0.5%, and the prevalence is seen to vary with gender, that is, 0.2%2.3% in males and 1.2%4.57% in females, with the smokeless form of tobacco being the more common form of tobacco to be used by the females, even more than the males. The malignant transformation rate of OSMF ranges between 2.3% and 7.6%.[7]

Oral cancer is the most common malignancy known in the head and neck region and is one of the major causes of deaths worldwide. Approximately 80,000 new cases of oral cancers are diagnosed each year, mainly due to consumption of different forms of tobacco.[8] Annually, 130,000 people succumb to oral cancers, which translates into approximately 14 deaths per hour in India.[9] The most commonly encountered oral neoplasm is oral squamous cell carcinoma (OSCC), and it accounts for 95% of all the oral cancers reported.[5] Squamous cell carcinoma has been defined by Pindborg and Sirsat[6] as a malignant epithelial neoplasm showing squamous differentiation characterized by the formation of keratin and/or the presence of intercellular bridges. All PMELs, eventually, progress to develop invasive OSCCs. To predict this aggressiveness, grading of the neoplasm is carried out, and it helps in the assessment of prognosis as well as deciding treatment guidelines for the disease. This grading is generally based on the assessment of the degree of keratinization, cellular and nuclear pleomorphism, and mitotic activity.[5]

Despite the recent advances in cancer treatments, the outcome and prognosis of OSCC is still relatively poor. The lacuna for this lies in the late diagnosis of the neoplasm when the tumor is already in advanced stages of the disease.[10] An early enough diagnosis is thus highly warranted to initiate treatment in the initial stage itself to arrest the progression of the malignant process. Such measures, therefore, are of great help and are desired for an early detection of this dreaded disease so as to ensue an early treatment, thereby reducing the mortality and morbidity, in case the patient survives, up to a certain level. The stability, progress of PMELs into frank malignancies, and/or their regression, though are not predictable by clinical and histological features, and here comes the role of tumor markers, which are certain specific substances released either by the tumor or the host while combating the tumor into the serum. The identification of such substances, which can predict disease progression is thus of utmost importance in the management of these lesions.[11]

Classically, a marker is synthesized by the tumor and released into circulation at the cell surface in large quantities by the malignant cells during the process. Altered concentration of these biomarkers in the serum or saliva of an individual, then gives the signal of the future alarming condition pertaining to the process of frank malignant transformations.[12]l-fucose is a hexose (C6H12O5) and a terminal sugar in most of the plasma glycoproteins. It is required for the optimum function of cell-to-cell communication and is a powerful immune modulator as it is an important constituent of macrophages, which are the important immune-mediating cells.[13] Elevation of l-fucose levels in the serum and other body fluids is due to the release of preformed glycoproteins from the tissue as a result of tissue destruction or may be caused by an increased local synthesis and liberation of such glycoproteins by the tumor cells. Several investigators have reported that monitoring serum or tissue l-fucose levels could be a promising approach for the early detection, diagnosis, and prognosis of cancers.[11],[14],[15] Physiologically, l-fucose is observed in lower concentrations in the serum but its levels are increased significantly in potentially malignant disorders, cancers, and several other disease processes, wherein the immune activity is enhanced in the host. Elevated tissue or serum l-fucose levels have been reported in leukemias, brain tumors, and numerous other malignant lesions apart from nonneoplastic conditions, including cirrhosis of liver, meningitis, rickets and osteomalacia, tuberculosis, and numerous cardiovascular disorders.[16] The purpose of this study was to estimate and evaluate the efficacy of serum l-fucose levels as a potential biomarker in the early detection of oral PMELs, including leukoplakia, OSMF, and OSCC.


  Materials and Methods Top


This observational study was conducted in the department of oral medicine and radiology for 2 years, wherein a total of 100 subjects aged between 18 and 60 years and clinically diagnosed and histopathologically confirmed as patients with oral leukoplakia, OSMF, and OSCC between the age range of 20 and 60 years were divided into four groups with each group consisting of 25 patients: group A consisting of 25 healthy controls who had no major illness in the recent past, group B with 25 patients clinically diagnosed with oral leukoplakia, group C with 25 patients clinically diagnosed with OSMF, and group D with 25 patients clinically diagnosed with OSCC. Patients with a present or past history of any major illness such as liver disease, diabetes, hypertension, and tuberculosis, patients undergoing radiotherapy or chemotherapy for cancer, and patients with a history of malignancy other than oral cancers and individuals >60 years of age with severely compromised immunity were excluded. Biopsy was considered as the gold standard for the confirmation of the said diagnoses. Ethical clearance was obtained from the Institutional Ethics Committee. The subjects were informed in detail regarding the need and protocol of the study, and a written, informed consent was obtained from them. The patients were then examined thoroughly [Figure 1], and a detailed case history was recorded in a specially designed pro forma. The patients were subjected to incisional biopsy taking tissue from the periphery of the lesions along with adjacent normal tissue after routine hematological investigation. The same sera samples were used for the analysis of sera l-fucose levels.
Figure 1: Armamentarium for clinical examination

