Squamous cell carcinoma antigen is a biomarker in determining the prognosis of lichen planus of the oral mucosa

Abstract

Lichen planus refers to chronic dermatoses with manifestation on the oral mucosa, the clinical manifestations of which are based on a violation of the balance of the immune system. The determination of biomarkers in blood and saliva makes it possible to detect predictors of clinical significance in the diagnosis and assessment of the prognosis of diseases of the oral mucosa. Squamous cell carcinoma (SCC) antigen is considered one of these markers. There are no studies in the open literature on the concentration of SCC in mixed saliva in patients with precancerous conditions of the oral mucosa, which determined the purpose of this study. . 47 women aged 35-70 years with a clinical diagnosis of “lichen planus of the oral mucosa” (L43 according to ICD) were examined. Depending on the form of lichen planus (with a low and potential possibility of tumor transformation) and the treatment protocol, patients were divided into 3 groups: I - 10 patients with a typical form of lichen planus of the oral mucosa; II - 14 patients with exudative hyperemic lichen planus; III - 23 patients with erosive and ulcerative form of lichen planus on the mucous membranes of the mouth. Local treatment of typical and exudative hyperemic forms of lichen planus consisted in the use of oral baths of an oil solution of natural origin based on a complex of biologically active substances from pumpkin seeds. Patients with erosive and ulcerative form of lichen planus were added mouthwash with antiseptic solution, application of calcineurin inhibitor ointment. The duration of the course of therapy was 2 weeks. Monitoring was carried out at the diagnostic stage, after 14 and 90 days. At the first visit and after treatment, unstimulated mixed saliva was collected on an empty stomach and the concentration of SCC was determined by enzyme immunoassay. . Before treatment, the median SCC concentration in group I patients was 468 μg/mL (Q1-Q3=299-505 μg/mL), which was twice that in the control group 232 μg/mL. In group II, the median SCC concentration was 489 μg/mL (Q1-Q3=293-784 μg/mL) and in group III it was 527 μg/mL (Q1-Q3=260-1340 μg/mL). After treatment, SCC values decreased to 365, 460, and 811 μg/mL in groups I, II, and III, respectively. Discussion. The content of SCC has a direct relationship with the concentration of interleukins IL-4 and IL-13 in the oral fluid. Activation of SCC-1 occurs due to an increase in IL-4, which in turn interacts with mast cells that secrete TNF-α, which causes the destruction of the basal cell membranes and the development of an inflammatory reaction. The second form of SCC is induced by IL-13, which has similar biological activity to IL-4 and is produced by differentiated cytotoxic T-lymphocytes, activated B-lymphocytes and mast cells. These immunocompetent cells are present in the active phase of lichen planus disease. In addition, a high level of SCC may indicate the severity of an allergic and autoimmune component in the etiopathogenesis of lichen planus. The dynamics of SCC concentration in the oral fluid is closely related to the degree of severity of inflammatory phenomena of the oral mucosa. A decrease in the concentration of SCC in mixed saliva after treatment relative to the initial values of the marker confirms a long period of remission, and its increase, on the contrary, indicates a relapse of the disease after 90 days. . At the diagnostic stage, the concentration of SCC <500 μg/ml and its decrease after treatment is characteristic of a benign course and susceptibility to therapy. The concentration of SCC >500 μg/ml and its increase indicates a severe recurrent nature of the disease and low effectiveness of drug therapy. Determination of SCC concentration in oral fluid expands the scope of biomarkers in assessing the prognosis, clinical course and effectiveness of therapy for lichen planus of the oral mucosa.