国际口腔医学杂志

国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (2): 166-174.doi: 10.7518/gjkq.2020051

• 论著 • 上一篇    下一篇

经首次根治性手术治疗口腔鳞状细胞癌患者的生存相关影响因素分析

薛伶俐,李雅冬()   

  1. 重庆医科大学附属第一医院颌面外科 重庆 400010
  • 收稿日期:2019-06-25 修回日期:2019-09-30 出版日期:2020-03-01 发布日期:2020-03-12
  • 通讯作者: 李雅冬
  • 作者简介:薛伶俐,住院医师,硕士,Email： llxue_kq348@163.com
  • 基金资助:
    重庆市科学技术委员会自然科学基金(cstc2018jcyjAX07-63);重庆市卫生与计划生育委员会医学高端后备人才培养项目(2017HBRC004);重庆市教育委员会资助项目(15SKG032)

Survival analysis of patients with oral squamous cell carcinoma treated by radical surgery for the first time

Xue Lingli,Li Yadong()   

  1. Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
  • Received:2019-06-25 Revised:2019-09-30 Online:2020-03-01 Published:2020-03-12
  • Contact: Yadong Li
  • Supported by:
    This study was supported by Natural Science Foundation Project of Chongqing Science and Technology Committee(cstc2018jcyjAX07-63);Medical High-end Reserve Talent Training Program of Chongqing Health and Family Planning Committee(2017HBRC004);Project of Chongqing Education Commission(15SKG032)

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摘要：

目的 分析口腔鳞状细胞癌（OSCC）患者的总体生存率,以及影响生存率的临床病理因素。方法 采集对首次接受根治性外科手术治疗的78例OSCC患者的临床病理及随访资料进行回顾性分析。对计数、计量资料进行描述性分析;采用Kaplan-Meier法绘制生存曲线;采用COX比例风险回归模型进行单因素和多因素分析,分析患者的生存率及预后相关影响因素。结果 最终纳入生存分析的患者共计68例,中位随访时间为63（6~87）个月,5年总体存活率为55.9%,随访期间因OSCC死亡患者的中位生存时间为20.5（6~52）个月。单因素分析表明,临床分期、原发灶大小、淋巴结转移、病理分化及复发转移是影响生存时间的暴露因素（P<0.05）;多因素分析表明,病理分化、复发转移是影响生存时间的独立危险因素（P<0.05）。78例OSCC患者中合并发生食道鳞状细胞癌（ESCC）者有4例（5.1%）。结论 根据肿瘤的临床分期（TNM分期）、原发灶大小、淋巴结转移、病理分化及复发转移可对患者的生存预后作出一定的预测,其中病理分化及复发转移是影响生存预后的独立危险因素。有吸烟饮酒史的OSCC患者应常规进行ESCC临床筛查。

关键词: 口腔鳞状细胞癌, 存活率, 预后, 影响因素, 食道鳞状细胞癌

Abstract:

Objective To analyze the overall survival (OS) and relevant risk factors for oral squamous cell carcinoma (OSCC) patients. Methods To retrospectively review the clinical, pathological, and follow-up records of 78 patients after primary radical tumor resection. Descriptive statistics were calculated for each variable, survival was calculated using the Kaplan-Meier method, differences in OS rate were analyzed via a log-rank test, and univariate and multivariate Cox proportional hazard models were performed to analyze the factors associated with overall survival and prognosis. Results A total of 68 patients were included in the final study. The five-year OS rate was 55.9%. The median survival time of the patients who died of this disease within five years was 20.5 (6-52) months. The univariate analysis showed that clinical stage, tumor size, lymph node metastasis, pathological differentiation, recurrence, and metastasis were the exposure factors affecting survival time (P<0.05). Multivariate analysis showed that pathological differentiation, recurrence, and metastasis were in-dependent factors affecting survival time (P<0.05). The patients with esophageal squamous cell carcinoma accounted for 5.1% (4/78) in total 78 OSCC. Conclusion The survival prognosis of patients with oral squamous cell carcinoma is correlated with clinical stage (TNM stage), tumor size, lymph node metastasis, pathological differentiation, recurrence, and metastasis. In this study, pathological differentiation, recurrence, and metastasis were independent factors affecting survival time. Some OSCC patients may be screened for esophageal squamous cell carcinoma.