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Collection of sample: Approximately 5mL of venous blood was drawn from the healthy subjects from the control group included in the study, whereas for patients with oral leukoplakia, OSMF, and OSCC, this procedure was carried out as a part of routine hematological investigation performed before biopsy. The samples of blood drawn were transferred to sterilized plain test tubes and allowed to clot at room temperature. The clot was then separated and centrifuged at 3000rpm for 15min to get clear sera samples. The samples were stored at -20°C temperature, and the required assay was performed with the help of select enzyme-linked immunosorbent assay (ELISA) kits. The serum l-Fucose level estimation was done by Human L-Fucose kinase (FUK) ELISA kit by CUSABIOCSB-EL009065HU (Biocompare, South San Francisco, CA, USA) [Figure 2].
Figure 2: Human l-fucose kinase (FUK) ELISA kit by CUSABIOCSB-EL009065HU for estimation of serum l-fucose levels

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Procedure for seruml-fucose level estimation: Serum l-fucose assay was based on quantitative sandwich enzyme immunoassay technique. The microplate was pre-coated with antibody, which was specific for FUK. Standards and samples were drawn into the wells with the help of pipette, and any FUK present got bound by the immobilized antibody. After removing any unbound substances, a biotin-conjugated antibody specific for FUK was added to the wells. After washing, avidin-conjugated horse radish peroxidase was added to the wells. The wells were then washed to remove any unbound avidin–enzyme reagent, followed by the addition of substrate solution, and the intensity of the color developed, which was in proportion to the amount of FUK bound in the initial step was measured using a microplate reader set to 450nm.

Statistical analysis: The data were statistically analyzed using the Statistical Package for the Social Sciences (SPSS version 17.0, EPI-INFO 6.0 version) and Graph Pad Prism version 5.0 (Chicago, USA). Comparison of serum l-fucose levels with the control group was performed using one-way analysis of variance (ANOVA) test (F test), whereas frequencies were compared with the help of chi-square test. Intergroup comparisons and multiple comparisons were carried out with the help of Tukey test. P < 0.05 was considered statistically significant.


  Results Top


[Table 1] reveals age-wise distribution of the patients showing that 64% of the patients in group A, 8% in group B, and 36% in group C were in the age-group of 2029 years, whereas 32% in group A, 24% in group B, 20% in group C, and 4% in group D were in the age-group of 3039 years. As the age advanced, 4% of the patients in group A, 52% in group B, 28% in group C, and 24% in group D were in the age-group of 4049 years, and 16% in group B and C and 64% in group D were in the age-group of 5059 years. By using chi-square test, statistically significant difference was found in the mean ages of the patients in the four groups (χ2 value = 69.50, P = 0.0001). [Table 2] reveals gender-wise distribution of patients showing that 64% of the patients in group A, 96% in group B, and 84% in group C and D each were males, whereas 36% of the patients in group A, 4% in group B, and 16% in group C and D each were females. By using chi-square analysis, statistically significant difference was found, again, as far as the gender of the patients was concerned in all four groups (χ2 value = 8.94, P = 0.030). [Table 3] reveals habit-wise distribution of patients showing that 16% of the patients in group A, 68% in group B, 96% in group C, and 36% in group D had a history of gutkha chewing, whereas 4% of the patients in group A and C each and 8% in group D had a history of betel nut chewing. Furthermore, 4% of the patients in group A and 32% of the patients each in group B and group D had a history of smoking, and 24% of the patients in group D had a history of alcohol consumption. Also, 76% of the patients in group A had no habit. Analyzing the findings using chi-square test revealed statistically significant difference in relation to the habit-wise distribution of the patients in all four groups (χ2 value = 107.60, P = 0.0001). [Table 4] reveals the descriptive statistics comparing mean serum l-fucose levels in the groups. The mean serum l-fucose level in the patients of group A was found to be 6.90 ± 0.91 mg/dL, whereas the corresponding values in group B, group C, and group D were found to be 15 ± 1.82, 13.28 ± 1.03, and 17.82 ± 2.17mg/dL, respectively. One-way ANOVA revealed variation in the values in the four groups to be statistically significant (F value = 214.35, P = 0.0001) [Table 5]. On comparing serum l-fucose levels in the patients of the four groups, a statistically significant difference was found in the values of the mean serum l-fucose levels in all the four groups (P < 0.05) [Table 6].
Table 1: Age-wise distribution of patients

