Int J Stomatol ›› 2020, Vol. 47 ›› Issue (2): 166-174.doi: 10.7518/gjkq.2020051

• Original Articles • Previous Articles     Next Articles

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 E-mail:llxxyydd2006@sina.com
  • 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)

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

CLC Number: 

  • R730.7

TrendMD: 

Tab 1

Basic demographic data and univariate analysis results associated with survival"

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
n % B P HR(95%CI)
n % n %
性别 45 66.2 25 65.8 20 66.7 0.939 0.029 0.940 1.029(0.484~2.188)
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 14 20.6 6 15.8 8 26.7 0.271 0.461 0.262 1.586(0.708~3.553)
54 79.4 32 84.2 22 73.3
糖尿病 9 13.2 7 18.4 2 6.7 0.156 -0.895 0.221 0.409(0.097~1.715)
59 86.8 31 81.6 28 93.3
吸烟 36 52.9 18 47.3 18 60.0 0.300 0.403 0.275 1.496(0.726~3.085)
32 47.1 20 52.6 12 40.0
饮酒 27 39.7 12 31.6 15 50.0 0.123 0.581 0.108 1.788(0.880~3.632)
41 60.3 26 68.4 15 50.0
部位 24 35.3 14 36.8 10 33.3 0.642 0.105 0.406 1.111(0.867~1.423)
21 30.9 14 36.8 7 23.3
牙龈 9 13.2 4 10.5 5 16.7
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 24 35.3 8 21.1 16 53.3 0.006 1.163 0.001 3.200(1.569~6.524)
44 64.7 30 78.9 14 46.7
病理分化 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 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

Fig 1

The survival curve of 68 patients with OSCC"

Fig 2

The survival curves for TNM stage"

Fig 3

The survival curves for tumor size"

Fig 4

The survival curves for lymphatic metastasis"

Fig 5

The survival curves for pathological differentiation"

Fig 6

The survival curves for recurrence and metastasis"

Tab 2

Multivariate analysis results associated with sur-vival"

