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Increased plasma and salivary cortisol levels in patients with oral cancer and their association with clinical stage
  1. Daniel Galera Bernabé1,2,
  2. Adriano Caires Tamae2,
  3. Glauco Issamu Miyahara1,
  4. Maria Lúcia Marçal Sundefeld3,
  5. Sandra Penha Oliveira2,
  6. Éder Ricardo Biasoli1
  1. 1Oral Oncology Center and Department of Pathology and Clinical Propedeutics, School of Dentistry of Araçatuba, UNESP, Univ Estadual Paulista, Araçatuba, São Paulo, Brazil
  2. 2Laboratory of Pharmacology, Department of Basic Sciences, School of Dentistry of Araçatuba, UNESP, Univ Estadual Paulista, Araçatuba, São Paulo, Brazil
  3. 3Oral Oncology Center and Discipline of Biostatistics and Informatics, Department of Pediatric Dentistry and Social, School of Dentistry of Araçatuba, UNESP, Univ Estadual Paulista, Araçatuba, São Paulo, Brazil
  1. Correspondence to Dr Daniel Galera Bernabé, Oral Oncology Center, School of Dentistry of Araçatuba, São Paulo State University, UNESP, José Bonifácio st. 1193, CEP 16015-050, Araçatuba, SP, Brasil; danielbernabe{at}


Objectives Dysregulation of the hypothalamus–pituitary–adrenal axis has been observed in patients with cancer. This cross-sectional study investigated whether patients with oral and oropharyngeal squamous cell carcinoma (SCC) show changes in cortisol levels in saliva and plasma compared with three control groups, and evaluated its correlation with clinicopathological data.

Methods Salivary and plasma cortisol levels of 34 patients with oral SCC were compared with hormonal levels of 17 oropharyngeal SCC patients, 17 oral leukoplakia patients, 27 smokers and/or drinkers and 25 healthy volunteers. Multivariate analysis was used to evaluate the impact of clinical variables on the cortisol levels.

Results The plasma (p<0.05) and salivary (p<0.01) cortisol levels were significantly higher in patients with oral SCC compared with all groups. Patients with oropharyngeal SCC had higher levels of salivary cortisol compared with smokers and/or drinkers (p<0.05) and patients with leukoplakia (p<0.01). Patients with advanced-stage oral SCC showed significantly higher levels of cortisol than those in an initial clinical stage. Men with oral SCC had higher salivary cortisol levels than women (p<0.05). Age, smoking, alcohol consumption, presence of teeth and awareness of cancer diagnosis had no significant effect on cortisol levels.

Conclusions These results indicate a dysregulation of cortisol secretion in patients with oral cancer and suggest that this hormone can be a biomarker associated with the disease's clinical status.

  • Cancer
  • cortisol
  • head and neck cancer
  • hormones
  • HPA axis
  • neuroendocrine
  • oral squamous cell carcinoma
  • SCC
  • stress

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  • An additional table is published online only. To view this file please visit the journal online (

  • Part of this study was presented at the 18th Annual Psychoneuroimmunology Research Society Meeting, 8–11 June 2011, Chicago, Illinois, USA.

  • Funding This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). DGB was supported by a fellowship from FAPESP (2006/59835-0).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Research Ethics Committee of the Faculty of Dentistry of Araçatuba (CEP-FOA).

  • Provenance and peer review Not commissioned; externally peer reviewed.