口腔医学研究

口腔医学研究 ›› 2019, Vol. 35 ›› Issue (3): 242-245.DOI: 10.13701/j.cnki.kqyxyj.2019.03.012

• 论著 • 上一篇    下一篇

福建地区老年口腔鳞状细胞癌预后影响因素研究

伍俊锋1, 施斌2, 曹裕杰2*, 陈法1, 曹熔锴3, 张诗蕾2, 黄跃2   

  1. 1. 福建医科大学公共卫生学院 福建省环境因素与癌症重点实验室 福建 福州 350108;
    2. 福建医科大学附属第一医院口腔科 福建 福州 350005;
    3. 同济大学口腔医学院 上海 310000
  • 收稿日期:2018-10-10 出版日期:2019-03-28 发布日期:2019-04-01
  • 通讯作者: * 曹裕杰,E-mail:cyjdentist@sina.com
  • 作者简介:伍俊锋(1992~ ),男,福建泉州人,硕士在读,主要从事肿瘤流行病学研究。
  • 基金资助:
    福建省卫计委医学创新课题(编号:2010-CX-26) 福建医科大学高层次人才科研启动基金(编号: XRCZ2018001)

Influence Factor on Prognosis of the Elderly with Oral Squamous Cell Carcinoma in Fujian Area

WU Jun-feng1, SHI Bin2, CAO Yu-jie2, CHEN Fa1, CAO Rong-kai3, ZHANG Shi-lei2, HUANG Yue2   

  1. 1. Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, Fuzhou 350108, China;
    2. Department of Stomatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China;
    3. School of Stomatology, Tongji University, Shanghai 310000, China.
  • Received:2018-10-10 Online:2019-03-28 Published:2019-04-01

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摘要： 目的:探讨福建地区288例老年口腔鳞状细胞癌(oral squamous cell carcinoma,OSCC)患者预后影响因素。方法:收集福建医科大学附属第一医院口腔颌面外科2004年1月~2018年1月经病理确诊的老年OSCC患者288例,对已确诊OSCC患者进行随访,同时收集病例的临床资料。运用Kaplan-Meier和累积风险模型计算生存率及累积发生率;组间比较分别采用Log-rank和Gray检验;采用Cox比例风险模型和Fine&Gray回归模型分析老年OSCC预后影响因素;对治疗方式按照BMI进行分层回归分析。结果:多因素Cox风险比例模型分析发现,佩戴假牙的HR(95%CI)为1.74(1.11,2.71);T3-4期HR(95%CI)为3.64(1.32,10.01);N1和N2-3期HR(95%CI)分别为2.78(1.36,5.645)和1.96(1.01,3.80);组织分化程度为低分化,HR(95%CI)为2.25(1.27,3.99)。多因素Fine&Gray回归模型分析发现,女性SHR(95%CI)为0.58(0.366,0.94);N1和N2-3期,SHR(95%CI)为2.29(1.29,4.05)和4.42(2.48,7.85);M1期SHR(95%CI)为2.97(1.08,8.20);手术联合放化疗,SHR(95%CI)为2.14(1.26,3.65)。对治疗方式按BMI进行分层,结果显示在BMI<18.5 kg/m2的老年OSCC患者中,手术联合放化疗为影响其生存和复发的危险因素。结论:术前假牙、T分期、N分期、M分期、分化程度及治疗方式是老年OSCC患者预后的影响因素。

关键词: 口腔鳞状细胞癌, 预后因素, 风险比

Abstract: Objective: To explore the influence factor on prognosis of the elderly with oral squamous cell carcinoma (OSCC) in Fujian area. Methods: From January 2004 to Jan 2018, a total of 288 elderly patients with pathologically confirmed OSCC were recruited in a hospital of Fujian. The clinical and follow-up data of all patients were collected to explore the influence factor on prognosis of the elderly with OSCC. Survival rate and cumulative incidence were calculated using the Kaplan-Meier method and the cumulative risk model. The differences of two groups were compared by Log rank and Gray test. The Cox proportional hazards regression model and the Fine-Gray model were performed to estimate the prognosis factors among elderly OSCC patients. It was also stratified by BMI to assess the association between treatments and the prognosis of the elderly with OSCC. Results: The Cox proportional hazards regression model indicated that preoperative dentures (HR=1.74,95%CI:1.11,2.71); T3-4 stage (HR=3.64,95%CI:1.32,10.01); N1 and N2-3 (HR=2.78, 95%CI:1.36,5.64) and (HR=1.96, 95%CI: 1.01,3.80); poor differentiation (HR=2.25, 95%CI: 1.27,3.99). The Fine-Gray regression model indicated that the female (SHR=0.58, 95%CI: 0.36,0.94); N1 and N2-3 (SHR=2.29, 95%CI: 1.29,4.05) and (SHR=4.42, 95%CI: 2.48,7.85); M1 stage (SHR=2.977, 95%CI: 1.08,8.20); surgery combined chemoradiotherapy (SHR=2.14, 95%CI: 1.26, 3.65). The stratification analysis demonstrated that surgery combined with radiotherapy increased the risk among BMI <18.5 elderly OSCC patients. Conclusion: Preoperative dentures, T stage, N stage, M stage, histologic grade, and treatment are risk factors for elderly OSCC.

Key words: Oral squamous cell carcinoma, Prognostic factors, Hazard ratio