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Table 2: Gender-wise distribution of patients

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Table 3: Habit-wise distribution of patients

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Table 4: Comparison of serum l-fucose levels in the groups: descriptive statistics

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Table 5: One-way ANOVA

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Table 6: Multiple Comparisons: Tukey’s Test

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  Discussion Top


Cancer, a disorder of cellular behavior, is characterized by alteration of serum glycoproteins and cell surface glycosylation changes and is associated with various types of transformation processes. Early detection and early treatment of PMELs and oral cancers not only reduces the mortality but also renders quality life to the survivors. A majority of neoplasms are preventable as well as curable if they are detected in the early enough stages, especially PMELs such as oral leukoplakia and OSMF, which usually precede frank oral cancer, are amenable to treatment.[17] Biomarkers provide a noninvasive means of diagnosis, facilitate early detection of PMELs or malignant conditions, and their early treatment eventually affects the prognosis these lesions have after treatment. Cell membrane mainly consists of glycoproteins and glycolipids. Glycoproteins are protein–carbohydrate complexes in which oligosaccharides and/or polysaccharides are joined to specific amino acids of proteins by covalent linkages.[17] The carbohydrate portion contains amino sugars such as glucosamine, galactosamine, and sialic acid, and hexoses such as galactose, mannose, or l-fucose. l-fucose is one of the glycoconjugate, which plays a major and important role in cell-to-cell interactions, development of cell adhesion, malignant transformation, and in the process of metastasis.[13]

Literature has documented that malignant cells modulate their surface by increasing fucosylation, thereby escaping recognition and resulting in decreased adhesion, eventually leading to uncontrolled tumor growth.[18] Increase in the turnover of cells increases the release of glycoproteins in the circulation. The exact mechanism or reason for increase in serum l-fucose levels is, though, still not clearly understood. According to some researchers, increased destruction and proliferation of diseased tissue may be one of the factors for its elevation. Shetlar et al.[19] suggested that the elevation of l-fucose levels in serum is due to tissue destruction and release of preformed l-fucose at the site or may be due to increased proliferation of the tissue. According to Rai et al.,[10] in oral cancers, elevated serum l-fucose levels may be a cancer product getting filtered in the blood stream or may be due to the generalized effect of oral cancer on the body metabolism. Elevated levels of serum l-fucose have also been reported in various other pathological conditions such as liver cirrhosis, osteomalacia, tuberculosis, cardiovascular disorders, and meningitis depressive disorders, and also in numerous malignancies such as in cases of breast cancers and leukemias. An alteration in the levels of serum l-fucose may be due to increasing tumor burden and due to primary or secondary inflammatory reactions. Thus, it is imperative to exclude these degenerative and proliferative diseases while estimating l-fucose levels for oral cancers. Few studies have also reported decrease in the levels of serum l-fucose posttreatment after successive long periodic follow-ups. Till now, many researchers have developed and successfully showed the use of protein markers as biomarkers in the diagnosis and management of oral cancers, several of which are marketed too. This study evaluated the diagnostic utility of serum l-fucose as a potential cancer marker. This study was carried out in the department of oral medicine and radiology with patients reported to be having PMELs and OSCC. In the course of investigation, commercially available kit for the detection of serum l-fucose levels manufactured by human l-fucose kinase (FUK) ELISA Kit was used.

