215例接受术后辅助化疗的口腔癌患者口腔黏膜炎发生风险及危险因素分析

doi:10.13701/j.cnki.kqyxyj.2025.08.012

摘要/Abstract

摘要： 目的: 分析215例接受术后辅助化疗的口腔癌患者口腔黏膜炎(oral mucositis,OM)的发生风险及危险因素。方法: 本研究为回顾性分析,选取2020年1月~2023年1月于新乡市中心医院口腔科就诊的215例接受术后辅助化疗的口腔癌患者为研究对象,根据化疗结束后是否合并OM分为发生OM组和未发生OM组。收集并对比两组患者临床资料,筛选与患者OM发生相关的影响因素并绘制列线图预测模型。绘制校准曲线、受试者工作特征曲线(receiver operating characteristic curve,ROC)评价列线图模型预测术后辅助化疗的口腔癌患者OM的准确性和效能。结果: 入组患者中男131例,女84例,年龄52~77岁,平均(64.57±7.04)岁,发生OM患者89例,发生率为41.4%。单因素分析及Logistic回归分析筛选出饮酒史(OR=12.302,95%CI:1.836~82.441)、肿瘤长径(OR=2.092,95%CI:1.221~3.584)、手术时间(OR=1.018,95%CI:1.005~1.031)、术中出血量(OR=1.012,95%CI:1.002~1.022)、含氟尿嘧啶方案(OR=6.450,95%CI:1.266~32.858)、化疗6个周期(OR=1.056,95%CI:1.002~1.112)、化疗前血清白细胞介素6(interleukin-6,IL-6)(OR=1.143,95%CI:1.074~1.217)为术后辅助化疗的口腔癌患者发生OM的独立危险因素,化疗前血清白蛋白(albumin,ALB)(OR=0.922,95%CI:0.865~0.983)、前白蛋白(pre-albumin,PA)(OR=0.985,95%CI:0.973~0.997)为术后辅助化疗的口腔癌患者发生OM的独立保护因素。校准曲线表明列线图模型拟合度较高(χ²=4.999,P=0.758);ROC曲线分析表明该模型预测术后辅助化疗的口腔癌患者发生OM的曲线下面积(area under the curve,AUC)为0.832(95%CI:0.777~0.887),显著高于各因素独立预测效能。结论: 饮酒史、肿瘤长径、手术时间、术中出血量、化疗方案及时间、化疗前血清ALB、PA、IL-6均为术后辅助化疗的口腔癌患者发生OM的影响因素。

关键词: 口腔癌, 化疗, 口腔黏膜炎, 危险因素

Abstract: Objective: To analyze the risk and risk factors of oral mucositis (OM) in 215 oral cancer patients who received postoperative adjuvant chemotherapy. Methods: A total of 215 oral cancer patients who received postoperative adjuvant chemotherapy and treated in the Department of Stomatology of our hospital from January 2020 to January 2023 were selected as the research subjects. According to whether OM occurred after the end of chemotherapy, they were divided into the OM occurrence group and the non-OM occurrence group. The clinical data of the two groups of patients were collected and compared. The influencing factors related to the occurrence of OM in patients were screened, and a nomogram prediction model was drawn. The calibration curve and the receiver operating characteristic curve (ROC) were plotted to evaluate the accuracy and effectiveness of the nomogram model in predicting OM in oral cancer patients receiving postoperative adjuvant chemotherapy. Results: Among the enrolled patients, there were 131 males and 84 females, with an age range of 52 to 77 years, and an average age of (64.57±7.04) years. OM occurred in 89 patients, with an incidence rate of 41.4%. Univariate analysis and logistic regression analysis screened out a history of alcohol consumption (OR=12.302, 95%CI: 1.836-82.441), the long diameter of the tumor (OR=2.092, 95%CI: 1.221-3.584), the operation time (OR=1.018, 95%CI: 1.005-1.031), the intraoperative blood loss (OR=1.012, 95%CI: 1.002-1.022), the fluorouracil-containing regimen (OR=6.450, 95%CI: 1.266-32.858), 6 cycles of chemotherapy (OR=1.056, 95%CI: 1.002-1.112), and serum interleukin-6 (IL-6) before chemotherapy (OR=1.143, 95%CI: 1.074-1.217) as independent risk factors for the occurrence of OM in oral cancer patients receiving postoperative adjuvant chemotherapy. Serum albumin (ALB) (OR=0.922, 95%CI: 0.865-0.983) and pre-albumin (PA) (OR=0.985, 95%CI: 0.973-0.997) before chemotherapy were independent protective factors for the occurrence of OM in oral cancer patients receiving postoperative adjuvant chemotherapy. The calibration curve showed that the nomogram model had a high goodness of fit (χ²=4.999, P=0.758). The ROC analysis demonstrated an area under the curve (AUC) of this model in predicting the occurrence of OM in oral cancer patients receiving postoperative adjuvant chemotherapy was 0.832 (95%CI:0.777-0.887), which was significantly higher than the independent prediction effectiveness of each factor. Conclusion: A history of alcohol consumption, tumor long diameter, operation time, intraoperative blood loss, chemotherapy regimen and duration, as well as serum ALB, PA, and IL-6 before chemotherapy are influencing factors for the occurrence of OM in oral cancer patients receiving postoperative adjuvant chemotherapy.

