Carvalho André L, Singh Bhuvanesh, Spiro Ronald H, Kowalski Luiz P, Shah Jatin P
Head and Neck and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa, Hospital do Cancer, A. C. Camargo, Rua Antonio Prudente 211, Sao Paulo, Brazil 01509-900.
Head Neck. 2004 Jan;26(1):31-8. doi: 10.1002/hed.10354.
The literature suggests that the natural history of squamous cell carcinoma of the oral cavity may vary and the prognosis is different in patients from developing and developed nations. The objective of this study was to compare the clinical presentation, management, and outcome of patients with oral cancer treated at tertiary care cancer institutions in a developing nation (Brazil- Centro de Tratamento e Pesquisa Hospital do Cancer A. C. Camargo [HCACC]) with those from a developed nation (United States- Memorial Sloan-Kettering Cancer Center [MSKCC]).
Between January 1990 and December 1994, 602 patients underwent initial treatment in the study institutions.
Overall, patients from HCACC had a higher predominance of men (78.8% vs 54.6%; p <.001) and a higher prevalence of tobacco (88.1% vs 77.8%; p =.002) and alcohol consumption (80.9% vs 69.8%; p =.004). More patients at HCACC had advanced disease (stage III/IV; 73.4% vs 37.4%; p<.001). Even though the overall outcome was poorer in patients from HCACC (p <.001), after controlling for stage, there was not a statistically significant difference in disease-free or overall survival between the two institutions. Only at cancer-specific survival for early-stage disease (stage I/II) patients showed a difference (p =.05). Moreover, clinical stage (RR, 3.7; 95% CI, 2.6-5.5) and definitive treatment (RR, 3.3; 95% CI, 2.4-4.6) were the only factors that remained as significant predictors of outcome on multivariate analysis. Finally, the rate of subsequent second primary cancers was higher in patients from HCACC (p =.03).
Statistically significant differences were found in clinical presentation, tumor characteristics, and outcome in OC patients between the two institutions from a developing and developed nation. Overall outcome was poorer in HACC patients. However, after controlling for site, stage, and treatment, the outcome of these patients was similar, with the exception of a higher rate of occurrence of second primary cancers in patients from HACC. Given that the use of standard protocols of treatment offer similar outcomes, the establishment of education programs and screening measures for early diagnosis might be the best chance to improve overall outcome in OC patients in developing nations.
文献表明，口腔鳞状细胞癌的自然病史可能有所不同，发展中国家和发达国家患者的预后也存在差异。本研究的目的是比较在发展中国家（巴西 - 卡马尔戈癌症治疗与研究中心医院[HCACC]）和发达国家（美国 - 纪念斯隆 - 凯特琳癌症中心[MSKCC]）的三级癌症治疗机构接受治疗的口腔癌患者的临床表现、治疗方法及治疗结果。
1990年1月至1994年12月期间，602例患者在研究机构接受了初始治疗。
总体而言，HCACC的患者中男性占比更高（78.8%对54.6%；p<.001），吸烟率（88.1%对77.8%；p =.002）和饮酒率（80.9%对69.8%；p =.004）也更高。HCACC有更多患者患有晚期疾病（III/IV期；73.4%对37.4%；p<.001）。尽管HCACC患者的总体治疗结果较差（p<.001），但在对分期进行控制后，两家机构在无病生存率或总生存率方面没有统计学上的显著差异。仅在早期疾病（I/II期）患者的癌症特异性生存率方面存在差异（p =.05）。此外，临床分期（风险比，3.7；95%置信区间，2.6 - 5.5）和确定性治疗（风险比，3.3；95%置信区间，2.4 - 4.6）是多变量分析中仅有的仍作为结果显著预测因素的因素。最后，HCACC患者后续发生第二原发性癌症的比率更高（p =.03）。
在来自发展中国家和发达国家的两家机构的口腔癌患者中，在临床表现、肿瘤特征和治疗结果方面发现了统计学上的显著差异。HCACC患者的总体治疗结果较差。然而，在对部位、分期和治疗进行控制后，这些患者的治疗结果相似，但HCACC患者发生第二原发性癌症的比率更高。鉴于使用标准治疗方案可提供相似的治疗结果，建立教育项目和早期诊断筛查措施可能是改善发展中国家口腔癌患者总体治疗结果的最佳机会。
