Wang Bo, Zhang Shu, Yue Kai, Wang Xu-Dong
Department of Head and Neck Surgery, Cancer Institute and Hospital of Tianjin Medical University, Tianjin 300060, P. R. China.
Chin J Cancer. 2013 Nov;32(11):614-8. doi: 10.5732/cjc.012.10219. Epub 2013 Apr 19.
Oral squamous cell carcinoma (OSCC) is a common malignant tumor of the head and neck, and recurrence is an important prognostic factor in patients with OSCC. We explored the factors associated with recurrence of OSCC and analyzed the survival of patients after recurrence. Clinicopathologic and follow-up data of 275 patients with OSCC treated by surgery in the Cancer Institute and Hospital of Tianjin Medical University between 2002 and 2006 were analyzed. Recurrence factors were analyzed with Chi-square or Fisher's exact test and multivariate analysis. The prognosis of patients after recurrence was analyzed with the Kaplan-Meier method and log-rank test. The recurrence rate was 32.7%. The recurrence time ranged from 2 to 96 months, with a median of 14 months. Univariate analysis showed that T stage, degree of differentiation, pN stage, flap application, resection margin, and lymphovascular invasion were factors of recurrence (P < 0.05). Multivariate analysis showed that T stage, degree of differentiation, and pN stage were independent factors of recurrence (P < 0.001). The differences in gender, age, tumor site, region of lymph node metastasis, and perineural invasion between the recurrence and non-recurrence groups were not significant (P > 0.05). Kaplan-Meier and log-rank tests showed that the 2- and 5-year survival rates were significantly lower in the recurrence group than in non-recurrence group (67.6% vs. 88.0%, 31.8% vs. 79.9%, P < 0.001). Therefore, to improve prognosis, we recommend extended local excision, flap, radical neck dissection, and adjuvant chemoradiotherapy for patients more likely to undergo recurrence.
口腔鳞状细胞癌(OSCC)是头颈部常见的恶性肿瘤,复发是OSCC患者重要的预后因素。我们探讨了与OSCC复发相关的因素,并分析了复发后患者的生存情况。分析了2002年至2006年期间在天津医科大学肿瘤医院接受手术治疗的275例OSCC患者的临床病理和随访数据。采用卡方检验或Fisher精确检验以及多因素分析对复发因素进行分析。采用Kaplan-Meier法和对数秩检验分析复发后患者的预后。复发率为32.7%。复发时间为2至96个月,中位时间为14个月。单因素分析显示,T分期、分化程度、pN分期、皮瓣应用、切缘和脉管浸润是复发的因素(P<0.05)。多因素分析显示,T分期、分化程度和pN分期是复发的独立因素(P<0.001)。复发组和未复发组在性别、年龄、肿瘤部位、淋巴结转移区域和神经侵犯方面的差异无统计学意义(P>0.05)。Kaplan-Meier法和对数秩检验显示,复发组的2年和5年生存率显著低于未复发组(67.6%对88.0%,31.8%对79.9%,P<0.001)。因此,为改善预后,我们建议对更有可能复发的患者进行扩大局部切除、皮瓣修复、根治性颈清扫和辅助放化疗。