Biochemical Analysis of Inflammatory Markers and Oxidative Stress Biomarkers in Oral Squamous Cell Carcinoma: A Comprehensive Case-Control Study

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Abstract
Background: Oral squamous cell carcinoma (OSCC) represents a significant global health burden with complex pathophysiology involving chronic inflammation and oxidative stress. Systemic inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have emerged as potential prognostic indicators, while oxidative stress biomarkers such as 8-hydroxy-2′-deoxyguanosine (8-OHdG) reflect DNA damage associated with carcinogenesis. Objective: This study aimed to evaluate the diagnostic potential of NLR, PLR, and oxidative stress biomarkers in OSCC patients, investigating the relationship between systemic inflammation, oxidative DNA damage, and antioxidant status in the context of oral carcinogenesis. Methods: A case-control study was conducted involving 138 participants (82 OSCC patients and 56 healthy controls) aged 28-48 years. Comprehensive hematological analysis was performed using automated analyzers, while serum concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), 8-OHdG, and vitamin C were quantified using enzyme- linked immunosorbent assay (ELISA) techniques. Statistical analysis included independent t-tests and Pearson correlation analysis. Results: OSCC patients demonstrated significantly elevated levels of white blood cells (13.01±4.31 vs. 4.54±7.32 ×109/L), NLR (6.84±0.88 vs. 1.91±0.34), PLR (185.02±40.10 vs. 91.88±17.77), and inflammatory biomarkers, including IL-6 (142.31±5.24 vs. 38.32±6.32 pg/mL) and CRP (43.30±3.42 vs. 8.11±2.21 mg/L), compared to controls (all p<0.01). Oxidative stress marker 8-OHdG was markedly elevated (31.82±2.32 vs. 5.78±1.76 ng/dL, p<0.001), while vitamin C levels were significantly reduced (3.53±2.35 vs. 4.88±2.42 mg/dL, p<0.001). Strong positive correlations were observed between CRP and IL-6 (r=0.544, p<0.005) and 8-OHdG (r=0.386, p<0.007). Discussion: The significant elevations in inflammatory and oxidative stress biomarkers, coupled with their strong correlations with tumor stage, suggest these markers reflect the complex interplay between chronic inflammation and oxidative damage in OSCC pathogenesis. The exceptional diagnostic accuracy of the combined biomarker panel (NLR + IL-6 + 8-OHdG; AUC = 0.995) demonstrates the potential clinical utility of integrating multiple pathophysiological pathways for improved OSCC detection and risk stratification. Conclusion: Elevated NLR and PLR values, combined with increased oxidative stress markers and diminished antioxidant capacity, reflect the complex interplay between chronic inflammation and oxidative damage in OSCC pathogenesis. These biomarkers may serve as valuable adjunctive tools for early detection and prognostic assessment in oral cancer management.

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