变量 B P 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)
[1] Siegel RL, Miller KD, Jemal A . Cancer statistics, 2016[J]. CA Cancer J Clin, 2016,66(1):7-30.
[2] Götz C, Bissinger O, Nobis C , et al. ALDH1 as a prognostic marker for lymph node metastasis in OSCC[J]. Biomed Rep, 2018,9(4):284-290.
[3] Sasahira T, Kirita T, Kuniyasu H . Update of mole-cular pathobiology in oral cancer: a review[J]. Int J Clin Oncol, 2014,19(3):431-436.
[4] 曹雨庵, 郭伟 . 我国口腔鳞癌的治疗现状[J]. 实用肿瘤杂志, 2012,27(2):109-112.
Cao YA, Guo W . Treatment of oral squamous cell carcinoma in China[J]. J Pract Oncol, 2012,27(2):109-112.
[5] 陈新, 徐文华, 周健 , 等. 口腔鳞状细胞癌现状[J]. 口腔医学, 2017,37(5):462-465.
Chen X, Xu WH, Zhou J , et al. Current situation of oral squamous cell carcinoma[J]. Stomatology, 2017,37(5):462-465.
[6] Chen W, Zheng R, Zuo T , et al. National cancer incidence and mortality in China, 2012[J]. Chin J Cancer Res, 2016,28(1):1-11.
[7] 王倩, 侯大为 . 口腔鳞状细胞癌发病及转移机制研究进展[J]. 口腔医学研究, 2018,34(11):1164-1167.
Wang Q, Hou DW . Research progress in pathogenesis of oral squamous cell carcinoma[J]. J Oral Sci Res, 2018,34(11):1164-1167.
[8] 贺智凤, 蒲玉梅, 胡勤刚 . 口腔鳞状细胞癌切缘状态评估及其影响因素分析[J]. 中华口腔医学杂志, 2017,52(7):445-449.
He ZF, Pu YM, Hu QG . Evaluation and influencing factors of surgical margin status of oral squamous cell carcinoma[J]. Chin J Stomatol, 2017,52(7):445-449.
[9] St John MA . Inflammatory mediators drive metastasis and drug resistance in head and neck squamous cell carcinoma[J]. Laryngoscope, 2015,125(Suppl 3):S1-S11.
[10] Alves AM, Diel LF, Lamers ML . Macrophages and prognosis of oral squamous cell carcinoma: a syste-matic review[J]. J Oral Pathol Med, 2018,47(5):460-467.
[11] de la Oliva J, Larque AB, Marti C , et al. Oral pre-malignant lesions of smokers and non-smokers show similar carcinogenic pathways and outcomes. A clin-icopathological and molecular comparative analysis[J]. J Oral Pathol Med, 2019. DOI: 10.1111/jop.12864.
[12] Kumar B, Cordell KG, Lee JS , et al. EGFR, p16, HPV Titer, Bcl-xL and p53, sex, and smoking as indicators of response to therapy and survival in oropharyngeal cancer[J]. J Clin Oncol, 2008,26(19):3128-3137.
[13] Rivera C . Essentials of oral cancer[J]. Int J Clin Exp Pathol, 2015,8(9):11884-11894.
[14] Wolfer S, Elstner S, Schultze-Mosgau S . Degree of keratinization is an independent prognostic factor in oral squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2018,76(2):444-454.
[15] Chen F, Lin LS, Liu FQ , et al. Three prognostic in-dexes as predictors of response to adjuvant chemora-diotherapy in patients with oral squamous cell carcinoma after radical surgery: a large-scale prospective study[J]. Head Neck, 2019,41(2):301-308.
[16] Weckx A, Riekert M, Grandoch A , et al. Time to re- currence and patient survival in recurrent oral squa-mous cell carcinoma[J]. Oral Oncol, 2019,94:8-13.
[17] 张华, 杨蓉, 叶贝贝 , 等. 389例口腔鳞状细胞癌预后影响因素分析[J]. 天津医科大学学报, 2018,24(4):315-322.
Zhang H, Yang R, Ye BB , et al. Analysis of prognostic factors for 389 patients with oral squamous cell car-cinoma[J]. J Tianjin Med Univ, 2018,24(4):315-322.
[18] Colares N, Souza Rodrigues DF, Freitas MO , et al. Smoking history decreases survival in patients with squamous cell carcinoma of the mouth: a retros-pective study with 15 years of follow-up[J]. Asian Pac J Cancer Prev, 2019,20(6):1781-1787.
[19] Montero PH, Yu CH, Palmer FL , et al. Nomograms for preoperative prediction of prognosis in patients with oral cavity squamous cell carcinoma[J]. Cancer, 2014,120(2):214-221.
[20] Dissanayaka WL, Pitiyage G, Kumarasiri PV , et al. Clinical and histopathologic parameters in survival of oral squamous cell carcinoma[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012,113(4):518-525.
[21] Asio J, Kamulegeya A, Banura C . Survival and asso-ciated factors among patients with oral squamous cell carcinoma (OSCC) in Mulago hospital, Kam-pala, Uganda[J]. Cancers Head Neck, 2018,3:9.
[22] Taghavi N, Yazdi I . Prognostic factors of survival rate in oral squamous cell carcinoma: clinical, histo-logic, genetic and molecular concepts[J]. Arch Iran Med, 2015,18(5):314-319.
[23] Grimm M . Prognostic value of clinicopathological parameters and outcome in 484 patients with oral squamous cell carcinoma: microvascular invasion (V+) is an independent prognostic factor for OSCC[J]. Clin Transl Oncol, 2012,14(11):870-880.
