Kim Myung-Jin, Lim Koo-Young, Kim Jong-Won, Nam Il-Woo, Lee Jong-Ho, Myoung Hoon
Department of Oral and Maxillofacial Surgery and Dental Research Institute, College of Dentistry, Seoul National University, Yeon-gun dong 28, Chouro-Ku, Seoul 110-749, South Korea.
Cancer Lett. 2005 Jun 28;224(2):253-61. doi: 10.1016/j.canlet.2005.01.009.
Squamous cell carcinoma (SCC) is the most common malignant head and neck tumor and is responsible for more than 90% of head and neck cancers and accounts for 4.5% of all malignant tumors in males and 3.5% in females in South Korea. The purpose of this study was to investigate the correlation of suggested clinico-pathological prognostic factors such as gender, age, T score (T number in TNM), clinical stage, proliferation, invasion index, and lymph node metastasis to the survival of SCC patients in Korea. Furthermore, cytokeratin (CK), carcinoembryonic antigen (CEA), and recently documented apoptosis related protein, survivin, were analyzed by RT-PCR. In 113 patients, survival curves were estimated by the Kaplan-Meier method and nominal or numeric variable influence on survival was studied by Univariate and Multivariate Regression analysis (Cox proportional hazards model). Univariate analysis demonstrated that gender and age factor had no significant effect on survival rate. T score, on the other hand, significantly influenced survival and univariate analysis demonstrated that Stage 4 group had a significantly lower survival rate than the other stage groups but differentiation and invasion index factors had no significant effect on survival rate. Using a 50% cut-off point, patients with lower PCNA scores showed no survival advantages over those with higher PCNA scores but lymph node metastasis was a significant survival predictor in univariate analysis. In addition, lymph node CK and survivin mRNA expression have significant effects on OSCC patient survival rate. This means that prognostic value can be amplified by coincident analysis of T score, pathologically confirmed lymph node metastasis, and lymph node CK or survivin mRNA expression. Multivariate analysis using Cox's proportional hazards model, clinical TNM stage and lymph node survivin mRNA expression were independent OSCC prognostic factors, which support cancer staging based on the TNM as a powerful prognostic variable and lymph node survivin expression might provide predictive information for OSCC patient survival.
鳞状细胞癌(SCC)是最常见的头颈部恶性肿瘤,占头颈部癌症的90%以上,在韩国占男性所有恶性肿瘤的4.5%,女性的3.5%。本研究的目的是调查性别、年龄、T分期(TNM中的T分期)、临床分期、增殖、侵袭指数和淋巴结转移等临床病理预后因素与韩国SCC患者生存率的相关性。此外,通过逆转录聚合酶链反应(RT-PCR)分析细胞角蛋白(CK)、癌胚抗原(CEA)以及最近报道的凋亡相关蛋白存活素。对113例患者采用Kaplan-Meier法估计生存曲线,并通过单因素和多因素回归分析(Cox比例风险模型)研究名义或数值变量对生存的影响。单因素分析表明,性别和年龄因素对生存率无显著影响。另一方面,T分期对生存有显著影响,单因素分析表明,IV期组的生存率明显低于其他分期组,但分化和侵袭指数因素对生存率无显著影响。以50%为界值点,增殖细胞核抗原(PCNA)评分较低的患者与评分较高的患者相比,在生存方面无优势,但在单因素分析中,淋巴结转移是一个显著的生存预测指标。此外,淋巴结CK和存活素mRNA表达对口腔鳞状细胞癌(OSCC)患者生存率有显著影响。这意味着通过同时分析T分期、病理证实的淋巴结转移以及淋巴结CK或存活素mRNA表达,可以增强预后价值。使用Cox比例风险模型进行多因素分析,临床TNM分期和淋巴结存活素mRNA表达是独立的OSCC预后因素,这支持将基于TNM的癌症分期作为一个强大的预后变量,并且淋巴结存活素表达可能为OSCC患者的生存提供预测信息。