Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Queen's University, 10 Stuart St., Level 2, Kingston, Ontario, Canada K7L 3N7.
Oral Oncol. 2011 Jul;47(7):642-7. doi: 10.1016/j.oraloncology.2011.04.018. Epub 2011 May 25.
Oral cavity cancers can be detected early yet many are diagnosed with advanced disease. We assessed risk factors for advanced stage disease in a population-based study. Study population was all Ontario patients with anterior tongue or floor of mouth cancers diagnosed between 1991 and 2000 (n=2033). Data are from a retrospective chart review. Risk factors included: demographic characteristics, co-morbidity, precancerous lesions, dental status, smoking, alcohol use, and social marginalization. Multivariate regression analyses assessed independent associations while controlling for disease grade and site. Forty percent had advanced disease. Eighty-nine percent presented with symptoms and 66% were referred by a family physician. Risk factors in the tongue group were being: age ≥80 (RR 1.47), widowed (RR 1.34), social marginalized (RR 1.69), a current smoker (RR 1.26), or a smoker-heavy drinker (RR 1.73). Risk factors in the floor of mouth group were being: age ≥70 (70-79: RR 1.24 and ≥80: RR 1.43), and socially marginalized (RR 1.22). Having a pre-cancerous lesion (RR 0.44) or a regular dentist (RR 0.84) was protective in the floor of mouth group. Risk factors for those with co-morbid illnesses were being: age ≥70 (70-79: RR 1.28 and ≥80: RR 1.55), separated/divorced (RR 1.26), socially marginalized (RR 1.37), or a smoker-heavy drinker (RR 1.44); while having a regular dentist was protective (RR 0.83). Targeted education to alert those at risk about oral cancer warning signs and better training coupled with opportunistic oral cavity exams by family physicians could reduce the burden of this disease.
口腔癌可以早期发现，但许多患者被诊断为晚期疾病。我们在一项基于人群的研究中评估了口腔癌晚期疾病的危险因素。研究人群为 1991 年至 2000 年间诊断为前舌或口底癌的所有安大略省患者（n=2033）。数据来自回顾性病历审查。危险因素包括：人口统计学特征、合并症、癌前病变、牙齿状况、吸烟、饮酒和社会边缘化。多变量回归分析评估了独立关联，同时控制了疾病分级和部位。40%的患者为晚期疾病。89%的患者出现症状，66%的患者由家庭医生转诊。舌癌组的危险因素为：年龄≥80 岁（RR1.47）、丧偶（RR1.34）、社会边缘化（RR1.69）、当前吸烟者（RR1.26）或吸烟者重度饮酒者（RR1.73）。口底癌组的危险因素为：年龄≥70 岁（70-79 岁：RR1.24，≥80 岁：RR1.43）和社会边缘化（RR1.22）。口底癌组有癌前病变（RR0.44）或定期看牙医（RR0.84）的患者为保护因素。合并症患者的危险因素为：年龄≥70 岁（70-79 岁：RR1.28，≥80 岁：RR1.55）、离异（RR1.26）、社会边缘化（RR1.37）或吸烟者重度饮酒者（RR1.44）；定期看牙医是保护因素（RR0.83）。针对高危人群开展口腔癌警示症状的教育，并加强家庭医生的培训和机会性口腔检查，可能会降低这种疾病的负担。