The age of the patients in the control group (A), patients with oral leukoplakia (B), OSMF (C), and OSCC (D) ranged from 2040, 2855, 2255, and 3960 years, respectively, thus showcasing a broad range of probability of the occurrence of the said PMELs and OSCC in the affected patients. The mean age for OSCC (D) was found to be 53 years indicating its peak incidence in the fifth decade of age. From the analysis of data, it was evident that OSCC showed progression with aging and became evident in the fifth decade of life. This observation was in accordance with the study conducted by Pradeep et al.[20] and Shetty et al.[13] in which the mean age observed in OSCC was found to be 51 and 55.92 ± 10.17 years, respectively. There are varying reports on sex ratio in the different published studies. In this study, of 25 patients with oral leukoplakia, 24 (96%), 25 patients with OSMF, 21 (84%), 25 patients with OSCC, 21 (84%) of the patients were males, whereas 1 (4%), 4 (16%), and 4 (16%) of the patients were females, respectively, indicating a male predominance in all the four said groups. The male to female ratio in the OSCC group in this study was found to be 5.25:1, which was similar to the findings of the study conducted by Shetty et al.[13] who found a higher male prevalence reported for the lesions with a male to female ratio of 5:1. In other studies by Elango et al.[21] and Mehrotra and Yadav,[22] the male-to-female ratio was found to be 4:1, whereas the mean age of the patients was observed to be 55.92 ± 10.17 years.

The occurrence of PMELs and oral cancers is found to be higher in the males, and this might be due to the much prevalent habit of chewing gutkha, betel nut, smoking, and drinking alcohol, and so on, in males as compared to the females. Literature is abuzz with correlation of oral malignancies and habits such as smoking and tobacco chewing. Gutkha chewing (36%) and smoking (32%) were the most common habits found in this study followed by alcohol (24%) along with betel nut chewing (8%). Thus, gutkha chewing, smoking, and alcohol were found to be the major risk factors as found from the observations in this study. Similar risk factors in head and neck malignancies have been reported in various other studies including the ones conducted by Shashikant and Rao[23] and Day and Blot.[24]

As per the values recorded for the said markers in this study, regarding serum l-fucose levels, it was observed that with the progression of PMELs such as oral leukoplakia (B) and OSMF (C) and OSCC (D), serum l-fucose levels showed a significant (P < 0.05) increase with the corresponding values being 15 ± 1.82, 13.28 ± 1.03, and 17.82 ± 2.17mg/dL, respectively, and also in comparison with the normal controls (A), 6.91 ± 1mg/dL, indicating the increasing trend of serum l-fucose levels from the patients with OSMF (C) and oral leukoplakia (B) toward the patients affected with OSCC (D). It has been known since long regarding the presence of l-fucose in serum glycoproteins as was first shown by Waldron and Woodhouse.[25] It is noteworthy that l-fucose is the only sugar that represents l-form, and hence selectively differentiates in the photoelectric field, and that is the reason it is easy to detect colorimetrically as suggested by Dische and Shettles.[26] Further determination of l-fucose in serum-bound glycoproteins was determined by Winzler,[27] who suggested the modified protocol based on the protocol given by Dische and Shettles.[26]

Now with the advancement in the technology, automated analyzer capable of even 25 mmol of l-fucose per liter could be assayed successfully as per the kit developed by Sakai et al.[28] As per kit assay, the present analysis showcased mean serum protein–bound l-fucose levels in the controls to be around 6.90 ± 1mg/dL, closer to the results in the studies conducted by Shetty et al.[13] and Kumar et al.[29] who reported the mean serum l-fucose levels in controls to be around 4.74 ± 1.55 and 7.22 ± 0.26mg/dL, respectively. In another study conducted by Pradeep et al.,[20] the mean serum l-fucose level in controls was found to be 3.3181 ± 2.31mg/dL. Parwani and Parwani,[30] in their study, found the mean serum l-fucose level as 5.323 ± 6767mg/dL. Another study by Rai et al.[10] highlighted the mean serum l-fucose level to be 5.29 ± 2.18mg/dL close to the finding of this study. In this study, the mean serum l-fucose levels in the PMELs including oral leukoplakia (B), OSMF (C), and OSCC (D) were recorded to be on the higher side as expected, and were found to be 15 ± 1.82, 13.28 ± 1.03, and 17.82 ± 2.17mg/dL, respectively, signifying the potential role of serum l-fucose levels as a biomarker of choice in the early detection of PMELs and OSCC as well as the propensity of the said PMELs to getting transformed into frank malignant lesions with the said levels to depict an ever increasing trend from OSMF to oral leukoplakia to frank OSCC. In agreement to the findings of this study, serum l-fucose levels showed an increase from during the precancerous stage toward transforming into frank cancerous stage as highlighted previously in numerous other studies conducted on the same grounds.