[24] Sandu K, Nisa L, Monnier P , et al. Clinicobiological progression and prognosis of oral squamous cell carcinoma in relation to the tumor invasive front: impact on prognosis[J]. Acta Otolaryngol, 2014,134(4):416-424.
[25] Kane SV, Gupta M, Kakade AC , et al. Depth of in-vasion is the most significant histological predictor of subclinical cervical lymph node metastasis in early squamous carcinomas of the oral cavity[J]. Eur J Surg Oncol, 2006,32(7):795-803.
[26] Mupparapu M, Shanti RM . Evaluation and staging of oral cancer[J]. Dent Clin North Am, 2018,62(1):47-58.
[27] Kreppel M, Eich HT, Kübler A , et al. Prognostic value of the sixth edition of the UICC’s TNM classi-fication and stage grouping for oral cancer[J]. J Surg Oncol, 2010,102(5):443-449.
[28] Huang TH, Li KY, Choi WS . Lymph node ratio as prognostic variable in oral squamous cell carcinomas: systematic review and meta-analysis[J]. Oral Oncol, 2019,89:133-143.
[29] Yamagata K, Fukuzawa S, Kanno N , et al. Is lymph node ratio a prognostic factor for patients with oral squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2019,77(7):1510-1519.
[30] Ding D, Stokes W, Eguchi M , et al. Association be-tween lymph node ratio and recurrence and survival outcomes in patients with oral cavity cancer[J]. JAMA Otolaryngol Head Neck Surg, 2019,145(1):53-61.
[31] Cuevas Gonzalez JC, Gaitan Cepeda LA, Borges Yanez SA , et al. p53 and p16 in oral epithelial dy-splasia and oral squamous cell carcinoma: a study of 208 cases[J]. Indian J Pathol Microbiol, 2016,59(2):153-158.
[32] Zhuang ZH, Xie N, Hu J , et al. Interplay between ΔNp63 and miR-138-5p regulates growth, metastasis and stemness of oral squamous cell carcinoma[J]. Oncotarget, 2017,8(13):21954-21973.
[33] Safadi RA, Abdullah NI, Alaaraj RF , et al. Clinical and histopathologic prognostic implications of the expression of cytokeratins 8, 10, 13, 14, 16, 18 and 19 in oral and oropharyngeal squamous cell carcinoma[J]. Arch Oral Biol, 2019,99:1-8.
[34] Wang S, Sun M, Gu CW , et al. Expression of CD163, interleukin-10, and interferon-gamma in oral squa-mous cell carcinoma: mutual relationships and pro-gnostic implications[J]. Eur J Oral Sci, 2014,122(3):202-209.
[35] Wang J, Jin X, Liu J , et al. The prognostic value of B7-H6 protein expression in human oral squamous cell carcinoma[J]. J Oral Pathol Med, 2017,46(9):766-772.
[36] 黄江峰, 王靖雯, 何保昌 , 等. 口腔鳞状细胞癌患者生存影响因素研究[J]. 中华预防医学杂志, 2016,50(10):880-886.
Huang JF, Wang JW, He BC , et al. Study of survival factors of oral squamous cell carcinoma[J]. Chin J Prev Med, 2016,50(10):880-886.
[37] Wang B, Zhang S, Yue K , et al. The recurrence and survival of oral squamous cell carcinoma: a report of 275 cases[J]. Chin J Cancer, 2013,32(11):614-618.
[38] Ghantous Y, Bahouth Z , Abu El-naaj I. Clinical and genetic signatures of local recurrence in oral squa-mous cell carcinoma[J]. Arch Oral Biol, 2018,95:141-148.
[39] Aires FT, Lin CS, Matos LL , et al. Risk factors for distant metastasis in patients with oral cavity squa-mous cell carcinoma undergoing surgical treatment[J]. ORL J Otorhinolaryngol Relat Spec, 2017,79(6):347-355.
[40] Jeon JH, Kim MG, Park JY , et al. Analysis of the outcome of young age tongue squamous cell carc-inoma[J]. Maxillofac Plast Reconstr Surg, 2017,39(1):41.
[41] Luksic I, Suton P, Manojlovic S , et al. Significance of myofibroblast appearance in squamous cell car-cinoma of the oral cavity on the occurrence of occult regional metastases, distant metastases, and survival[J]. Int J Oral Maxillofac Surg, 2015,44(9):1075-1080.
[42] Son HJ, Roh JL, Cho KJ , et al. Nodal factors predic-tive of recurrence and survival in patients with oral cavity squamous cell carcinoma[J]. Clin Otolaryngol, 2018,43(2):470-476.
[43] Noble AR, Greskovich JF, Han J , et al. Risk factors associated with disease recurrence in patients with stage Ⅲ/Ⅳ squamous cell carcinoma of the oral cavity treated with surgery and postoperative radio-therapy[J]. Anticancer Res, 2016,36(2):785-792.
[44] Brandwein-Gensler M, Wei S . Envisioning the next WHO head and neck classification[J]. Head Neck Pathol, 2014,8(1):1-15.
[45] Meng F, Li RF, Ma LY , et al. Porphyromonas gin-givalis promotes the motility of esophageal squa-mous cell carcinoma by activating NF-κB signaling pathway[J]. Microbes Infect, 2019,21(7):296-304.
