Salivary monoacetylated polyamines as noninvasive biomarkers for early detection and stratification of oral squamous cell carcinoma: A targeted metabolomics study

Objectives: This study aimed to evaluate salivary monoacetylated polyamines as noninvasive biomarkers for the detection and staging of oral squamous cell carcinoma (OSCC). Design: Unstimulated saliva samples were collected from healthy controls (n = 15), oral leukoplakia (OLK) patients (n = 15), and OSCC patients stratified into early (n = 28) and advanced stages (n = 46). Seven polyamines were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Diagnostic performance was assessed via receiver operating characteristic (ROC) analysis, logistic regression modeling, and multivariate clustering. Results: N¹-acetylspermidine and N¹-acetylspermine showed progressive elevation from OLK to advanced OSCC, with AUCs of 0.87 and 0.81, respectively. A two-marker logistic model achieved a cross-validated AUC of 0.85, demonstrating good discriminatory performance between malignant and non-malignant states. Multivariate analysis confirmed their contribution to disease stratification, while calibration plots supported model reliability. Conclusions: Salivary N¹-acetylspermidine and N¹-acetylspermine are promising biomarkers for noninvasive OSCC detection and staging.