Contemporary Oncology
eISSN: 1897-4309
ISSN: 1428-2526
Contemporary Oncology/Współczesna Onkologia
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1/2026
vol. 30
 
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abstract:
Original paper

Serum citrulline as a prognostic marker in patients with oropharyngeal carcinoma treated with chemoradiotherapy

Kasper Kuna
1
,
Jacek Burzyński
1
,
Damian Mikulski
1
,
Bartosz Kamil Sobocki
2
,
Anna Papis-Ubych
3
,
Konrad Stawiski
1
,
Jacek Fijuth
4
,
Piotr Kędzierawski
5
,
Jacek Sadowski
6
,
Rafał Stando
6
,
Robert Bibik
7
,
Łukasz Graczyk
7
,
Tomasz Latusek
8
,
Tomasz Rutkowski
8
,
Wojciech Fendler
1, 9
,
Bartłomiej Tomasik
2, 10

  1. Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
  2. Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
  3. Department of Radiotherapy, Nicholas Copernicus Memorial Regional Specialist Hospital, Lodz, Poland
  4. Department of Radiotherapy, Medical University of Lodz, Lodz, Poland
  5. Department of Oncology, Jan Kochanowski University, Collegium Medicum, Kielce, Poland
  6. Department of Radiotherapy, Holy Cross Cancer Centre, Kielce, Poland
  7. Department of Radiation Oncology, Oncology Centre of Radom, Radom, Poland
  8. Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
  9. Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
  10. Centre for Experimental Cardiooncology, Medical University of Gdansk, Gdansk, Poland
Contemp Oncol (Pozn) 2026; 30 (1): 33–39
DOI: https://doi.org/10.5114/wo.2025.158130
Online publish date: 2026/03/10
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Introduction
Oropharyngeal carcinoma (OPC) represents one of the most rapidly increasing head and neck cancers worldwide, with prognosis strongly influenced by human papillomavirus (HPV) infection. Given the clinical significance, there is a strong demand to evaluate novel biomarkers to monitor treatment outcomes. Therefore, we conducted a study to assess the prognostic value of citrulline, a well- established marker of enterocyte injury, in patients undergoing OPC treatment.

Material and methods
We reanalysed a cohort of patients with OPC recruited across three tertiary oncology centres in Poland. All patients were treated with intensity-modulated radiotherapy, with concurrent chemotherapy. Serum citrulline levels were measured prior to treatment using a dedicated ELISA kit. The associations between pre-treatment citrulline levels, clinical characteristics, and patient survival outcomes were evaluated.

Results
A total of 64 patients treated with chemoradiotherapy (CRT) were included. The baseline citrulline level showed no significant association with clinical characteristics. In univariable Cox regression, tumour size, along with induction chemotherapy, were significantly associated with poorer overall survival (OS) and progression- free survival (PFS). In contrast, the baseline citrulline level was not predictive in univariate analysis. In the subgroup analysis of patients with positive HPV status, both the larger tumour size and higher citrulline level were significantly associated with poorer OS and PFS.

Conclusions
Baseline citrulline demonstrated prognostic value for OS and PFS in HPV-positive patients treated with CRT. These findings suggest a potential role for citrulline as a biomarker of treatment-related vulnerability in OPC and warrant further validation in larger, independent cohorts.

keywords:

prognosis, survival, biomarker, head and neck cancer, human papillomavirus, chemoradiotherapy, oropharyngeal carcinoma, citrulline
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