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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 31  |  Issue : 4  |  Page : 323-327

Serum lipid profile in patients with oral potentially malignant disorders


Department of Oral Medicine and Radiology, St. Joseph Dental College, Duggirala, Eluru, Andhra Pradesh, India

Date of Submission20-Sep-2019
Date of Acceptance23-Dec-2019
Date of Web Publication03-Mar-2020

Correspondence Address:
Dr. Goteti Elizabeth Sharanya
Department of Oral Medicine and Radiology, St. Joseph Dental College, Duggirala, - 534 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_167_19

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   Abstract 


Aim: To estimate serum lipid profile in patients with oral potentially malignant disorders. Materials and Methods: Around 100 patients with oral potentially malignant disorders and 20 patients as controls were subjected to serum lipid profile after obtaining institutional ethical clearance. Estimation of lipid profile value was done for total serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and triglycerides (TG) using Endpoint method. Results: HDL levels were significantly lower in females with oral potentially malignant disorders (P = 0.047). The mean value of total cholesterol, HDL, VLDL, and TG was lower in leukoplakia compared to lichen planus, smoker's palate, combined leukoplakia, and smoker's palate lesion and oral submucous fibrosis, i.e. 140.78, 32.444, 28.444, 141.33, respectively. The mean value of LDL was low in lichen planus compared to other groups, i.e. 73.167. Conclusion: This study concluded that the lower serum lipid levels might serve as a diagnostic indicator or marker in the early diagnosis of oral potentially malignant disorders in females.

Keywords: Biomarkers, oral cancer, oral potentially malignant disorders, serum lipid profile


How to cite this article:
Ramaswamy P, Kiran CS, Raju B M, Swathi M, Anusha A, Sharanya GE. Serum lipid profile in patients with oral potentially malignant disorders. J Indian Acad Oral Med Radiol 2019;31:323-7

How to cite this URL:
Ramaswamy P, Kiran CS, Raju B M, Swathi M, Anusha A, Sharanya GE. Serum lipid profile in patients with oral potentially malignant disorders. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2020 Apr 4];31:323-7. Available from: http://www.jiaomr.in/text.asp?2019/31/4/323/279856




   Introduction Top


Oral cancer is ranked as the sixth most common cancer worldwide.[1] Oral squamous cell carcinoma constitutes about 94% of all oral cancers.[2] Although early detection is the key to control oral cancer, for a better outcome; cancer needs to be diagnosed as early as possible, since early detection serves as a means of secondary prevention.[3] Specific oral potentially malignant disorders precede oral cancer; the most common among them are the oral leukoplakia, oral submucous fibrosis (OSMF), oral lichen planus, and smoker's palate in patients with smoking habit.[4] Moreover, consumption of tobacco, areca nut, alcohol are considered risk factors for carcinoma development which may further result in increased free radicals production.[5]

Increase in clinical severity of the disease may be accompanied by epithelial hyperplasia or atrophy. These atrophic changes in mucosa predispose to malignant changes in epithelium.[6] An intricate mechanism comprising of proliferation, apoptosis, and differentiation leads to tumor development and progression, and the interaction between these complex processes decides carcinoma development.[1] The study of oral precancerous lesions and condition is of paramount importance, as the prevention of oral cancer is most desirable and should be considered superior for the diagnosis and treatment of oral cancer.[6]

Tumor markers are the substances that alter quantitatively in serum during tumor development. If the biochemical changes occur even before cancer has occurred, it helps in predicting whether a particular individual would develop cancer or not later in life.[7] Body fluids such as saliva, blood, urine, and others are used for early diagnosis, predicting prognosis and monitoring the progression of the disease.[5] Blood-based tests are more appealing because of its easiness, economic advantage, noninvasiveness, and the possibility of repeated sampling.[5]

Principally, uncontrolled and excessive proliferation of cells is essential for the development of a malignancy. In the physiological process, many basic components are needed by rapidly forming cells well above the normal limits. Lipids are one such component, which forms major cell membrane components critical for various biological functions with cell division and growth of normal and malignant tissues.[7] Tobacco carcinogens produce free radicals and reactive oxygen species which cause oxidation/peroxidation of polyunsaturated fatty acids. This peroxidation further releases peroxide radicals. Increased consumption of lipids such as total cholesterol, lipoproteins, and triglycerides results in lipid peroxidation. The increased usage of lipids is accomplished either from circulation, synthesis through the metabolism or from the degradation of major lipoprotein fractions like very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), or high-density lipoprotein (HDL). It affects the essential constituents of the cell membrane and might be involved in carcinogenesis tumorigenesis.[8] Therefore, low levels of lipids might serve as a marker and prognostic indicator in early detection of oral precancerous lesions and conditions.

