CORTISOL, A-AMYLASE AND CYTOKINES TRAJECTORIES IN PEDIATRIC CANCER PATIENTS WITH OSTEOSARCOMA UNDERGOING CHEMOTHERAPY: A CASE CONTROL STUDY

Introduction: Cancer is marked by disruption of circadian rhythms, resulting in an exacerbation of cancer symptom clusters, which may affect the response to treatment and the patient’s quality of life. Objective: The main purpose of this study was to investigate basal sAA activity, salivary cortisol and cytokine levels in osteosarcoma pediatric patients at 4 points of a day of hospitalization for chemotherapy and to compare with those of healthy individuals matched both in sex and age. Method: A case-control study was undertaken with 24 children and adolescents, being n=6 osteosarcoma pediatric patients who were paired (1:3) by sex and age with n=18 healthy individuals. Four saliva samples were collected at baseline (+1h, +4h, +9h, and +13h post- awakening) for both groups. Salivary cortisol, sAA, and cytokine concentrations were determined using high sensitivity ELISA kits. Sociodemographic and clinical data were recorded and stress was evaluated using the Child Stress Scale(ESI)™. Also, the association of psychological stress scoring and Area Under Curve (AUC) for biomarkers was investigated using non-parametric statistics. Results: sAA and salivary cortisol levels was rather high in osteosarcoma group in comparison to healthy individuals (p<0.05). Also, the disruption of salivary cortisol circadian rhythm concomitant to the reduction of IL-1β and TNF-α in osteosarcoma pediatric patients with regards to healthy individuals were observed. The overall psychological stress scoring assessed by ESI™ was higher in osteosarcoma group (p =0.035). In addition, total stress scores correlated positively with cortisol AUC levels (r =0.82, p =0.045) and negatively with sAA AUC levels in osteosarcoma group (r =−0.82, p =0.045). There were no significant correlations between sAA and cortisol for both AUC of osteosarcoma pediatric patients and for healthy individuals. Conclusions: These findings suggest that there is a close relationship between stress, neuroendocrine and circadian dysfunctions and the immune system in osteosarcoma pediatric patients.