Chen Ya-Wei, Chen I-Ling, Lin I-Ching, Kao Shou-Yen
Division of Oral & Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, No. 201, Section 2, Shi-Pai Road, Beitou District, Taipei 112, Taiwan, ROC; Faculty of Dentistry, School of Dentistry, National Yang-Ming University, No. 155, Section 2, Linong Street, Beitou District, Taipei 112, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Beitou District, Taipei 112, Taiwan, ROC.
Division of Oral & Maxillofacial Surgery, Department of Stomatology, Taipei Veterans General Hospital, No. 201, Section 2, Shi-Pai Road, Beitou District, Taipei 112, Taiwan, ROC.
Br J Oral Maxillofac Surg. 2014 May;52(5):425-31. doi: 10.1016/j.bjoms.2014.02.014. Epub 2014 Mar 18.
Hypercalcaemia and leucocytosis are common in our patients with progressive oral squamous cell carcinoma (SCC). However, the precise incidence, prognostic value, and correlation with the condition of the tumour remain obscure. A total of 618 patients with oral SCC who were treated primarily between 2007 and 2012 and had serum calcium concentrations and white blood cell count (WCC) measured postoperatively were included in the study. Primary TNM stage, pathological features, and the presence of locoregional recurrence or distant metastasis after comprehensive surgical treatment were recorded. The incidence of hypercalcaemia was 9.1% and that of leucocytosis 7.2%. Hypercalcaemia correlated significantly with size of primary tumour (T status), nodal involvement (N status), TNM stage, perineural invasion, lymphovascular permeation, and recurrence or metastasis of disease. Leucocytosis, however, correlated only with T status, lymphovascular permeation, and recurrence or metastasis. In multivariate analysis of survival, recurrence, metastasis, hypercalcaemia, and leucocytosis were strong independent prognostic factors. Median survival was low if the patient had hypercalcaemia or leucocytosis (179 (range 3-73) days if the patient had distant metastasis, and 43 (range 3-102) days if the patient had locoregional recurrence). The incidence of hypercalcaemia and leucocytosis was high during the course of the disease, and both conditions have an adverse impact on survival from oral SCC. Periodic evaluation of serum calcium concentrations and WCC should be routine during the postoperative period.
高钙血症和白细胞增多症在我们的进展期口腔鳞状细胞癌（SCC）患者中很常见。然而，其确切发病率、预后价值以及与肿瘤状况的相关性仍不明确。本研究纳入了2007年至2012年间接受主要治疗且术后测量了血清钙浓度和白细胞计数（WCC）的618例口腔SCC患者。记录了原发TNM分期、病理特征以及综合手术治疗后局部区域复发或远处转移的情况。高钙血症的发生率为9.1%，白细胞增多症的发生率为7.2%。高钙血症与原发肿瘤大小（T分期）、淋巴结受累（N分期）、TNM分期、神经周围侵犯、淋巴管浸润以及疾病的复发或转移显著相关。然而，白细胞增多症仅与T分期、淋巴管浸润以及复发或转移相关。在生存、复发、转移、高钙血症和白细胞增多症的多因素分析中，它们都是强有力的独立预后因素。如果患者患有高钙血症或白细胞增多症，中位生存期较短（如果患者有远处转移，为179（范围3 - 73）天；如果患者有局部区域复发，为43（范围3 - 102）天）。在疾病过程中，高钙血症和白细胞增多症的发生率较高，这两种情况均对口腔SCC的生存有不利影响。术后定期评估血清钙浓度和WCC应成为常规操作。
