肿瘤特征和治疗方式对口腔鳞状细胞癌患者局部复发和生存的影响。

Kos Marcin, Łuczak Klaudiusz, Brusco Daniel, Engelke Werner

Department of Maxillofacial Surgery, Klinikum Minden Hans-Nolte-Strasse 1, 32 427 Minden, Germany.

Otolaryngol Pol. 2008;62(6):722-6. doi: 10.1016/S0030-6657(08)70347-0.

PURPOSE OF THE STUDY

To evaluate the impact of tumour location, local and regional advancement, histological differentiation, status of the surgical margins and radiotherapy on the disease-free time and overall survival rates in patients with oral squamous cell carcinoma.

MATERIAL AND METHODS

A retrospective analysis of 67 patients treated with surgery (61 pts.), radiotherapy (6 pts.) and their combination (28 pts.). Follow time on average 40 months. The probabilities of survival were assessed using the Kaplan-Meier estimates, the differences were calculated with the log-rank test. An analysis of the influence of the neck recurrences on the prognosis was additionally performed. Relationship between independent categorical variables as: primary local advancement, location of the tumour, histological grading and lymph node metastases was evaluated with Fisher's Exact Test.

RESULTS

Disease-free time rate amounted to 40.1%. There was no independent prognostic importance of primary location, T-staging and N-staging, histological grading of the tumour or radiation on disease-free time, just opposite to the status of the resection margins. However, the number of neck metastases was directly proportional to the tumour dimension and poor histological differentiation. Overall survival rate amounted to 87,5%. Posterior location in the oral cavity, involvement of cervical lymph nodes, surgical margins with the presence of tumour cells, poor histological differentiation and necessity of irradiation negatively correlated with the survival.

CONCLUSIONS

A complete resection of the tumour was the most important independent prognostic parameter for the disease-free and overall survivals in oral squamous cell carcinomas in this study. An adjuvant radiation therapy could improve the results of treatment of oral squamous cell carcinoma also in cases were so far considered only for surgical management.

研究目的

评估肿瘤位置、局部和区域进展、组织学分化、手术切缘状态及放疗对口腔鳞状细胞癌患者无病生存期和总生存率的影响。

材料与方法

对67例接受手术治疗（61例）、放疗（6例）及其联合治疗（28例）的患者进行回顾性分析。随访时间平均为40个月。采用Kaplan-Meier估计法评估生存概率，用对数秩检验计算差异。此外，还分析了颈部复发对预后的影响。采用Fisher精确检验评估原发性局部进展、肿瘤位置、组织学分级和淋巴结转移等独立分类变量之间的关系。

结果

无病生存率为40.1%。肿瘤的原发部位、T分期、N分期、组织学分级或放疗对无病生存期均无独立的预后意义，与手术切缘状态相反。然而，颈部转移灶的数量与肿瘤大小和组织学低分化直接相关。总生存率为87.5%。口腔后部位置、颈部淋巴结受累、手术切缘存在肿瘤细胞、组织学低分化以及放疗的必要性与生存率呈负相关。