Key words: oral squamous cell carcinoma, survival rate, prognosis, influence factors, esophageal squamous cell carcinoma

中图分类号: 

  • R730.7

表 1

基线资料及生存相关单因素分析结果"

变量 例数及百分比1) 5年生存情况 COX生存时间单因素分析
生存组（n=38）2) 死亡组（n=30）3) T/χ²检验P值
n % B P值 HR（95%CI）
n % n %
性别 男 45 66.2 25 65.8 20 66.7 0.939 0.029 0.940 1.029（0.484~2.188）
女 23 33.8 13 34.2 10 33.3
年龄/岁 60.9±10.64) 58.9±11.15) 63.5±9.66)
≤60 35 51.5 23 60.5 12 40.0 0.093 0.627 0.090 1.872（0.906~3.864）
>60 33 48.5 15 39.5 18 60.0
病程/月 5（3~12）7) 5.5（3~12）8) 4（2~7.5）9) 0.098 -0.068 0.088 0.934（0.864~1.010）
高血压 有 14 20.6 6 15.8 8 26.7 0.271 0.461 0.262 1.586（0.708~3.553）
无 54 79.4 32 84.2 22 73.3
糖尿病 有 9 13.2 7 18.4 2 6.7 0.156 -0.895 0.221 0.409（0.097~1.715）
无 59 86.8 31 81.6 28 93.3
吸烟 有 36 52.9 18 47.3 18 60.0 0.300 0.403 0.275 1.496（0.726~3.085）
无 32 47.1 20 52.6 12 40.0
饮酒 有 27 39.7 12 31.6 15 50.0 0.123 0.581 0.108 1.788（0.880~3.632）
无 41 60.3 26 68.4 15 50.0
部位 舌 24 35.3 14 36.8 10 33.3 0.642 0.105 0.406 1.111（0.867~1.423）
颊 21 30.9 14 36.8 7 23.3
牙龈 9 13.2 4 10.5 5 16.7
腭 5 7.4 2 5.3 3 10.0
口底 9 13.2 4 10.5 5 16.7
临床分期 早（Ⅰ、Ⅱ） 33 48.5 23 60.5 10 33.3 0.026 0.858 0.023 2.358（1.126~4.939）
中、晚（Ⅲ、Ⅳ） 35 51.5 15 39.5 20 66.7
T分期 T1 8 11.8 6 15.8 2 6.7 0.141 0.599 0.022 1.820（1.090~3.040）
T2 37 54.4 22 57.9 15 50.0
T3 20 29.4 10 26.3 10 33.3
T4 3 4.4 0 0 3 10.0
淋巴结转移 有 24 35.3 8 21.1 16 53.3 0.006 1.163 0.001 3.200（1.569~6.524）
无 44 64.7 30 78.9 14 46.7
病理分化 高 48 70.6 33 86.8 15 50.0 0.001 1.232 0.001 3.429（1.662~7.077）
中、低 20 29.4 5 13.2 15 50.0
复发转移 无 32 47.1 29 76.3 3 10.0 <0.001 1.175 <0.001 3.238（2.187~4.796）
原位 14 20.6 7 18.4 7 23.3
颈部 17 25.0 2 5.3 15 50.0
远处 5 7.3 0 0 5 16.7

图 1

68例OSCC患者的总体生存曲线 访止：随访截止时间;生存函数：以时间为自变量,以相应时刻的生存率为函数值的函数,反映每一时刻事件的生存率。"

图 2

临床分期生存曲线"

图 3

原发灶大小生存曲线"

图 4

淋巴结转移生存曲线"

图 5

病理分化生存曲线"

图 6

复发转移生存曲线"

表 2

生存相关多因素分析结果"

变量 B P值 HR（95%CI）
临床分期 -0.434 0.442 0.648（0.214~1.959）
T分期 0.205 0.527 1.227（0.650~2.315）
淋巴结转移 0.760 0.098 2.139（0.869~5.269）
病理分化 0.958 0.015 2.607（1.205~5.638）
复发转移 1.041 <0.001 2.832（1.851~4.333）
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