Many studies have reported the alterations in lipid profile level in OSMF, leukoplakia, and lichen planus. Therefore, the present study is aimed at the estimation of serum lipid profile in patients with the oral potentially malignant disorder, and its objective was to compare serum lipid profile in between oral potentially malignant disorders and controls.


   Material and Methods Top


Of the total 120 patients subjected for the study; 100 patients were diagnosed clinically for oral sub mucous fibrosis, leukoplakia, lichen planus, and smoker's palate and 20 healthy individuals were included in the control group, matching for age and sex, who had no complaint or any other major illness in the recent past. Patients were subjected to serum lipid profile including total cholesterol, LDL, HDL, VLDL, and TG after obtaining institutional ethical clearance (Ref. No: CEC/1/2/2017-18). The inclusion criteria consisted of patients with precancerous lesions and conditions. The exclusion criteria included individuals suffering from diseases such as uremia, nephritic syndrome, hypothyroidism, hyperthyroidism, acromegaly, and individuals on lipid-lowering drugs, patients below and above 20–65 years of age, and pregnant and lactating patients. The importance of the study was explained to each individual, and the study sample was selected only upon their acceptance. Patients were informed prior and written consent was taken from each patient. These patients were recalled the next day with 12-h fasting and 3 mL of fasting blood samples were collected in plain vials. Blood was drawn from the patient's cephalic or middle vein [Figure 1]. Blood was allowed to clot and then it was centrifuged to separate serum. REMI centrifugation machine [Figure 2] was used at 2000 rpm for 3 min for centrifugation.
Figure 1: Drawing blood sample

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Figure 2: REMI centrifugation machine

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About 500 μL of cholesterol reagent and 500 μL of TG reagent [Figure 3] were taken in different test tubes, and 0.5 μL of serum was added to each of them separately, mixed and allowed to wait for 10 min whereas 500μL of HDL reagent was taken in another test tube, 0.25 μl of serum was added, mixed and allowed to wait for 10 min. With the use of ROBONIK ANALYZER machine [Figure 4], serum lipid values were analyzed for total cholesterol, HDL, and TG. VLDL and LDL were calculated using formulas; VLDL = TG/5 and LDL = Total cholesterol-HDL-TG/5.
Figure 3: Armamentarium

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Figure 4: Robonik analyzer machine

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Estimation of lipid profile value was done for total serum cholesterol, HDL, LDL, VLDL, and TG using Endpoint method. The data were then subjected to statistical analysis using SPSS software version 16. Statistical analyzation was done for all the variables for mean values, standard deviation (SD), and standard errors, and P value. The student's “t-test” and one way ANOVA test were done at P < 0.05.


   Results Top


Out of 120 patients; 100 were in the case group and 20 were in the control group. Around 33 were female with 17 cases and 16 control groups, and 87 were males with 80 cases and 4 control group. The student's”t-test” was done between case and control group in females for all the lipid profile values with significance (P < 0.05 only in case of HDL levels), i.e. 0.047 [Table 1]. In addition, “t- test” was done between case and control group in males which revealed no significant results for lipid profile values [Table 2].
Table 1: Table showing mean values, standard deviation, and P value of serum lipid levels among females (case and control) using t-test

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Table 2: Table showing mean values, standard deviation, and P value of serum lipid levels among males (case and control) using t-test

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The mean value of total cholesterol, HDL, VLDL, and TG was lower in leukoplakia compared to lichen planus, smoker's palate, combined leukoplakia, and smoker's palate lesion and oral submucous fibrosis, i.e. 140.78, 32.444, 28.444, 141.33, respectively [Graph 1], [Graph 2], [Graph 4], and [Graph 5]. [Graph 3] shows the mean value of LDL, which was low in lichen planus compared to other groups, i.e. 73.167.




