Postsurgical Drain Fluid Biomarkers May Predict Oral Cancer Recurrence

Pilot study points to the feasibility of evaluating surgical wound fluid samples as an indicator of outcomes

medwireNews: Early results suggest that levels of certain matrix metalloproteinases (MMPs) and angiogenesis-related markers in the surgical fluid of patients with squamous cell carcinoma of the oral cavity and oropharynx could be a marker of disease recurrence.

The investigators admit that the findings of their “very small” pilot study need to be validated in larger cohorts, but add that they “used a novel means of evaluating head and neck cancer that, if replicated, has the potential for real-life clinical utility in the future.”

Amy Anne Lassig, from the University of Minnesota in Minneapolis, USA, and fellow researchers point out that wound fluid is “collected from the region surrounding the tumor and may be an easily accessible means by which to interrogate the tumour environment.”

Additionally, “this specimen type is routinely clinically collected and discarded and, as such, adds no additional risk to the patient and little inconvenience to the investigator”, they write.

Between 2011 and 2016, the team recruited 20 patients (70% with stage IV disease) who required open surgical treatment with drain placement. Starting from the morning of the first day postoperatively, surgical fluid samples were collected every 8 hours until drains were removed, and biomarker levels were evaluated.

As measured by electrochemiluminescent, patterned array, multiplex technology, levels of MMP-1 and MMP-3, previously shown to be involved in head and neck cancer tumourigenesis, invasion and metastasis, were significantly lower among patients who did versus did not experience local, regional or distant recurrence, with a relative difference of 2.78 and 5.29, respectively.

Levels of soluble fms-like tyrosine kinase-1 – the soluble form of the vascular endothelial growth factor (VEGF) receptor 1, which is believed to be a VEGF antagonist – were similarly lower in patients with disease recurrence, with a relative difference of 3.75.

Certain markers were also associated with prognostic cancer variables. Specifically, VEGF isoform A levels were significantly lower in patients with versus without nodal disease (relative difference=1.98) and levels of basic fibroblastic growth factor were decreased in individuals who had lymphovascular invasion compared with those who did not (relative difference=1.74).

By contrast, none of the evaluated biomarkers were associated with survival at the 1-year follow-up.

“Measurement of biomarkers in surgical drain fluid potentially represents a novel means of assessing cancer prognosis in this population”, the team concludes in JAMA Otolaryngology–Head & Neck Surgery.


Lassig AAD, Joseph AM, Lindgren BR, Yueh B. Association of oral cavity and oropharyngeal cancer biomarkers in surgical drain fluid with patient outcomes. JAMA Otolaryngol Head Neck Surg; Advance online publication 13 April 2017. doi:10.1001/jamaoto.2016.3595

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