Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan.
Oral Oncol. 2013 May;49(5):427-30. doi: 10.1016/j.oraloncology.2012.12.004. Epub 2012 Dec 27.
Oral cancer (OC) is the leading cause of death from cancer in men between the ages of 25 and 44 in Taiwan. The survival rate for the last stage of OC is <20% while that for the earliest stage is >75%, which suggests the importance of the diagnosis of oral precancerous lesions (OPLs) in reducing OC mortality. The aim of this study was to analyze the time to OC event after OPL diagnosis, and to suggest the surveillance period necessary according to OPL type.
This was a retrospective cohort study based on 1.0 million people randomly selected from the Taiwan National Health Insurance Database, which provided data on 3058 adult male patients aged ≥20 years who were diagnosed with OPL for the first time between 1996 and 2009. The patient population was divided into two groups according to the type of lesion: oral submucous fibrosis (OSF) or oral leukoplakia (OLE). Age-standardized incidence rate (ASIR) and hazards rate (HR) were then estimated.
The ASIR for OPL showed an increasing trend over the study period, the main contributor to this being OSF. The OSF group demonstrated a higher OC incidence rate than the OLE group.
Patients with both OLE and OSF carry a higher risk for OC than those with either OLE or OSF alone, and they may also experience malignant transformation at an earlier date (mostly within 5 years). The 5- and 10-year OC rate for both OLE and OSF was found to be 5% and around 10%, respectively. However, 10 years after the diagnosis of OPL, OSF carries a higher risk of developing into OC than OLE.
口腔癌（OC）是台湾 25 至 44 岁男性癌症死亡的主要原因。OC 晚期的存活率<20%，而早期的存活率>75%，这表明诊断口腔癌前病变（OPL）对于降低 OC 死亡率非常重要。本研究旨在分析 OPL 诊断后发生 OC 的时间，并根据 OPL 类型建议必要的监测期。
这是一项基于台湾全民健康保险数据库的回顾性队列研究，该数据库提供了 1996 年至 2009 年间首次被诊断为 OPL 的 3058 名 20 岁以上成年男性患者的数据。根据病变类型将患者分为两组：口腔黏膜下纤维化（OSF）或口腔白斑（OLE）。然后估计年龄标准化发病率（ASIR）和危害比（HR）。
OPL 的 ASIR 呈上升趋势，主要原因是 OSF。OSF 组的 OC 发病率高于 OLE 组。
患有 OLE 和 OSF 的患者比患有 OLE 或 OSF 单一病变的患者患 OC 的风险更高，而且他们也可能更早发生恶性转化（主要在 5 年内）。OLE 和 OSF 的 5 年和 10 年 OC 发生率分别约为 5%和 10%左右。然而，在 OPL 诊断 10 年后，OSF 发生 OC 的风险高于 OLE。