   Discussion Top


According to estimates, there are 9 million new cases of cancer every year, and over 4.5 million deaths occur due to cancer. In males, one of the most common cancers is oral cancer, which is also the sixth most common cancer in the world. In certain types of malignancies, there are reports of early and significant changes in phospholipids and cholesterol. Cholesterol and triglycerides are imperative lipid components of the cell and are critical in carrying out necessary physiological functions such as maintaining structural and functional cell integrity.[9] It is also involved in the activity of membrane-bound enzymes and is important for stabilization of the DNA helix. Lipoprotein receptors located on the surface of the cells mediate cellular uptake and regulation of cholesterol. TGL and cholesterol are packaged into lipoproteins for transport in plasma which are then taken up and degraded by cells to fulfill the requirement for cellular functions.[10] In cases of malignancy, significant changes in serum cholesterol occur.[9] One of the postulated mechanisms for the lower levels of serum cholesterol in cancer patients was due to increased membrane permeability to carcinogens induced by trans-fatty acids.[5]

It is has been recognized that oral cancer significantly interferes with food intake as well as lipid ingestion and absorption. Therefore, patients with oral cancer are expected to have low serum levels of lipids; however, other factors, such as genes and hormones, also intermingle to regulate the plasma cholesterol levels. These mechanisms can be understood through the lipoprotein transport system. Lipoprotein receptors in the liver and extrahepatic tissues are the crucial components of this system that mediate the cellular uptake and degradation of cholesterol carrying lipoproteins. Lipoproteins are degraded because they deliver their cholesterol to tissues, whereas the cholesterol survives eventually to be excreted from the tissues and bind to new lipoprotein carriers. The plasma cholesterol concentration varies due to continuous cycling of cholesterol into and out of the bloodstream.[5]

Chao et al. reported that the neoplastic cells directly utilize cholesterol for their metabolism resulting in hypolipidemia.[11] Reduced cholesterol may be due to increased lipid membrane biogenesis by cancer cells or direct lipid-lowering or altered lipid metabolism or antioxidant activity.[9]

In the present study, >75% of patients were tobacco consumers. Tobacco produces carcinogens such as reactive oxygen species and lipid peroxides resulting in elevated lipid peroxidation leading to tissue injury.[5]

Numerous prospective and retrospective studies have shown an inverse association between blood lipid profiles and different cancers.[5] In our study, there was a significant reduction in serum total cholesterol, HDL, VLDL, and TG in patients with leukoplakia. Similar studies were conducted by Goel et al.,[8] Lohe et al.,[3] Gupta et al.,[6] and Patel et al.[12] stating that serum lipid profile had an inverse relationship with oral precancerous conditions/lesions. Serum lipid levels showed a significant reduction in patients with leukoplakia and lichen planus as compared with controls in their studies.

Garg et al. also conducted a similar study which concluded that there is a decrease in plasma total cholesterol, triglycerides, HDL, LDL, and VLDL in the subjects with the oral precancer and oral cancer as compared to the controls.[7] This could be because leukoplakia is a habit-associated disease with free radical release leading to lipid peroxidation, causing a decrease in the lipid levels.[13],[14],[15]

In our study, in lichen planus, LDL level was reduced compared to other lesions, and all other parameters were within the normal range. These results were in contrast to the study conducted by Boringi et al. in which they concluded that there was no change in the lipid profile of the lichen planus.[5]

HDL cholesterol may serve as a useful indicator, reflecting the initial changes occurring in neoplastic conditions since the drastic reduction in levels of HDL have been seen in numerous reports.[16],[17],[18] It makes to believe that low HDL is an added predictor of malignancy and which might be an outcome of disease that is mediated by the utilization of cholesterol for membrane biogenesis of the proliferating malignant cells.[1],[19],[20]

In our study, HDL was significantly lower in female patients with potentially malignant disorders when compared to controls. Studies conducted by Vijay et al. was in contrast to our study which concluded that total cholesterol and HDL were highest in the females.[9] Further, in-depth studies on lipid profile values may be useful for early diagnosis of potentially malignant disorders in the case of female patients.


   Conclusion Top


Our study had significantly lower HDL levels in female patients with potentially malignant disorders when compared to the control group. Thus, lower serum lipid levels might serve as a diagnostic indicator or marker in the early diagnosis of oral potentially malignant disorders in females and it requires further extensive research on a large sample size to make it effective as a prognostic tool.

Financial support and sponsorship

Nil.



 
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Bailwad SA, Singh N, Jani DR, Patil P, Singh M, Deep G, et al. Alterations in serum lipid profile patterns in oral cancer: Correlation with histological grading and tobacco abuse. Oral Health Dent Manage 2014;13:573-9.  Back to cited text no. 1
    
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Patel PS, Shah MH, Jha FP, Raval GN, Rawal RM, Patel MM, et al. Alterations in plasma lipid profile patterns in head and neck cancer and oral precancerous conditions. Indian J Cancer 2004;41:25-31.  Back to cited text no. 12
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    Tables

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