In early years of 1955, Winzler[27] observed a significant change in serum protein bound l-fucose levels in patients with cancer. Likewise, in a study conducted by Sakai et al.,[28] in advanced stages of cancers, patients showed serum l-fucose levels to be around 14.2 ± 2.1 mg% as against the normal controls who revealed the vales to be around 8.9 ± 0.6 mg%. This study found similar variations in the study groups wherein the assay was carried out with the help of highly specific ELISA-based assay kits confirming the significant rise in serum l-fucose levels in the PMELs and frank OSCC, and hence reported regarding the potential use and marker status that serum l-fucose possessed may become an ideal marker in the probable early detection of PMELs and early cancer detection. Likewise, in a study conducted by Rai et al.,[10] highly significant results were obtained regarding serum l-fucose levels in patients with OSCC as well as oral leukoplakia compared to the normal controls. Furthermore, there was a gradual increase in the values noted from the controls (5.29 ± 2.18mg/dL) to oral leukoplakia (8.95 ± 1.92mg/dL) and to OSCC (13.85 ± 4.34mg/dL) almost similar to the findings of this study.

According to Shetty et al.,[13] in head and neck malignancies, serum glycoprotein l-fucose levels in the two groups showed more than a twofold rise in the cases as compared to those in the controls with mean values being 11.33 ± 7.39 and 4.74 ± 1.55mg/dL in the cases and controls, respectively. Though no relationship was observed between the serum l-fucose levels according to age, sex, and the level of differentiation of the tumor as was observed in the study. Similar findings were noted in another study conducted by Parwani and Parwani,[30] wherein again serum l-fucose levels were found to be independent of the age and sex in the subjects included; however, the said study also revealed significant increase in mean serum l-fucose levels in patients with OSCC (15.34 ± 0.86mg/dL) as compared with the healthy controls (5.323 ± 6767mg/dL) in confirmation with the results of this study. Kumar et al.[29] also found significantly higher levels of serum l-fucose levels in oral cancer cases (46.63 ± 5.29mg/dL) as compared to the controls (7.22 ± 0.26mg/dL), and also correlated the same with the histopathological grading of oral cancer in the patients. Though the values obtained were much higher in the patients with OSCC (46.63 ± 5.29mg/dL) than the levels observed in this study (17.82 ± 2.17mg/dL), confirming an increasing trend in serum l-fucose levels with the grades of carcinoma in the patients included.

The variations in the values obtained in the said studies could be explained on the basis of the difference in the method of assessment of the biomarkers used in different studies. Poojary et al.[31] suggested the severity of the lesions, the stage, and the inflammation of the tissues to be the compounding reasons for the significant increase observed regarding serum l-fucose levels in the various stages of precancers and cancers. The results obtained in the said study were also found to be in close confirmation of the results obtained in this study, wherein a significant rise was observed in precancer and cancerous stages as compared to the subjects in the control group. In a similar kind of study conducted by Solanki et al.[32] on patients with breast cancer, the mean serum l-fucose levels were found to be 19.51 ± 0.86 mg% in case of malignant lesions as against 11.55 ± 1.15 mg% in case of benign tumors. The said study also proved a strong relation of serum l-fucose levels with cancers close to the findings of this study and numerous other studies conducted on similar grounds. Keeping the said findings in consideration, further investigations are therefore required to confirm the significance of the said marker as serum l-fucose levels showed a remarkable difference with the progression of the PMELs into frank OSCC and could be the marker of choice based on its reliability for the diagnosis of PMELs as well as OSCC and to check for the progression of PMELs turning into frank OSCC.

Limitations of this study: One of the significant limitations of this study was that the serum l-fucose levels were not correlated with the histopathological grading and staging of the included PMELs including oral leukoplakia, OSMF, and OSCC. Also, posttreatment serum l-fucose levels were not evaluated, so their impact on the prognosis of the lesions or their ability to predict the prognosis of the said lesions could not be commented on.


  Conclusion Top


The observations of this study revealed that serum l-fucose levels were found to be raised in all the three groups and showcased an increasing trend with the progression of the severity of the disease from the potentially malignant to the malignant stages. Also, a definitive association was found between the harmful habits in decreasing order of gutkha chewing, smoking, alcohol, and betel nut consumption to the incidence of the PMELs and OSCC. Thus, it could be concluded from the observations made in this study that serum l-fucose in conjunction with the clinical diagnostic procedures can be used as a potentially reliable, adjunctive serological marker for monitoring and assessing the precancers and cancer and also their disease severity.

Acknowledgement

We would like to thank all the patients who contributed in the study without whom this study would not have been feasible.

Financial support and sponsorship

Nil.

Conflicts of interests

There are no conflicts of interest.



 
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    Figures

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    Tables

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