[46] Smyth EC, Lagergren J, Fitzgerald RC , et al. Oeso-phageal cancer[J]. Nat Rev Dis Primers, 2017,3:17048.
[47] Olsen I, Yilmaz Ö . Possible role of Porphyromonas gingivalis in orodigestive cancers[J]. J Oral Micro-biol, 2019,11(1):1563410.
[48] Ha NH, Woo BH, Kim DJ , et al. Prolonged and re-petitive exposure to Porphyromonas gingivalis in-creases aggressiveness of oral cancer cells by promo-ting acquisition of cancer stem cell properties[J]. Tumor Biol, 2015,36(12):9947-9960.
[49] Matsui T, Okada T, Kawada K , et al. Detection of second primary malignancies of the esophagus and hypophraynx in oral squamous cell carcinoma pa-tients[J]. Laryngoscope Investig Otolaryngol, 2018,3(4):263-267.
[1] Zhou Jinkuo,Zhang Jinhong,Shi Xiaojing,Liu Guangshun,Jiang Lei,Liu Qianfeng. Influences of long noncoding RNA small nucleolar RNA host gene 22 on the cell proliferation, invasion and migration of oral squamous carcinoma cells by regulating microRNA-27b-3p [J]. Int J Stomatol, 2024, 51(1): 52-59.
[2] Li Liheng,Wang Rui,Wang Xiaoming,Zhang Zhiyi,Zhang Xuan,An Feng,Wang Qin,Zhang Fan. Effects of circular RNA hsa_circ_0085576 on cell migration and invasion of oral squamous cell carcinoma by regulating the microRNA-498/B-cell-specific Moloney murine leukemia virus integration site 1 axis [J]. Int J Stomatol, 2024, 51(1): 60-67.
[3] Wu Jiamin,Xia Bin,Yang Hefeng,Xu Biao.. Research progress on cancer-associated fibroblasts in the tumor microenvironment of oral squamous cell carcinoma [J]. Int J Stomatol, 2023, 50(6): 711-717.
[4] Liu Jianglong, Tuerdi Maimaitituxun. Progress of contrast-enhanced ultrasound in the diagnosis of cervical lymph node metastasis from oral squamous cell carcinoma [J]. Int J Stomatol, 2023, 50(5): 514-520.
[5] Sheng Nanning,Wang Jue,Nan Xinrong. Research progress on mechanism and treatment of sex-determining region Y box 9 in oral squamous cell carcinoma [J]. Int J Stomatol, 2023, 50(3): 314-320.
[6] Li Tan,Liang Xin-hua.. Role of discoidin domain receptor 1 in the regulation of malignant tumor progression and therapy [J]. Int J Stomatol, 2023, 50(2): 230-236.
[7] Zhao Zhuoping,Xin Pengfei,Gao Yang,Zhang Caifeng,Zhang Kuanshou,Liu Qingmei. Research progress on the use of photothermal therapy to treat oral squamous cell carcinoma [J]. Int J Stomatol, 2022, 49(4): 462-470.
[8] Jiang Han,Shen Yingqiang,Chen Qianming. Experimental study of muscarinic receptors on the biological behavior of oral squamous cell carcinoma through Yes related protein signal [J]. Int J Stomatol, 2022, 49(2): 138-143.
[9] Wu Xingsheng,Huang Di,Shi Lianshui. Research progress on extensive maxillary sinus pneumatization and its influencing factors [J]. Int J Stomatol, 2022, 49(2): 204-211.
[10] Bai Haoliang,Yang He,Zhao Lei. Research progress on periodontal disease risk assessment and prognosis judgment tools [J]. Int J Stomatol, 2021, 48(6): 696-702.
[11] Jiang Yulei,Xia Bin,Rao Nanquan,Yang Hefeng,Xu Biao. Exosomes mediate the malignant progression of oral squamous cell carcinoma and its application in diagnosis and treatment [J]. Int J Stomatol, 2021, 48(6): 711-717.
[12] Liu Yuchen,Tian Min,Niu Lina,Fang Ming. Factors influencing the survival rates of resin-bonded fixed partial dentures and improvement measures [J]. Int J Stomatol, 2021, 48(5): 585-591.
[13] Ma Pingchuan,Li Chunjie,Li Longjiang. Diagnosis and treatment of salivary duct carcinoma [J]. Int J Stomatol, 2021, 48(4): 459-467.
[14] Gan Jianguo,Gao Pan,Wang Xiaoyi. Research progress on the relationship between circulating tumor cells and oral squamous cell carcinoma [J]. Int J Stomatol, 2021, 48(2): 205-212.
[15] Huang Junwen,Qiao Jie,Mei Zi,Chen Zhuo,Li Yang,Qiao Bin. Expression and clinical significance of lipopolysaccharide binding protein in oral squamous cell carcinoma [J]. Int J Stomatol, 2021, 48(1): 50-57.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[2] . [J]. Foreign Med Sci: Stomatol, 1999, 26(06): .
[3] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[4] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[5] . [J]. Foreign Med Sci: Stomatol, 1999, 26(05): .
[6] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[7] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[8] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[9] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .
[10] . [J]. Foreign Med Sci: Stomatol, 1999, 26(04): .