Kademani Deepak, Baltali Evre, Lewis Jason, Keller Eugene
Division of Oral and Maxillofacial Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
J Oral Maxillofac Surg. 2007 Jun;65(6):1191-7. doi: 10.1016/j.joms.2006.09.009.
Although patients with T1 oral cavity carcinoma have a generally good prognosis, there is a significant burden of patients that have locoregional recurrence and mortality from early stage disease. The aim of this study was to investigate the specific cause of death in patients with T1N0M0 oral cavity squamous cell carcinoma (OCSCC) by analysis of death certification.
Patients were identified with T1 OCSCC treated over a 15-year period between 1986 to 2001 from the Mayo Clinic Tumor Registry. All patients were treated by operation without neck dissection or postoperative neoadjuvant therapy as the initial method of treatment. On detailed examination of the death certificate the leading cause of death was identified along with other clinical predictors of death.
Two hundred fifty patients were identified and met inclusion criteria from the Mayo Clinic Tumor Registry. Of the study group, 8.5% and 16% developed local and regional recurrence, respectively, as the first recurrence. The majority of recurrences that were amenable to surgery were managed by radical resection and postoperative neoadjuvant therapy. Of 85 deaths in the study group, 40 death certificates were obtained and reviewed to ascertain a specific cause of death. Patients were grouped into death from oral cancer, other cancer, or medical disease. Primary cause of death from the death certificates available for review included uncontrolled locoregional disease (20%), metastatic oral cancer (15%), development of secondary nonoral malignancy (15%), and a variety of medical causes (50%). Patient age at the time of diagnosis older than 65 had a statistically significant increase in mortality. Interestingly, the presence of premorbid medical conditions, history, or persistent tobacco and alcohol use did not seem to be related to overall mortality.
Early stage OCSCC continues to portend a poor prognosis. Analysis of death certification provides useful information of the specific cause of death.
尽管T1期口腔癌患者总体预后良好，但仍有相当一部分患者出现局部区域复发，并死于早期疾病。本研究旨在通过分析死亡证明来调查T1N0M0期口腔鳞状细胞癌（OCSCC）患者的具体死因。
从梅奥诊所肿瘤登记处确定1986年至2001年期间接受治疗的T1期OCSCC患者。所有患者均以手术作为初始治疗方法，未行颈部清扫或术后新辅助治疗。在详细检查死亡证明时，确定主要死因以及其他死亡临床预测因素。
从梅奥诊所肿瘤登记处确定了250例符合纳入标准的患者。在研究组中，分别有8.5%和16%的患者首次复发为局部和区域复发。大多数适合手术的复发患者通过根治性切除和术后新辅助治疗进行处理。在研究组的85例死亡患者中，获取并审查了40份死亡证明以确定具体死因。患者被分为死于口腔癌、其他癌症或内科疾病。可供审查的死亡证明中的主要死因包括局部区域疾病控制不佳（20%）、转移性口腔癌（15%）、继发性非口腔恶性肿瘤的发生（15%）以及各种内科原因（50%）。诊断时年龄大于65岁的患者死亡率有统计学显著增加。有趣的是，病前内科疾病、病史或持续吸烟饮酒似乎与总体死亡率无关。
早期OCSCC预后仍然较差。对死亡证明的分析提供了具体死因的有用信息。
