Kesting Marco Rainer, Schurr Christian, Robitzky Luisa, Steinstraesser Lars, Nieberler Markus, Baurecht Hansjörg, Wolff Klaus-Dietrich, Loeffelbein Denys John, Mücke Thomas
Department of Oral and Maxillofacial Surgery, Klinikum Rechts Der Isar, Technische Universität München, München, Germany.
J Oral Maxillofac Surg. 2009 Aug;67(8):1649-55. doi: 10.1016/j.joms.2009.04.061.
Oral squamous cell carcinoma (OSCC) represents more than 90% of oral malignancies. Risk factors such as smoking and alcohol abuse can result in additional diseases, particularly of the upper gastrointestinal tract. The aim of the present study was to assess the synchronous pathologic changes of the upper gastrointestinal tract using endoscopy at the diagnosis of OSCC using a retrospective cohort study design.
The clinical records of 806 patients with OSCC from 1997 to 2007 were reviewed. Of the 806 patients, 570 (188 females and 382 males) with primary OSCC were identified. All patients underwent esophagogastroduodenoscopy at the initial tumor staging. The tumor stage was defined according to the International Union Against Cancer classification for head and neck malignancies. The clinical and histologic data were analyzed for probability using univariate and multivariate analyses.
Of the 570 patients, 289 had limited and 281 advanced disease. A statistically significant association was found between the advanced and limited tumor stage for Barrett's esophagus with an odds ratio of 4.986 (95% confidence interval 1.370 to 27.360, P = .0061). Pathologic findings were observed in 169 patients. Additional risk factors for the development of secondary upper aerodigestive tract cancers were found in 103 patients.
Esophagogastroduodenoscopy provides the opportunity to identify second malignancies, precancerous lesions, and risk factors and to obtain biopsies using one procedure. The results can be immediately integrated into the therapeutic concept of the primary disease. Although new imaging techniques have been available, esophagogastroduodenoscopy still plays a decisive role in the routine staging of OSCC.
口腔鳞状细胞癌（OSCC）占口腔恶性肿瘤的90%以上。吸烟和酗酒等风险因素会引发其他疾病，尤其是上消化道疾病。本研究旨在采用回顾性队列研究设计，评估OSCC诊断时上消化道的同步病理变化。
回顾了1997年至2007年806例OSCC患者的临床记录。在这806例患者中，确定了570例原发性OSCC患者（188例女性和382例男性）。所有患者在初始肿瘤分期时均接受了食管胃十二指肠镜检查。肿瘤分期根据国际抗癌联盟头颈部恶性肿瘤分类进行定义。使用单变量和多变量分析对临床和组织学数据进行概率分析。
570例患者中，289例患有局限性疾病，281例患有晚期疾病。发现巴雷特食管的晚期和局限性肿瘤分期之间存在统计学上的显著关联，优势比为4.986（95%置信区间1.370至27.360，P = 0.0061）。169例患者观察到病理结果。103例患者发现了继发性上呼吸道消化道癌症发生的其他风险因素。
食管胃十二指肠镜检查提供了通过一次检查识别第二原发恶性肿瘤、癌前病变和风险因素并获取活检的机会。结果可立即纳入原发性疾病的治疗方案。尽管已有新的成像技术，但食管胃十二指肠镜检查在OSCC的常规分期中仍起着决定性作用。
