口腔鳞状细胞癌合并第四原发性肿瘤患者的发病率及预后：槟榔咀嚼流行地区的长期随访研究
Incidence and Outcomes of Patients With Oral Cavity Squamous Cell Carcinoma and Fourth Primary Tumors: A Long-term Follow-up Study in a Betel Quid Chewing Endemic Area.
作者信息
Adel Mohamad, Liao Chun-Ta, Lee Li-Yu, Hsueh Chuen, Lin Chien-Yu, Fan Kang-Hsing, Wang Hung-Ming, Ng Shu-Hang, Lin Chih-Hung, Tsao Chung-Kan, Huang Shiang-Fu, Kang Chung-Jan, Fang Ku-Hao, Wang Yu-Chien, Chang Kai-Ping, Fang Tuan-Jen, Yang Lan Yan, Yen Tzu-Chen
机构信息
From the Division of Surgical Oncology, Department of Surgery (MA), Al-Azhar University Hospital, Al-Azhar Faculty of Medicine, Cairo, Egypt; Department of Otorhinolaryngology, Head and Neck Surgery (MA, C-TL, S-FH, C-JK, K-HF, YCW, K-PC, T-JF); Head and Neck Oncology Group (C-TL, L-YL, CH, C-YL, K-HF, H-MW, S-HN, C-HL, C-KT, S-FH, C-JK, K-HF, Y-CW, K-PC, T-JF, LYY, T-CY), Chang Gung Memorial Hospital and Chang Gung University; Department of Pathology (L-YL, CH); Department of Radiation Oncology (C-YL, K-HF); Department of Medical Oncology (H-MW); Department of Diagnostic Radiology (S-HN); Department of Plastic and Reconstructive Surgery (C-HL, C-KT); Biostatistics and Informatics Unit, Clinical Trial Center (LYY); and Department of Nuclear Medicine and Molecular Imaging Center (T-CY), Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC.
出版信息
Medicine (Baltimore). 2016 Mar;95(12):e2950. doi: 10.1097/MD.0000000000002950.
The aim of this study was to explore the incidence and outcomes of patients with oral cavity squamous cell carcinoma (OSCC) and fourth primary tumors (PTs) in a betel-chewing endemic area.We retrospectively examined the records of 1836 OSCC patients who underwent radical tumor resection between 1996 and 2014. The outcome measures included the incidence and number of multiple PTs, the main risk factors, and their associations with overall survival (OS).Of the 1836 patients, 1400 (76.3%) had a single PT, 344 (18.7%) a second PT, 67 (3.6%) a third PT, and 25 (1.4%) a fourth PT. Univariate analyses (log-rank test) identified the following factors as significantly associated with a fourth PT: simultaneous first and second PTs, betel quid chewing, buccal subsite, and pT3-4 status. After allowance for the potential confounding effect of other risk factors, all of these factors retained their independent prognostic significance in stepwise multivariate analyses, the only exception being betel chewing. The incidences of second, third, and fourth PTs at 5 and 10 years were 20.2%/34.6%, 4.0%/8.6%, and 1.0%/2.3%, respectively. The 5 and 10-year OS rates (calculated from the diagnosis of each PTs) for patients with a single, second, third, and fourth PTs were 68%/61%, 43%/37%, 45%/39%%, and 30%/30%, respectively (P < 0.0001). Among patients with a fourth PT, those who underwent radical surgery showed a significantly higher 3-year OS than those who did not (57% vs 13%; P = 0.0442).Fourth PTs are rarely observed in OSCC patients in a betel quid-chewing endemic area. Long-term survival rates of patients treated with radical surgery seems acceptable, being 4-fold higher than their counterparts.
本研究旨在探讨在槟榔咀嚼流行地区口腔鳞状细胞癌（OSCC）患者和第四原发性肿瘤（PTs）的发生率及预后情况。我们回顾性分析了1996年至2014年间接受根治性肿瘤切除术的1836例OSCC患者的记录。观察指标包括多发PTs的发生率和数量、主要危险因素及其与总生存期（OS）的关联。在这1836例患者中，1400例（76.3%）有单个PT，344例（18.7%）有第二个PT，67例（3.6%）有第三个PT，25例（1.4%）有第四个PT。单因素分析（对数秩检验）确定以下因素与第四个PT显著相关：同时存在第一和第二个PT、咀嚼槟榔、颊部亚部位以及pT3 - 4状态。在考虑其他危险因素的潜在混杂效应后，所有这些因素在逐步多因素分析中均保留其独立的预后意义，唯一的例外是咀嚼槟榔。第二、第三和第四个PT在5年和10年时的发生率分别为20.2%/34.6%、4.0%/8.6%和1.0%/2.3%。单个、第二个、第三个和第四个PT患者的5年和10年OS率（从每个PT诊断时开始计算）分别为68%/61%、43%/37%、45%/39%和30%/30%（P<0.0001）。在有第四个PT的患者中，接受根治性手术的患者3年OS率显著高于未接受手术的患者（57%对13%；P = 0.0442）。在槟榔咀嚼流行地区的OSCC患者中很少观察到第四个PT。接受根治性手术治疗的患者长期生存率似乎可以接受，比未接受手术的患者高4倍。
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