Key words: oral cancer, chemotherapy, oral mucositis, risk factors

王恪钢, 张文静. 215例接受术后辅助化疗的口腔癌患者口腔黏膜炎发生风险及危险因素分析[J]. 口腔医学研究, 2025, 41(8): 707-714.

WANG Kegang, ZHANG Wenjing. Analysis on Incidence Risk and Risk Factors of Oral Mucositis in 215 Oral Cancer Patients Receiving Postoperative Adjuvant Chemotherapy[J]. Journal of Oral Science Research, 2025, 41(8): 707-714.

参考文献

[1] Kijowska J, Grzegorczyk J, Gliwa K, et al. Epidemiology, diagnostics, and therapy of oral cancer-update review [J]. Cancers (Basel), 2024, 16(18):3156.
[2] 中国抗癌协会头颈肿瘤专业委员会,中国抗癌协会口腔癌整合防筛专业委员会,阮敏,等. 口咽癌外科治疗专家共识[J].口腔疾病防治,2024,32(11):821-833.
[3] 吴素兰,黄蓉.以全视角风险预控管理为主导的综合干预在口腔癌根治术手术室中的应用价值[J].临床口腔医学杂志,2024,40(11):683-686.
[4] 赵驰,金芮竹.化疗联合放疗治疗晚期口腔癌的临床效果[J].临床合理用药杂志,2023,16(1):169-171,175.
[5] 王润堃,陆汉强,黄秋生.口腔癌调强放疗中靶区优化对患者口腔黏膜反应、唾液腺功能的影响[J].中国医学物理学杂志,2024,41(2):145-150.
[6] Li E, Zeng J, Hong F, et al. The prevalence of oral mucositis after radiotherapy in patients with Head and Neck Cancer and its associated factors: a meta-analysis [J]. Clin Transl Oncol, 2025, 27(4):1767-1778.
[7] 闫慧颖,洪志超,张玉皎,等.肿瘤治疗引起口腔黏膜炎的治疗研究进展[J].现代肿瘤医学,2023,31(12):2347-2352.
[8] 谢兆勤,漆晓芹,吴晶晶,等. 紫外线联合康复新液、氧疗用于化疗后口腔黏膜炎的效果[J].中华现代护理杂志,2024,30(9):1223-1227.
[9] 中华口腔医学会口腔颌面-头颈肿瘤专业委员会. 舌黏膜鳞状细胞癌外科治疗的专家共识[J].中华口腔医学杂志,2022,57(8):836-848.
[10] 雷聆艺.头颈恶性肿瘤放射性口腔黏膜炎危险因素Meta分析[D].西南医科大学,2022.
[11] Coppini M, Caponio VCA, Mauceri R, et al. Efficacy of topical agents in oral mucositis prevention: Systematic review and network meta-analysis [J]. Oral Dis,2024,30(7):4126-4144.
[12] Koushik K, Janaki MG, Kumawat R, et al. Safety and efficacy of Oro-T oral rinse in oral mucositis during cancer radiotherapy and/or chemotherapy: Cumulative analysis of two studies [J]. J Cancer Res Ther, 2021, 17(6):1503-1509.
[13] 雷聆艺,巫瑞雪,王丁婷,等.头颈恶性肿瘤放射性口腔黏膜炎危险因素meta分析[J].实用预防医学,2022,29(3):276-280.
[14] 杨明燕,张帆,赵蕾.口腔菌群变化影响放射治疗和化学治疗相关性口腔黏膜炎病程的研究进展[J].国际口腔医学杂志,2023,50(1):43-51.
[15] Lorini L, Perri F, Vecchio S, et al. Confounding factors in the assessment of oral mucositis in head and neck cancer [J]. Support Care Cancer, 2022, 30(10):8455-8463.
[16] 王璇.头颈部肿瘤放射性口腔黏膜炎患者营养状况及影响因素分析[D].中国医科大学,2020.
[17] Tirelli G, Piccinato A, Antonucci P, et al. Surgical resection of oral cancer: en-bloc versus discontinuous approach [J]. Eur Arch Otorhinolaryngol, 2020, 277(11):3127-3135.
[18] Cao YN, Wang Y, Zhang L, et al. Protective effect of endoplasmic reticulum stress inhibition on 5-fluorouracil-induced oral mucositis [J]. Eur J Pharmacol, 2022, 919:174810.
[19] 姬智博,陈瑞果,杨浩,等.口腔鳞状细胞癌化疗药物的现状及研究进展[J].安徽医科大学学报,2024,59(4):736-741.
[20] 方诗萌,王玥蓉.老年口腔癌患者围术期营养不良的影响因素及免疫营养支持的效果分析[J].老年医学与保健,2024,30(3):650-654,670.
[21] 黄丹,黄春明.口腔癌游离皮瓣修复术后血红蛋白、白蛋白及前白蛋白水平分析[J].临床口腔医学杂志,2021,37(8):499-501.
[22] Bastías D, Maturana A, Marín C, et al. Salivary biomarkers for oral cancer detection: An exploratory systematic review [J]. Int J Mol Sci, 2024, 25(5):2634.
[23] Min Z, Yang L, Hu Y, et al. Oral microbiota dysbiosis accelerates the development and onset of mucositis and oral ulcers [J]. Front Microbiol, 2023, 14:1061032.