Green Salad Intake Is Associated with Improved Oral Cancer Survival and Lower Soluble CD44 Levels.

Elizabeth Bradford Bell,Elizabeth J Franzmann,W Jarrard Goodwin,Carmen Gomez-Fernandez,Faisal Alotaibi,Drew H Smith,Isildinha M Reis,Turki Almuhaimid,Erin R Cohen,Claudia Gordon

doi:10.3390/nu13020372

Abstract

Deficiencies in fruit and vegetable intake have been associated with oral cancer (oral cavity and oropharyngeal). Salivary rinses contain measurable biomarkers including soluble CD44 (solCD44) and total protein, which are known markers of oral cancer risk. This study investigates the effect of nutritional factors on solCD44 and protein levels to evaluate oral cancer risk and survival. We evaluated solCD44 and protein levels from 150 patients with oral and oropharyngeal squamous cell carcinoma and 150 frequency-matched controls. We subsequently characterized the effect of food group consumption and these biomarkers on progression-free survival (PFS) and overall survival (OS). Patients reported eating fewer servings of salad (p = 0.015), while controls reported eating fewer servings of potatoes (p < 0.001). Oral cancer patients who consumed at least one serving per week of green salad were found to have significantly lower CD44 levels than those who ate salad less frequently (mean of log2[solCD44]1.73 versus 2.25, p = 0.014). Patients who consumed at least one serving per week of “salad or other vegetables” had significantly longer PFS (median 43.5 versus 9.1 months, p = 0.003, adjusted hazard ratio (HR) = 0.39 p = 0.014) and OS (median 83.6 versus 10 months, p = 0.008, adjusted HR = 0.04 p = 0.029). These findings suggest that dietary factors, namely greater green salad and vegetable intake, may be associated with lower CD44 levels and better prognosis in oral cancer patients.

Highlights

Each year, approximately 650,000 people are diagnosed with cancers arising in the head and neck worldwide [1]
Our patient cohort had a high number of ever smokers, which was defined by a lifetime history of smoking at least 100 cigarettes, and less than half were moderate/heavy drinkers (48.0%; 43.3%)
Since poor nutritional intake has been associated with increased risk of cancer, we evaluated whether differences in nutritional intake were associated with significant differences in soluble CD44 (solCD44) or protein levels

Summary

Introduction

Approximately 650,000 people are diagnosed with cancers arising in the head and neck worldwide [1]. Has a better prognosis, and is more commonly found in the oropharynx as opposed to the oral cavity [4] Prolonged exposure to these risk factors in a genetically susceptible patient can lead to the transformation of normal cells and, eventually, to the development of cancer through the formation of carcinogens. In a large prospective study conducted using the National Institutes of Health-AARP Diet and Health cohort, an inverse relationship between fruit and vegetable intake and head and neck cancer risk was established. The European Investigation into Cancer and Nutrition conducted a prospective study that included patients from seven European countries; this group demonstrated a significant inverse relationship between fruit and vegetable intake and head and neck cancer risk [9]. A separate prospective study from Spain showed that vegetable intake was associated with improved prognosis in multivariable analysis [10]

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Discussion

Conclusion