Department of Maxillofacial Surgery, Theagenio Cancer Hospital, Thessaloniki, Greece.
Eur J Cancer. 2010 Jun;46(9):1563-72. doi: 10.1016/j.ejca.2010.02.046. Epub 2010 Mar 24.
Head and neck cutaneous squamous cell carcinoma (HNCSCC) although rarely fatal has significant adverse public health effects due to high medical costs, compromised quality of life, functional impairment and other serious consequences. The present longitudinal cohort study of HNCSCC was designed to determine whether certain clinical-pathologic features of HNCSCC are associated with reduced overall and recurrence-free survival, as suggested by previous data.
The cohort sample consisted of 315 consecutive patients presenting with primary HNCSCC of the head and neck. Life-table analysis and Kaplan-Meier survival analysis were performed. Multivariate Cox's proportional hazards regression models were used to assess the effects of covariates on the length of the interval.
There were 145 male and 170 female Caucasian patients. At the time of analysis, 222 patients were alive. The mean follow-up time of a patient after enrolment has been 46.7 months (range, 12-124 months). Broder's differentiation grade, perineural involvement, the presence of inflammation and T-stage were independent adjusted predictors for overall survival. pT and N-stage, inflammation and perineural involvement were significant predictors for recurrence-free survival while adjuvant irradiation was associated with a 92% reduced risk for recurrence. Life-table analysis showed that 87% and 69% study patients were free from recurrence at years 3 and 5, respectively.
Certain clinico-pathological predictors can be used to discriminate subsets of high-risk patients that could benefit from long-term follow-up. After excision in negative margins, patients with HNCSCC should be referred to specialised multidisciplinary oncology clinics for counselling on adjuvant radiotherapy and follow-up.
尽管头颈部皮肤鳞状细胞癌（HNCSCC）很少致命，但由于高昂的医疗费用、生活质量下降、功能障碍和其他严重后果，对公众健康仍有重大不利影响。本研究对 HNCSCC 进行了纵向队列研究，旨在确定之前的数据是否表明 HNCSCC 的某些临床病理特征与总生存率和无复发生存率降低有关。
队列样本由 315 例连续就诊的头颈部原发性 HNCSCC 患者组成。进行生命表分析和 Kaplan-Meier 生存分析。多变量 Cox 比例风险回归模型用于评估协变量对间隔长度的影响。
共有 145 名男性和 170 名女性白种人患者。在分析时，222 名患者存活。患者入组后的平均随访时间为 46.7 个月（范围 12-124 个月）。Broder 分化等级、神经周围侵犯、炎症和 T 分期是总生存率的独立调整预测因子。pT 和 N 分期、炎症和神经周围侵犯是无复发生存的显著预测因子，而辅助放疗与复发风险降低 92%相关。生命表分析显示，87%和 69%的研究患者在 3 年和 5 年内无复发。
某些临床病理预测因子可用于区分高危患者亚组，这些患者可能受益于长期随访。在切缘阴性切除后，应将 HNCSCC 患者转介至专门的多学科肿瘤诊所，进行辅助放疗和随访咨询。
